What is on your mind? Using the perceptual cycle model and critical decision method to understand the decision-making process in the cockpit.

PubMed

Plant, Katherine L; Stanton, Neville A

2013-01-01

Aeronautical decision-making is complex as there is not always a clear coupling between the decision made and decision outcome. As such, there is a call for process-orientated decision research in order to understand why a decision made sense at the time it was made. Schema theory explains how we interact with the world using stored mental representations and forms an integral part of the perceptual cycle model (PCM); proposed here as a way to understand the decision-making process. This paper qualitatively analyses data from the critical decision method (CDM) based on the principles of the PCM. It is demonstrated that the approach can be used to understand a decision-making process and highlights how influential schemata can be at informing decision-making. The reliability of this approach is established, the general applicability is discussed and directions for future work are considered. This paper introduces the PCM, and the associated schema theory, as a framework to structure and explain data collected from the CDM. The reliability of both the method and coding scheme is addressed.

Application of the Consumer Decision-Making Model to Hearing Aid Adoption in First-Time Users

PubMed Central

Amlani, Amyn M.

2016-01-01

Since 1980, hearing aid adoption rates have remained essentially the same, increasing at a rate equal to the organic growth of the population. Researchers have used theoretical models from psychology and sociology to determine those factors or constructs that lead to the adoption of hearing aids by first-time impaired listeners entering the market. In this article, a theoretical model, the Consumer Decision-Making Model (CDM), premised on the neobehavioral approach that considers an individual's psychological and cognitive emphasis toward a product or service, is described. Three theoretical models (i.e., transtheoretical, social model of disability, Health Belief Model), and their relevant findings to the hearing aid market, are initially described. The CDM is then presented, along with supporting evidence of the model's various factors from the hearing aid literature. Future applications of the CDM to hearing health care also are discussed. PMID:27516718

Application of the Consumer Decision-Making Model to Hearing Aid Adoption in First-Time Users.

PubMed

Amlani, Amyn M

2016-05-01

Since 1980, hearing aid adoption rates have remained essentially the same, increasing at a rate equal to the organic growth of the population. Researchers have used theoretical models from psychology and sociology to determine those factors or constructs that lead to the adoption of hearing aids by first-time impaired listeners entering the market. In this article, a theoretical model, the Consumer Decision-Making Model (CDM), premised on the neobehavioral approach that considers an individual's psychological and cognitive emphasis toward a product or service, is described. Three theoretical models (i.e., transtheoretical, social model of disability, Health Belief Model), and their relevant findings to the hearing aid market, are initially described. The CDM is then presented, along with supporting evidence of the model's various factors from the hearing aid literature. Future applications of the CDM to hearing health care also are discussed.

Facilitating Adoption of News Tool to Develop Clinical Decision Making

ERIC Educational Resources Information Center

Brown, Robin T.

2017-01-01

This scholarly project was a non-experimental, pre/post-test design to (a) facilitate the voluntary adoption of the National Early Warning Score (NEWS), and (b) develop clinical decision making (CDM) in one cohort of junior level nursing students participating in a simulation lab. NEWS is an evidence-based predictive scoring tool developed by the…

Exploring the clinical decision-making used by experienced cardiorespiratory physiotherapists: A mixed method qualitative design of simulation, video recording and think aloud techniques.

PubMed

Thackray, Debbie; Roberts, Lisa

2017-02-01

The ability of physiotherapists to make clinical decisions is a vital component of being an autonomous practitioner, yet this complex phenomenon has been under-researched in cardiorespiratory physiotherapy. The purpose of this study was to explore clinical decision-making (CDM) by experienced physiotherapists in a scenario of a simulated patient experiencing acute deterioration of their respiratory function. The main objective of this observational study was to identify the actions, thoughts, and behaviours used by experienced cardiorespiratory physiotherapists in their clinical decision-making processes. A mixed-methods (qualitative) design employing observation and think-aloud, was adopted using a computerised manikin in a simulated environment. The participants clinically assessed the manikin programmed with the same clinical signs, under standardised conditions in the clinical skills practice suite, which was set up as a ward environment. Experienced cardiorespiratory physiotherapists, recruited from clinical practice within a 50-mile radius of the University(*). Participants were video-recorded throughout the assessment and treatment and asked to verbalise their thought processes using the 'think-aloud' method. The recordings were transcribed verbatim and managed using a Framework approach. Eight cardiorespiratory physiotherapists participated (mean 7years clinical experience, range 3.5-16years. CDM was similar to the collaborative hypothetico-deductive model, five-rights nursing model, reasoning strategies, inductive reasoning and pattern recognition. However, the CDM demonstrated by the physiotherapists was complex, interactive and iterative. Information processing occurred continuously throughout the whole interaction with the patient, and the specific cognitive skills of recognition, matching, discriminating, relating, inferring, synthesising and prediction were identified as being used sequentially. The findings from this study were used to develop a new conceptual model of clinical decision-making for cardiorespiratory physiotherapy. This conceptual model can be used to inform future educational strategies to prepare physiotherapists and nurses for working in acute respiratory care. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

SARDA: An Integrated Concept for Airport Surface Operations Management

NASA Technical Reports Server (NTRS)

Gupta, Gautam; Hoang, Ty; Jung, Yoon Chul

2013-01-01

The Spot and Runway Departure Advisor (SARDA) is an integrated decision support tool for airlines and air traffic control tower enabling surface collaborative decision making (CDM) and departure metering in order to enhance efficiency of surface operations at congested airports. The presentation describes the concept and architecture of the SARDA as a CDM tool, and the results from a human-in-the-loop simulation of the tool conducted in 2012 at the FutureFlight Central, the tower simulation facility. Also, presented is the current activities and future plan for SARDA development. The presentation was given at the meeting with the FAA senior advisor of the Surface Operations Office.

Cognitive continuum theory in interprofessional healthcare: A critical analysis.

PubMed

Parker-Tomlin, Michelle; Boschen, Mark; Morrissey, Shirley; Glendon, Ian

2017-07-01

Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.

The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

PubMed

Noon, Amy J

2014-01-01

High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Investigation of the Impact of User Gaming in the Next Generation National Airspace System

NASA Technical Reports Server (NTRS)

Hunter, George C.; Gao, Huina

2011-01-01

Over the past three decades, growth in the demand for air transportation has exceeded the growth in the national airspace system (NAS) capacity. Systems operating near capacity inevitably have delays and NAS d elays have increased in recent years. The desire to minimize delay costs has placed attention on the NAS air traffic management (ATM) syste m.One initiative that has helped to provide user representation in the ATM solution is the collaborative decision making (CDM) process. CDM addresses this issue by bringing users (referred to here as airline operation centers [AOCs]) and ATM providers together for information e xchange and cooperative planning. Such cooperative planning has been instituted, for instance, for the purpose of planning airport slot control strategies and rerouting strategies. While the CDM initiatives ha ve met with much success, they have also introduced the potential for AOCs to manipulate the system in unforeseen, unintended, and perhaps undesirable ways, from a system-wide, synoptic perspective. This type of manipulation is sometimes referred to as "gaming" the system. This study uses a high-fidelity simulation tool to investigate several models of user decision making behavior which could be considered to be gaming behavior and the emergent system dynamics and interactions between AOCs and traffic management.

Web based collaborative decision making in flood risk management

NASA Astrophysics Data System (ADS)

Evers, Mariele; Almoradie, Adrian; Jonoski, Andreja

2014-05-01

Stakeholder participation in the development of flood risk management (FRM) plans is essential since stakeholders often have a better understanding or knowledge of the potentials and limitation of their local area. Moreover, a participatory approach also creates trust amongst stakeholders, leading to a successful implementation of measures. Stakeholder participation however has its challenges and potential pitfalls that could lead to its premature termination. Such challenges and pitfalls are the limitation of financial resources, stakeholders' spatial distribution and their interest to participate. Different type of participation in FRM may encounter diverse challenges. These types of participation in FRM can be classified into (1) Information and knowledge sharing (IKS), (2) Consultative participation (CP) or (3) Collaborative decision making (CDM)- the most challenging type of participation. An innovative approach to address these challenges and potential pitfalls is a web-based mobile or computer-aided environment for stakeholder participation. This enhances the remote interaction between participating entities such as stakeholders. This paper presents a developed framework and an implementation of CDM web based environment for the Alster catchment (Hamburg, Germany) and Cranbrook catchment (London, UK). The CDM framework consists of two main stages: (1) Collaborative modelling and (2) Participatory decision making. This paper also highlights the stakeholder analyses, modelling approach and application of General Public License (GPL) technologies in developing the web-based environments. Actual test and evaluation of the environments was through series of stakeholders workshops. The overall results based from stakeholders' evaluation shows that web-based environments can address the challenges and potential pitfalls in stakeholder participation and it enhances participation in flood risk management. The web-based environment was developed within the DIANE-CM project (Decentralised Integrated Analysis and Enhancement of Awareness through Collaborative Modelling and Management of Flood Risk) of the 2nd ERANET CRUE funding initiative.

Improving nurses' knowledge of continuous ST-segment monitoring.

PubMed

Chronister, Connie

2014-01-01

Continuous ST-segment monitoring can result in detection of myocardial ischemia, but in clinical practice, continuous ST-segment monitoring is conducted incorrectly and underused by many registered nurses (RNs). Many RNs are unable to correctly institute ST-segment monitoring guidelines because of a lack of education. To evaluate whether an educational intervention, provided to 32 RNs, increases knowledge and correct clinical decision making (CDM) for the use of continuous ST-segment monitoring. At a single institution, an ST-segment monitoring class was provided to RNs in 2 cardiovascular units. Knowledge and correct CDM instruments were used for a baseline pretest and subsequent posttest after ST-segment monitoring education. Statistical significance between pretest and posttest scores for knowledge and correct CDM practice was noted with dependent t tests (P = .0001). Many RNs responsible for electrocardiographic monitoring are not aware of evidence-based ST-segment monitoring practice guidelines and cannot properly place precordial leads needed for ST-segment monitoring. Knowledge and correct CDM with ST-segment monitoring can be improved with focused education.

The Scorer Reliability of Self-Scored Interest Inventories.

ERIC Educational Resources Information Center

O'Shea, Arthur J.; Harrington, Thomas F.

1980-01-01

Describes the procedures the authors of the System for Career Decision-Making (CDM) followed in establishing client scoring reliability. Authors recommend that manuals of self-scored inventories provide data establishing scorer reliability, that scoring be supervised, and that APGA test standards deal directly with scorer reliability. (Author)

Stem revenue losses with effective CDM management.

PubMed

Alwell, Michael

2003-09-01

Effective CDM management not only minimizes revenue losses due to denied claims, but also helps eliminate administrative costs associated with correcting coding errors. Accountability for CDM management should be assigned to a single individual, who ideally reports to the CFO or high-level finance director. If your organization is prone to making billing errors due to CDM deficiencies, you should consider purchasing CDM software to help you manage your CDM.

NASA Research on an Integrated Concept for Airport Surface Operations Management

NASA Technical Reports Server (NTRS)

Gupta, Gautam

2012-01-01

Surface operations at airports in the US are based on tactical operations, where departure aircraft primarily queue up and wait at the departure runways. There have been attempts to address the resulting inefficiencies with both strategic and tactical tools for metering departure aircraft. This presentation gives an overview of Spot And Runway Departure Advisor with Collaborative Decision Making (SARDA-CDM): an integrated strategic and tactical system for improving surface operations by metering departure aircraft. SARDA-CDM is the augmentation of ground and local controller advisories through sharing of flight movement and related operations information between airport operators, flight operators and air traffic control at the airport. The goal is to enhance the efficiency of airport surface operations by exchanging information between air traffic control and airline operators, while minimizing adverse effects on stakeholders and passengers. The presentation motivates the need for departure metering, and provides a brief background on the previous work on SARDA. Then, the concept of operations for SARDA-CDM is described. Then the preliminary results from testing the concept in a real-time automated simulation environment are described. Results indicate benefits such as reduction in taxiing delay and fuel consumption. Further, the preliminary implementation of SARDA-CDM seems robust for two minutes delay in gate push-back times.

GIS-based integrated assessment and decision support system for land use planning in consideration of carbon sequestration benefits

NASA Astrophysics Data System (ADS)

Wang, Jun; Chen, J. M.; Li, Manchun; Ju, Weimin

2007-06-01

As the major eligible land use activities in the Clean Development Mechanism (CDM), afforestation and reforestation offer opportunities and potential economic benefits for developing countries to participate in carbon-trade in the potential international carbon (C) sink markets. However, the design and selection of appropriate afforestation and reforestation locations in CDM are complex processes which need integrated assessment (IA) of C sequestration (CS) potential, environmental effects, and socio-economic impacts. This paper promotes the consideration of CS benefits in local land use planning and presents a GIS-based integrated assessment and spatial decision support system (IA-SDSS) to support decision-making on 'where' and 'how' to afforest. It integrates an Integrated Terrestrial Ecosystem Carbon Model (InTEC) and a GIS platform for modeling regional long-term CS potential and assessment of geo-referenced land use criteria including CS consequence, and produces ranking of plantation schemes with different tree species using the Analytic hierarchy process (AHP) method. Three land use scenarios are investigated: (i) traditional land use planning criteria without C benefits, (ii) land use for CS with low C price, and (iii) land use for CS with high price. Different scenarios and consequences will influence the weights of tree-species selection in the AHP decision process.

Calibrating the Medical Council of Canada's Qualifying Examination Part I using an integrated item response theory framework: a comparison of models and designs.

PubMed

De Champlain, Andre F; Boulais, Andre-Philippe; Dallas, Andrew

2016-01-01

The aim of this research was to compare different methods of calibrating multiple choice question (MCQ) and clinical decision making (CDM) components for the Medical Council of Canada's Qualifying Examination Part I (MCCQEI) based on item response theory. Our data consisted of test results from 8,213 first time applicants to MCCQEI in spring and fall 2010 and 2011 test administrations. The data set contained several thousand multiple choice items and several hundred CDM cases. Four dichotomous calibrations were run using BILOG-MG 3.0. All 3 mixed item format (dichotomous MCQ responses and polytomous CDM case scores) calibrations were conducted using PARSCALE 4. The 2-PL model had identical numbers of items with chi-square values at or below a Type I error rate of 0.01 (83/3,499 or 0.02). In all 3 polytomous models, whether the MCQs were either anchored or concurrently run with the CDM cases, results suggest very poor fit. All IRT abilities estimated from dichotomous calibration designs correlated very highly with each other. IRT-based pass-fail rates were extremely similar, not only across calibration designs and methods, but also with regard to the actual reported decision to candidates. The largest difference noted in pass rates was 4.78%, which occurred between the mixed format concurrent 2-PL graded response model (pass rate= 80.43%) and the dichotomous anchored 1-PL calibrations (pass rate= 85.21%). Simpler calibration designs with dichotomized items should be implemented. The dichotomous calibrations provided better fit of the item response matrix than more complex, polytomous calibrations.

Dynamic CDM strategies in an EHR environment.

PubMed

Bieker, Michael; Bailey, Spencer

2012-02-01

A dynamic charge description master (CDM) integrates information from clinical ancillary systems into the charge-capture process, so an organization can reduce its reliance on the patient accounting system as the sole source of billing information. By leveraging the information from electronic ancillary systems, providers can eliminate the need for paper charge-capture forms and see increased accuracy and efficiency in the maintenance of billing information. Before embarking on a dynamic CDM strategy, organizations should first determine their goals for implementing an EHR system, include revenue cycle leaders on the EHR implementation team, and carefully weigh the pros and cons of CDM design decisions.

Applying Krumboltz's Theory of Career Decision Making (CDM) to the Longevity of Principals in the North American Division of Seventh-Day Adventists

ERIC Educational Resources Information Center

Saint-Ulysse, Sadrail

2017-01-01

Problem: Ledesma (2011) reports that principals' average tenure in Adventist schools in North America "ranges from 2.5-4.0 years. Elementary principals remain in leadership for 2.5 years, day academy principals stay for 3.6 years, and boarding academy principals leave after 4.0 years" (p, 8). Ledesma also noted that the length of tenure…

Decision & Management Tools for DNAPL Sites: Optimization of Chlorinated Solvent Source and Plume Remediation Considering Uncertainty

DTIC Science & Technology

2010-09-01

differentiated between source codes and input/output files. The text makes references to a REMChlor-GoldSim model. The text also refers to the REMChlor...To the extent possible, the instructions should be accurate and precise. The documentation should differentiate between describing what is actually...Windows XP operating system Model Input Paran1eters. · n1e input parameters were identical to those utilized and reported by CDM (See Table .I .from

Identification of Crew-Systems Interactions and Decision Related Trends

NASA Technical Reports Server (NTRS)

Jones, Sharon Monica; Evans, Joni K.; Reveley, Mary S.; Withrow, Colleen A.; Ancel, Ersin; Barr, Lawrence

2013-01-01

NASA Vehicle System Safety Technology (VSST) project management uses systems analysis to identify key issues and maintain a portfolio of research leading to potential solutions to its three identified technical challenges. Statistical data and published safety priority lists from academic, industry and other government agencies were reviewed and analyzed by NASA Aviation Safety Program (AvSP) systems analysis personnel to identify issues and future research needs related to one of VSST's technical challenges, Crew Decision Making (CDM). The data examined in the study were obtained from the National Transportation Safety Board (NTSB) Aviation Accident and Incident Data System, Federal Aviation Administration (FAA) Accident/Incident Data System and the NASA Aviation Safety Reporting System (ASRS). In addition, this report contains the results of a review of safety priority lists, information databases and other documented references pertaining to aviation crew systems issues and future research needs. The specific sources examined were: Commercial Aviation Safety Team (CAST) Safety Enhancements Reserved for Future Implementation (SERFIs), Flight Deck Automation Issues (FDAI) and NTSB Most Wanted List and Open Recommendations. Various automation issues taxonomies and priority lists pertaining to human factors, automation and flight design were combined to create a list of automation issues related to CDM.

The Effect of Achievement Test Selection on Identification of Learning Disabilities within a Patterns of Strengths and Weaknesses Framework

ERIC Educational Resources Information Center

Miciak, Jeremy; Taylor, W. Pat; Denton, Carolyn A.; Fletcher, Jack M.

2015-01-01

Few empirical investigations have evaluated learning disabilities (LD) identification methods based on a pattern of cognitive strengths and weaknesses (PSW). This study investigated the reliability of LD classification decisions of the concordance/discordance method (C/DM) across different psychoeducational assessment batteries. C/DM criteria were…

Combining Multiple Rupture Models in Real-Time for Earthquake Early Warning

NASA Astrophysics Data System (ADS)

Minson, S. E.; Wu, S.; Beck, J. L.; Heaton, T. H.

2015-12-01

The ShakeAlert earthquake early warning system for the west coast of the United States is designed to combine information from multiple independent earthquake analysis algorithms in order to provide the public with robust predictions of shaking intensity at each user's location before they are affected by strong shaking. The current contributing analyses come from algorithms that determine the origin time, epicenter, and magnitude of an earthquake (On-site, ElarmS, and Virtual Seismologist). A second generation of algorithms will provide seismic line source information (FinDer), as well as geodetically-constrained slip models (BEFORES, GPSlip, G-larmS, G-FAST). These new algorithms will provide more information about the spatial extent of the earthquake rupture and thus improve the quality of the resulting shaking forecasts.Each of the contributing algorithms exploits different features of the observed seismic and geodetic data, and thus each algorithm may perform differently for different data availability and earthquake source characteristics. Thus the ShakeAlert system requires a central mediator, called the Central Decision Module (CDM). The CDM acts to combine disparate earthquake source information into one unified shaking forecast. Here we will present a new design for the CDM that uses a Bayesian framework to combine earthquake reports from multiple analysis algorithms and compares them to observed shaking information in order to both assess the relative plausibility of each earthquake report and to create an improved unified shaking forecast complete with appropriate uncertainties. We will describe how these probabilistic shaking forecasts can be used to provide each user with a personalized decision-making tool that can help decide whether or not to take a protective action (such as opening fire house doors or stopping trains) based on that user's distance to the earthquake, vulnerability to shaking, false alarm tolerance, and time required to act.

Do Processing Patterns of Strengths and Weaknesses Predict Differential Treatment Response?

PubMed

Miciak, Jeremy; Williams, Jacob L; Taylor, W Pat; Cirino, Paul T; Fletcher, Jack M; Vaughn, Sharon

2016-08-01

No previous empirical study has investigated whether the LD identification decisions of proposed methods to operationalize processing strengths and weaknesses (PSW) approaches for LD identification are associated with differential treatment response. We investigated whether the identification decisions of the concordance/discordance model (C/DM; Hale & Fiorello, 2004) and Cross Battery Assessment approach (XBA method; Flanagan, Ortiz, & Alfonso, 2007) were consistent and whether they predicted intervention response beyond that accounted for by pretest performance on measures of reading. Psychoeducational assessments were administered at pretest to 203 4 th graders with low reading comprehension and individual results were utilized to identify students who met LD criteria according to the C/DM and XBA methods and students who did not. Resulting group status permitted an investigation of agreement for identification methods and whether group status at pretest (LD or not LD) was associated with differential treatment response to an intensive reading intervention. The LD identification decisions of the XBA and C/DM demonstrated poor agreement with one another (κ = -.10). Comparisons of posttest performance for students who met LD criteria and those who did not meet were largely null, with small effect sizes across all measures. LD status, as identified through the C/DM and XBA approaches, was not associated with differential treatment response and did not contribute educationally meaningful information about how students would respond to intensive reading intervention. These results do not support the value of cognitive assessment utilized in this way as part of the LD identification process.

Who's minding the charge description master?

PubMed

Schaum, Kathleen D

2011-11-01

Just as it takes a team to manage chronic wounds, it takes a team to maintain the CDM. The technical staff from the wound care department should be represented on this team and should share the appropriate HCPCS codes and CPT codes, product descriptions, and costs for all procedures, services, supplies, drugs, and biologics used in their department. The billing department should ensure that the appropriate revenue codes for each payer are listed for each item on the CDM. Based on costs supplied by the wound care department, the finance department should consistently assign hospital charges to each line item on the CDM. The information technology department is responsible for making the specific changes to the CDM in the computer system. Most hospitals have a CDM coordinator. The technical staff from the wound care department should work closely with the CDM coordinator and should obtain from him/her the policies and procedures for maintaining the wound care department CDM. Most CDM coordinators will also provide a CDM Change Request Form. Use that form each year when the hospital is performing its annual CDM maintenance and throughout the year to add procedures, services, supplies, drugs, or biologics to your wound care offerings and/or when the cost for these offerings change.

CLUMP-3D: Testing ΛCDM with Galaxy Cluster Shapes

NASA Astrophysics Data System (ADS)

Sereno, Mauro; Umetsu, Keiichi; Ettori, Stefano; Sayers, Jack; Chiu, I.-Non; Meneghetti, Massimo; Vega-Ferrero, Jesús; Zitrin, Adi

2018-06-01

The ΛCDM model of structure formation makes strong predictions on the concentration and shape of dark matter (DM) halos, which are determined by mass accretion processes. Comparison between predicted shapes and observations provides a geometric test of the ΛCDM model. Accurate and precise measurements needs a full three-dimensional (3D) analysis of the cluster mass distribution. We accomplish this with a multi-probe 3D analysis of the X-ray regular Cluster Lensing and Supernova survey with Hubble (CLASH) clusters combining strong and weak lensing, X-ray photometry and spectroscopy, and the Sunyaev–Zel’dovich effect (SZe). The cluster shapes and concentrations are consistent with ΛCDM predictions. The CLASH clusters are randomly oriented, as expected given the sample selection criteria. Shapes agree with numerical results for DM-only halos, which hints at baryonic physics being less effective in making halos rounder.

Ending on a positive: Examining the role of safety leadership decisions, behaviours and actions in a safety critical situation.

PubMed

Donovan, Sarah-Louise; Salmon, Paul M; Horberry, Timothy; Lenné, Michael G

2018-01-01

Safety leadership is an important factor in supporting safe performance in the workplace. The present case study examined the role of safety leadership during the Bingham Canyon Mine high-wall failure, a significant mining incident in which no fatalities or injuries were incurred. The Critical Decision Method (CDM) was used in conjunction with a self-reporting approach to examine safety leadership in terms of decisions, behaviours and actions that contributed to the incidents' safe outcome. Mapping the analysis onto Rasmussen's Risk Management Framework (Rasmussen, 1997), the findings demonstrate clear links between safety leadership decisions, and emergent behaviours and actions across the work system. Communication and engagement based decisions featured most prominently, and were linked to different leadership practices across the work system. Further, a core sub-set of CDM decision elements were linked to the open flow and exchange of information across the work system, which was critical to supporting the safe outcome. The findings provide practical implications for the development of safety leadership capability to support safety within the mining industry. Copyright © 2017 Elsevier Ltd. All rights reserved.

Chronic disease management: improving care for people with osteoarthritis.

PubMed

Brand, Caroline A; Ackerman, Ilana N; Tropea, Joanne

2014-02-01

Chronic disease management (CDM) service models are being developed for many conditions; however, there is limited evidence to support their effectiveness in osteoarthritis (OA). A systematic review was undertaken to examine effectiveness, cost effectiveness and barriers to the use of osteoarthritis-chronic disease management (OA-CDM) service models. Thirteen eligible studies (eight randomised controlled trial (RCTs)) were identified. The majority focussed on delivery system design (n = 9) and/or providing self-management support (SMS) (n = 8). Overall, reported model effectiveness varied, and where positive impacts on process or health outcomes were observed, they were of small to moderate effect. There was no information about cost effectiveness. There is some evidence to support the use of collaborative care/multidisciplinary case management models in primary and community care and evidence-based pathways/standardisation of care in hospital settings. Multiple barriers were identified. Future research should focus on identifying the effective components of multi-faceted interventions and evaluating cost-effectiveness to support clinical and policy decision-making. Copyright © 2014 Elsevier Ltd. All rights reserved.

ETHOS - an effective theory of structure formation: predictions for the high-redshift Universe - abundance of galaxies and reionization

NASA Astrophysics Data System (ADS)

Lovell, Mark R.; Zavala, Jesús; Vogelsberger, Mark; Shen, Xuejian; Cyr-Racine, Francis-Yan; Pfrommer, Christoph; Sigurdson, Kris; Boylan-Kolchin, Michael; Pillepich, Annalisa

2018-07-01

We contrast predictions for the high-redshift galaxy population and reionization history between cold dark matter (CDM) and an alternative self-interacting dark matter model based on the recently developed ETHOS framework that alleviates the small-scale CDM challenges within the Local Group. We perform the highest resolution hydrodynamical cosmological simulations (a 36 Mpc3 volume with gas cell mass of ˜ 105 M_{⊙} and minimum gas softening of ˜180 pc) within ETHOS to date - plus a CDM counterpart - to quantify the abundance of galaxies at high redshift and their impact on reionization. We find that ETHOS predicts galaxies with higher ultraviolet (UV) luminosities than their CDM counterparts and a faster build-up of the faint end of the UV luminosity function. These effects, however, make the optical depth to reionization less sensitive to the power spectrum cut-off: the ETHOS model differs from the CDM τ value by only 10 per cent and is consistent with Planck limits if the effective escape fraction of UV photons is 0.1-0.5. We conclude that current observations of high-redshift luminosity functions cannot differentiate between ETHOS and CDM models, but deep James Webb Space Telescope surveys of strongly lensed, inherently faint galaxies have the potential to test non-CDM models that offer attractive solutions to CDM's Local Group problems.

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

Dirian, Yves; Foffa, Stefano; Kunz, Martin

We study the cosmological predictions of two recently proposed non-local modifications of General Relativity. Both models have the same number of parameters as ΛCDM, with a mass parameter m replacing the cosmological constant. We implement the cosmological perturbations of the non-local models into a modification of the CLASS Boltzmann code, and we make a full comparison to CMB, BAO and supernova data. We find that the non-local models fit these datasets very well, at the same level as ΛCDM. Among the vast literature on modified gravity models, this is, to our knowledge, the only example which fits data as wellmore » as ΛCDM without requiring any additional parameter. For both non-local models parameter estimation using Planck +JLA+BAO data gives a value of H{sub 0} slightly higher than in ΛCDM.« less

Efficacy of a chronic disease management model for patients with chronic liver failure.

PubMed

Wigg, Alan J; McCormick, Rosemary; Wundke, Rachel; Woodman, Richard J

2013-07-01

Despite the economic impacts of chronic liver failure (CLF) and the success of chronic disease management (CDM) programs in routine clinical practice, there have been no randomized controlled trials of CDM for CLF. We investigated the efficacy of CDM programs for CLF patients in a prospective, controlled trial. Sixty consecutive patients with cirrhosis and complications from CLF were assigned randomly to groups given intervention (n = 40) or usual care (n = 20), from 2009 to 2010. The 12-month intervention comprised 4 CDM components: delivery system redesign, self-management support, decision support, and clinical information systems. The primary outcome was the number of days spent in a hospital bed for liver-related reasons. Secondary outcomes were rates of other hospital use measures, rate of attendance at planned outpatient care, disease severity, quality of life, and quality of care. The intervention did not reduce the number of days patients spent in hospital beds for liver-related reasons, compared with usual care (17.8 vs 11.0 bed days/person/y, respectively; incidence rate ratio, 1.6; 95% confidence interval, 0.5-4.8; P = .39), or affect other measures of hospitalization. Patients given the intervention had a 30% higher rate of attendance at outpatient care (incidence rate ratio, 1.3; 95% confidence interval, 1.1-1.5; P = .004) and significant increases in quality of care, based on adherence to hepatoma screening, osteoporosis and vaccination guidelines, and referral to transplant centers (P < .05 for all). In a pilot study to determine the efficacy of CDM for patients with CLF, patients receiving CDM had significant increases in attendance at outpatient centers and quality of care, compared with patients who did not receive CDM. However, CDM did not appear to reduce hospital admission rates or disease severity or improve patient quality of life. Larger trials with longer follow-up periods are required to confirm these findings and assess cost effectiveness. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Contrast-guided image interpolation.

PubMed

Wei, Zhe; Ma, Kai-Kuang

2013-11-01

In this paper a contrast-guided image interpolation method is proposed that incorporates contrast information into the image interpolation process. Given the image under interpolation, four binary contrast-guided decision maps (CDMs) are generated and used to guide the interpolation filtering through two sequential stages: 1) the 45(°) and 135(°) CDMs for interpolating the diagonal pixels and 2) the 0(°) and 90(°) CDMs for interpolating the row and column pixels. After applying edge detection to the input image, the generation of a CDM lies in evaluating those nearby non-edge pixels of each detected edge for re-classifying them possibly as edge pixels. This decision is realized by solving two generalized diffusion equations over the computed directional variation (DV) fields using a derived numerical approach to diffuse or spread the contrast boundaries or edges, respectively. The amount of diffusion or spreading is proportional to the amount of local contrast measured at each detected edge. The diffused DV fields are then thresholded for yielding the binary CDMs, respectively. Therefore, the decision bands with variable widths will be created on each CDM. The two CDMs generated in each stage will be exploited as the guidance maps to conduct the interpolation process: for each declared edge pixel on the CDM, a 1-D directional filtering will be applied to estimate its associated to-be-interpolated pixel along the direction as indicated by the respective CDM; otherwise, a 2-D directionless or isotropic filtering will be used instead to estimate the associated missing pixels for each declared non-edge pixel. Extensive simulation results have clearly shown that the proposed contrast-guided image interpolation is superior to other state-of-the-art edge-guided image interpolation methods. In addition, the computational complexity is relatively low when compared with existing methods; hence, it is fairly attractive for real-time image applications.

Using cognitive task analysis to facilitate the integration of decision support systems into the neonatal intensive care unit.

PubMed

Baxter, Gordon D; Monk, Andrew F; Tan, Kenneth; Dear, Peter R F; Newell, Simon J

2005-11-01

New medical systems may be rejected by staff because they do not integrate with local practice. An expert system, FLORENCE, is being developed to help staff in a neonatal intensive care unit (NICU) make decisions about ventilator settings when treating babies with respiratory distress syndrome. For FLORENCE to succeed it must be clinically useful and acceptable to staff in the context of local work practices. The aim of this work was to identify those contextual factors that would affect FLORENCE's success. A cognitive task analysis (CTA) of the NICU was performed. First, work context analysis was used to identify how work is performed in the NICU. Second, the critical decision method (CDM) was used to analyse how staff make decisions about changing the ventilator settings. Third, naturalistic observation of staff's use of the ventilator was performed. A. The work context analysis identified the NICU's hierarchical communication structure and the importance of numerous types of record in communication. B. It also identified important ergonomic and practical requirements for designing the displays and positioning the computer. C. The CDM interviews suggested instances where problems can arise if the data used by FLORENCE, which is automatically read, is not manually verified. D. Observation showed that most alarms cleared automatically. When FLORENCE raises an alarm, staff will normally be required to intervene and make a clinical judgement, even if the ventilator settings are not subsequently changed. FLORENCE must not undermine the NICU's hierarchical communication channels (A). The re-design of working practices to incorporate FLORENCE, reinforced through its user interface, must ensure that expert help is called on when appropriate (A). The procedures adopted with FLORENCE should ensure that the data the advice is based upon is valid (C). For example, FLORENCE could prompt staff to manually verify the data before implementing any suggested changes. FLORENCE's audible alarm should be clearly distinguishable from other NICU alarms (D); new procedures should be established to ensure that FLORENCE alarms receive attention (D), and false alarms from FLORENCE should be minimised (B, D). FLORENCE should always provide the data and reasoning underpinning its advice (A, C, D). The methods used in the CTA identified several contextual issues that could affect FLORENCE's acceptance. These issues, which extend beyond FLORENCE's capability to suggest changes to the ventilator settings, are being addressed in the design of the user interface and plans for FLORENCE's subsequent deployment.

Operational Characteristics Identification and Simulation Model Verification for Incheon International Airport

NASA Technical Reports Server (NTRS)

Eun, Yeonju; Jeon, Daekeun; Lee, Hanbong; Zhu, Zhifan; Jung, Yoon C.; Jeong, Myeongsook; Kim, Hyounkyong; Oh, Eunmi; Hong, Sungkwon; Lee, Junwon

2016-01-01

Incheon International Airport (ICN) is one of the hub airports in East Asia. Airport operations at ICN have been growing more than 5% per year in the past five years. According to the current airport expansion plan, a new passenger terminal will be added and the current cargo ramp will be expanded in 2018. This expansion project will bring 77 new stands without adding a new runway to the airport. Due to such continuous growth in airport operations and future expansion of the ramps, it will be highly likely that airport surface traffic will experience more congestion, and therefore, suffer from efficiency degradation. There is a growing awareness in aviation research community of need for strategic and tactical surface scheduling capabilities for efficient airport surface operations. Specific to ICN airport operations, a need for A-CDM (Airport - Collaborative Decision Making) or S-CDM(Surface - Collaborative Decision Making), and controller decision support tools for efficient air traffic management has arisen since several years ago. In the United States, there has been independent research efforts made by academia, industry, and government research organizations to enhance efficiency and predictability of surface operations at busy airports. Among these research activities, the Spot and Runway Departure Advisor (SARDA) developed and tested by National Aeronautics and Space Administration (NASA) is a decision support tool to provide tactical advisories to the controllers for efficient surface operations. The effectiveness of SARDA concept, was successfully verified through the human-in-the-loop (HITL) simulations for both spot release and runway operations advisories for ATC Tower controllers of Dallas/Fort Worth International Airport (DFW) in 2010 and 2012, and gate pushback advisories for the ramp controller of Charlotte/Douglas International Airport (CLT) in 2014. The SARDA concept for tactical surface scheduling is further enhanced and is being integrated into NASA's Airspace Technology Demonstration - 2 (ATD-2) project for technology demonstration of Integrated Arrival/Departure/Surface (ADS) operations at CLT. This study is a part of the international research collaboration between KAIA (Korea Agency for Infrastructure Technology Advancement)/KARI (Korea Aerospace Research Institute) and NASA, which is being conducted to validate the effectiveness of SARDA concept as a controller decision support tool for departure and surface management of ICN. This paper presents the preliminary results of the collaboration effort. It includes investigation of the operational environment of ICN, data analysis for identification of the operational characteristics of the airport, construction and verification of airport simulation model using Surface Operations Simulator and Scheduler (SOSS), NASA's fast-time simulation tool.

Operational Characteristics Identification and Simulation Model Verification for Incheon International Airport

NASA Technical Reports Server (NTRS)

Eun, Yeonju; Jeon, Daekeun; Lee, Hanbong; Zhu, Zhifan; Jung, Yoon C.; Jeong, Myeongsook; Kim, Hyounkyong; Oh, Eunmi; Hong, Sungkwon; Lee, Junwon

2016-01-01

Incheon International Airport (ICN) is one of the hub airports in East Asia. Airport operations at ICN have been growing more than 5 percent per year in the past five years. According to the current airport expansion plan, a new passenger terminal will be added and the current cargo ramp will be expanded in 2018. This expansion project will bring 77 new stands without adding a new runway to the airport. Due to such continuous growth in airport operations and future expansion of the ramps, it will be highly likely that airport surface traffic will experience more congestion, and therefore, suffer from efficiency degradation. There is a growing awareness in aviation research community of need for strategic and tactical surface scheduling capabilities for efficient airport surface operations. Specific to ICN airport operations, a need for A-CDM (Airport - Collaborative Decision Making) or S-CDM (Surface - Collaborative Decision Making), and controller decision support tools for efficient air traffic management has arisen since several years ago. In the United States, there has been independent research efforts made by academia, industry, and government research organizations to enhance efficiency and predictability of surface operations at busy airports. Among these research activities, the Spot and Runway Departure Advisor (SARDA) developed and tested by National Aeronautics and Space Administration (NASA) is a decision support tool to provide tactical advisories to the controllers for efficient surface operations. The effectiveness of SARDA concept, was successfully verified through the human-in-the-loop (HITL) simulations for both spot release and runway operations advisories for ATC Tower controllers of Dallas-Fort Worth International Airport (DFW) in 2010 and 2012, and gate pushback advisories for the ramp controller of Charlotte-Douglas International Airport (CLT) in 2014. The SARDA concept for tactical surface scheduling is further enhanced and is being integrated into NASA's Airspace Technology Demonstration-2 (ATD-2) project for technology demonstration of Integrated Arrival-Departure-Surface (IADS) operations at CLT. This study is a part of the international research collaboration between KAIA (Korea Agency for Infrastructure Technology Advancement), KARI (Korea Aerospace Research Institute) and NASA, which is being conducted to validate the effectiveness of SARDA concept as a controller decision support tool for departure and surface management of ICN. This paper presents the preliminary results of the collaboration effort. It includes investigation of the operational environment of ICN, data analysis for identification of the operational characteristics of the airport, construction and verification of airport simulation model using Surface Operations Simulator and Scheduler (SOSS), NASA's fast-time simulation tool.

Potential contribution of the forestry sector in Bangladesh to carbon sequestration.

PubMed

Yong Shin, Man; Miah, Danesh M; Lee, Kyeong Hak

2007-01-01

The Kyoto Protocol provides for the involvement of developing countries in an atmospheric greenhouse gas reduction regime under its Clean Development Mechanism (CDM). Carbon credits are gained from reforestation and afforestation activities in developing countries. Bangladesh, a densely populated tropical country in South Asia, has a huge degraded forestland which can be reforested by CDM projects. To realize the potential of the forestry sector in developing countries for full-scale emission mitigation, the carbon sequestration potential of different species in different types of plantations should be integrated with the carbon trading system under the CDM of the Kyoto Protocol. This paper discusses the prospects and problems of carbon trading in Bangladesh, in relation to the CDM, in the context of global warming and the potential associated consequences. The paper analyzes the effects of reforestation projects on carbon sequestration in Bangladesh, in general, and in the hilly Chittagong region, in particular, and concludes by demonstrating the carbon trading opportunities. Results showed that tree tissue in the forests of Bangladesh stored 92tons of carbon per hectare (tC/ha), on average. The results also revealed a gross stock of 190tC/ha in the plantations of 13 tree species, ranging in age from 6 to 23 years. The paper confirms the huge atmospheric CO(2) offset by the forests if the degraded forestlands are reforested by CDM projects, indicating the potential of Bangladesh to participate in carbon trading for both its economic and environmental benefit. Within the forestry sector itself, some constraints are identified; nevertheless, the results of the study can expedite policy decisions regarding Bangladesh's participation in carbon trading through the CDM.

Gravitational lensing in a cold dark matter universe

NASA Technical Reports Server (NTRS)

Narayan, Ramesh; White, Simon D. M.

1988-01-01

Gravitational lensing due to mass condensations in a biased cold dark matter (CDM) universe is investigated using the Press-Schechter (1974) theory with density fluctuation amplitudes taken from previous N-body work. Under the critical assumption that CDM haloes have small core radii, a distribution of image angular separations for high-z lensed quasars with a peak at about 1 arcsec and a half-width of a factor of about 10. Allowing for selection effects at small angular separations, this is in good agreement with the observed separations. The estimated frequency of lensing is somewhat lower than that observed, but the discrepancy can be removed by invoking amplification bias and by making a small upward adjustment to the density fluctuation amplitudes assumed in the CDM model.

Sustainable waste management in Africa through CDM projects.

PubMed

Couth, R; Trois, C

2012-11-01

Only few Clean Development Mechanism (CDM) projects (traditionally focussed on landfill gas combustion) have been registered in Africa if compared to similar developing countries. The waste hierarchy adopted by many African countries clearly shows that waste recycling and composting projects are generally the most sustainable. This paper undertakes a sustainability assessment for practical waste treatment and disposal scenarios for Africa and makes recommendations for consideration. The appraisal in this paper demonstrates that mechanical biological treatment of waste becomes more financially attractive if established through the CDM process. Waste will continue to be dumped in Africa with increasing greenhouse gas emissions produced, unless industrialised countries (Annex 1) fund carbon emission reduction schemes through a replacement to the Kyoto Protocol. Such a replacement should calculate all of the direct and indirect carbon emission savings and seek to promote public-private partnerships through a concerted support of the informal sector. Copyright © 2012 Elsevier Ltd. All rights reserved.

Chronic disease management in general practice: results from a national study.

PubMed

Darker, C; Martin, C; O'Dowd, T; O'Kelly, F; O'Shea, B

2012-04-01

The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380; 71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380; 76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future changes in CDM.

Dental Hygienist-Led Chronic Disease Management System to Control Early Childhood Caries.

PubMed

Ng, Man Wai; Fida, Zameera

2016-06-01

Management of the complex chronic disease of early childhood caries requires a system of coordinated health care interventions which can be led by a dental hygienist and where patient self-care efforts are paramount. Even after receiving costly surgical treatment under general anesthesia in the operating room, many children develop new and recurrent caries after only 6-12 months, a sequela that can be prevented. This article describes the chronic disease management (CDM) of dental caries, a science-based approach that can prevent and control caries. In this article, we (1) introduce the concept of CDM of dental caries, (2) provide evidence that CDM improves oral health outcomes, and (3) propose a dental hygienist-led team-based oral health care approach to CDM. Although we will be describing the CDM approach for early childhood caries, CDM of caries is applicable in children, adolescents, and adults. Early childhood caries disease control requires meaningful engagement of patients and parents by the oral health care team to assist them with making behavioral changes in the unique context of their families and communities. The traditional dentist/hygienist/assistant model needs to evolve to a collaborative partnership between care providers and patients/families. This partnership will be focused on systematic risk assessment and behaviorally based management of the disease itself, with sensitivity toward the familial environment. Early pilot study results demonstrate reductions in the rates of new caries, dental pain, and referral to the operating room compared with baseline rates. Dental hygienists are the appropriate team members to lead this approach because of their expertise in behavior change and prevention. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Cosmological model-independent test of ΛCDM with two-point diagnostic by the observational Hubble parameter data

NASA Astrophysics Data System (ADS)

Cao, Shu-Lei; Duan, Xiao-Wei; Meng, Xiao-Lei; Zhang, Tong-Jie

2018-04-01

Aiming at exploring the nature of dark energy (DE), we use forty-three observational Hubble parameter data (OHD) in the redshift range 0 < z ≤slant 2.36 to make a cosmological model-independent test of the ΛCDM model with two-point Omh^2(z2;z1) diagnostic. In ΛCDM model, with equation of state (EoS) w=-1, two-point diagnostic relation Omh^2 ≡ Ωmh^2 is tenable, where Ωm is the present matter density parameter, and h is the Hubble parameter divided by 100 {km s^{-1 Mpc^{-1}}}. We utilize two methods: the weighted mean and median statistics to bin the OHD to increase the signal-to-noise ratio of the measurements. The binning methods turn out to be promising and considered to be robust. By applying the two-point diagnostic to the binned data, we find that although the best-fit values of Omh^2 fluctuate as the continuous redshift intervals change, on average, they are continuous with being constant within 1 σ confidence interval. Therefore, we conclude that the ΛCDM model cannot be ruled out.

Relaxing the σ 8-tension through running vacuum in the Universe

NASA Astrophysics Data System (ADS)

Gómez-Valent, Adrià; Solà, Joan

2017-11-01

It has recently been shown that the class of running vacuum models (RVMs) has the capacity to fit the overall cosmological observations better than the concordance ΛCDM model, therefore supporting the possibility of dynamical dark energy (DE). Apart from the cosmic microwave background (CMB) anisotropies, the most crucial datasets involved are: i) baryonic acoustic oscillations (BAO), and ii) direct large scale structure (LSS) formation data. Analyses mainly focusing on CMB and with insufficient BAO + LSS input generally fail to capture the dynamical DE signature, whereas the few existing studies accounting for the wealth of known CMB+BAO+LSS data (see in particular Solà, Gómez-Valent and de Cruz Pérez (2015), (2017); and Zhao et al. (2017)) do converge to the remarkable conclusion that dynamical DE might well be encoded in the current cosmological observations at 3-4σ c.l. A decisive factor is the persistent σ 8-tension between the ΛCDM and the data. Because the issue is obviously pressing, we devote this work to explain how and why running vacuum in the expanding universe successfully relaxes the existing σ 8-tension and describes the LSS formation data significantly better than the ΛCDM.

A Semantic Transformation Methodology for the Secondary Use of Observational Healthcare Data in Postmarketing Safety Studies.

PubMed

Pacaci, Anil; Gonul, Suat; Sinaci, A Anil; Yuksel, Mustafa; Laleci Erturkmen, Gokce B

2018-01-01

Background: Utilization of the available observational healthcare datasets is key to complement and strengthen the postmarketing safety studies. Use of common data models (CDM) is the predominant approach in order to enable large scale systematic analyses on disparate data models and vocabularies. Current CDM transformation practices depend on proprietarily developed Extract-Transform-Load (ETL) procedures, which require knowledge both on the semantics and technical characteristics of the source datasets and target CDM. Purpose: In this study, our aim is to develop a modular but coordinated transformation approach in order to separate semantic and technical steps of transformation processes, which do not have a strict separation in traditional ETL approaches. Such an approach would discretize the operations to extract data from source electronic health record systems, alignment of the source, and target models on the semantic level and the operations to populate target common data repositories. Approach: In order to separate the activities that are required to transform heterogeneous data sources to a target CDM, we introduce a semantic transformation approach composed of three steps: (1) transformation of source datasets to Resource Description Framework (RDF) format, (2) application of semantic conversion rules to get the data as instances of ontological model of the target CDM, and (3) population of repositories, which comply with the specifications of the CDM, by processing the RDF instances from step 2. The proposed approach has been implemented on real healthcare settings where Observational Medical Outcomes Partnership (OMOP) CDM has been chosen as the common data model and a comprehensive comparative analysis between the native and transformed data has been conducted. Results: Health records of ~1 million patients have been successfully transformed to an OMOP CDM based database from the source database. Descriptive statistics obtained from the source and target databases present analogous and consistent results. Discussion and Conclusion: Our method goes beyond the traditional ETL approaches by being more declarative and rigorous. Declarative because the use of RDF based mapping rules makes each mapping more transparent and understandable to humans while retaining logic-based computability. Rigorous because the mappings would be based on computer readable semantics which are amenable to validation through logic-based inference methods.

Semantic Enhancement for Enterprise Data Management

NASA Astrophysics Data System (ADS)

Ma, Li; Sun, Xingzhi; Cao, Feng; Wang, Chen; Wang, Xiaoyuan; Kanellos, Nick; Wolfson, Dan; Pan, Yue

Taking customer data as an example, the paper presents an approach to enhance the management of enterprise data by using Semantic Web technologies. Customer data is the most important kind of core business entity a company uses repeatedly across many business processes and systems, and customer data management (CDM) is becoming critical for enterprises because it keeps a single, complete and accurate record of customers across the enterprise. Existing CDM systems focus on integrating customer data from all customer-facing channels and front and back office systems through multiple interfaces, as well as publishing customer data to different applications. To make the effective use of the CDM system, this paper investigates semantic query and analysis over the integrated and centralized customer data, enabling automatic classification and relationship discovery. We have implemented these features over IBM Websphere Customer Center, and shown the prototype to our clients. We believe that our study and experiences are valuable for both Semantic Web community and data management community.

What do gas-rich galaxies actually tell us about modified Newtonian dynamics?

PubMed

Foreman, Simon; Scott, Douglas

2012-04-06

It has recently been claimed that measurements of the baryonic Tully-Fisher relation (BTFR), a power-law relationship between the observed baryonic masses and outer rotation velocities of galaxies, support the predictions of modified Newtonian dynamics for the slope and scatter in the relation, while challenging the cold dark matter (CDM) paradigm. We investigate these claims, and find that (1) the scatter in the data used to determine the BTFR is in conflict with observational uncertainties on the data, (2) these data do not make strong distinctions regarding the best-fit BTFR parameters, (3) the literature contains a wide variety of measurements of the BTFR, many of which are discrepant with the recent results, and (4) the claimed CDM "prediction" for the BTFR is a gross oversimplification of the complex galaxy-scale physics involved. We conclude that the BTFR is currently untrustworthy as a test of CDM. © 2012 American Physical Society

Learning from professionals: Exploring cognitive rehabilitation strategies for the definition of the functional requirements of a telerehabilitation platform.

PubMed

Rosso, Giovanni; Frisiello, Antonella; Trizio, Marco; Mosso, Cristina O; Bazzani, Marco

2018-04-01

In the past few years, the advances in Information and Communication Technology (ICT) led to the development of platforms and applications that aim to support cognitive rehabilitation therapy that contributes to extend patients' treatment at home. In our research we adopted the Human Centered Approach to design a cognitive rehabilitation platform that is able to provide tools and features tailored to the professional needs and strategies and also able to engage patients in their treatment process. In order to explore the clinicians' point of view on the neuropsychological intervention strategies, we applied two different techniques often used in human factors research: the Critical Decision Method to study professionals' strategies with a descriptive perspective, and the Hierarchical Task Analysis to analyze the processes with a normative view. The results of our research showed that the hybrid approach adopted allowed us to have a better focus on the cognitive rehabilitation process and on the professionals' decision making mechanism. This led to a better understanding of functional requirements for supporting clinician's strategic decision making, in terms of personalization of treatments, cognitive exercises settings and feedback customization. In conclusion, our research highlights the value of the CDM to focus deeply on which functionalities professionals require from a cognitive telerehabilitation system and allowed us to design more precisely clinician-patients interactions inside the system compared to prescriptive methods currently used. Our study offers contribution to the comprehension of the rehabilitation processes, suggesting the positive impacts of an "extended" clinic treatment by adopting a flexible and adaptable tool. Copyright © 2017. Published by Elsevier Ltd.

Comparison between the Logotropic and ΛCDM models at the cosmological scale

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

Chavanis, Pierre-Henri; Kumar, Suresh, E-mail: chavanis@irsamc.ups-tlse.fr, E-mail: suresh.kumar@pilani.bits-pilani.ac.in

We perform a detailed comparison between the Logotropic model [P.H. Chavanis, Eur. Phys. J. Plus, 130 (2015)] and the ΛCDM model. These two models behave similarly at large (cosmological) scales up to the present. Differences will appear only in the far future, in about 25 Gyrs, when the Logotropic Universe becomes phantom while the ΛCDM Universe enters in the de Sitter era. However, the Logotropic model differs from the ΛCDM model at small (galactic) scales, where the latter encounters serious problems. Having a nonvanishing pressure, the Logotropic model can solve the cusp problem and the missing satellite problem of themore » ΛCDM model. In addition, it leads to dark matter halos with a constant surface density Σ{sub 0}=ρ{sub 0} r {sub h} , and can explain its observed value Σ{sub 0}=141 M {sub ⊙}/pc{sup 2} without adjustable parameter. This makes the logotropic model rather unique among all the models attempting to unify dark matter and dark energy. In this paper, we compare the Logotropic and ΛCDM models at the cosmological scale where they are very close to each other in order to determine quantitatively how much they differ. This comparison is facilitated by the fact that these models depend on only two parameters, the Hubble constant H {sub 0} and the present fraction of dark matter Ω{sub m0}. Using the latest observational data from Planck 2015+Lensing+BAO+JLA+HST, we find that the best fit values of H {sub 0} and Ω{sub m0} are H {sub 0}=68.30 km s{sup −1} Mpc{sup −1} and Ω{sub m0}=0.3014 for the Logotropic model, and H {sub 0}=68.02 km s{sup −1} Mpc{sup −1} and Ω{sub m0}=0.3049 for the ΛCDM model. The difference between the two models is at the percent level. As a result, the Logotropic model competes with the ΛCDM model at large scales and solves its problems at small scales. It may therefore represent a viable alternative to the ΛCDM model. Our study provides an explicit example of a theoretically motivated model that is almost indistinguishable from the ΛCDM model at the present time while having a completely different (phantom) evolution in the future. We analytically derive the statefinders of the Logotropic model for all values of the logotropic constant B . We show that the parameter s {sub 0} is directly related to this constant since s {sub 0}=− B /( B +1) independently of any other parameter like H {sub 0} or Ω{sub m0}. For the predicted value of B =3.53× 10{sup −3}, we obtain ( q {sub 0}, r {sub 0}, s {sub 0})=(−0.5516,1.011,−0.003518) instead of ( q {sub 0}, r {sub 0}, s {sub 0})=(−0.5427,1,0) for the ΛCDM model corresponding to 0 B =.« less

Disentangling interacting dark energy cosmologies with the three-point correlation function

NASA Astrophysics Data System (ADS)

Moresco, Michele; Marulli, Federico; Baldi, Marco; Moscardini, Lauro; Cimatti, Andrea

2014-10-01

We investigate the possibility of constraining coupled dark energy (cDE) cosmologies using the three-point correlation function (3PCF). Making use of the CODECS N-body simulations, we study the statistical properties of cold dark matter (CDM) haloes for a variety of models, including a fiducial ΛCDM scenario and five models in which dark energy (DE) and CDM mutually interact. We measure both the halo 3PCF, ζ(θ), and the reduced 3PCF, Q(θ), at different scales (2 < r [h-1 Mpc ] < 40) and redshifts (0 ≤ z ≤ 2). In all cDE models considered in this work, Q(θ) appears flat at small scales (for all redshifts) and at low redshifts (for all scales), while it builds up the characteristic V-shape anisotropy at increasing redshifts and scales. With respect to the ΛCDM predictions, cDE models show lower (higher) values of the halo 3PCF for perpendicular (elongated) configurations. The effect is also scale-dependent, with differences between ΛCDM and cDE models that increase at large scales. We made use of these measurements to estimate the halo bias, that results in fair agreement with the one computed from the two-point correlation function (2PCF). The main advantage of using both the 2PCF and 3PCF is to break the bias-σ8 degeneracy. Moreover, we find that our bias estimates are approximately independent of the assumed strength of DE coupling. This study demonstrates the power of a higher order clustering analysis in discriminating between alternative cosmological scenarios, for both present and forthcoming galaxy surveys, such as e.g. Baryon Oscillation Spectroscopic Survey and Euclid.

Cost of nursing most frequent procedures performed on severely burned patients.

PubMed

Melo, Talita de Oliveira; Lima, Antônio Fernandes Costa

2017-01-01

to identify the mean direct cost (MDC) of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit. exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed) spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions. a MDC of US$ 0.65 (SD=0.36) was obtained for "vital signs monitoring"; US$ 10.00 (SD=24.23) for "intravenous drug administration"; US$ 5.90 (SD=2.75) for "measurement of diuresis"; US$ 0.93 (SD=0.42) for "capillary blood glucose monitoring"; and US$ 99.75 (SD=129.55) for "bandaging". the knowledge developed can support managerial decision-making, contribute to the efficiency distribution of the resources involved and, when possible, provide cost-containment or cost-minimization strategies without impairing the quality of nursing care. identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, em uma Unidade de Terapia Intensiva, aos pacientes grandes queimados. pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. obteve-se o CDM de US$ 0.65 (SD=0.36) para "controle dos sinais vitais"; US$ 10.00 (SD=24.23) para "administração de medicamentos via intravenosa"; US$ 5.90 (SD=2.75) para "mensuração de diurese"; US$ 0.93 (SD=0.42) para "verificação de glicemia capilar"; e US$ 99.75 (SD=129.55) para "curativo". o conhecimento desenvolvido pode fundamentar as tomadas de decisão gerenciais subsidiando a eficiência alocativa dos recursos envolvidos e, quando possível, indicar estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem.

Towards an ontology for data quality in integrated chronic disease management: a realist review of the literature.

PubMed

Liaw, S T; Rahimi, A; Ray, P; Taggart, J; Dennis, S; de Lusignan, S; Jalaludin, B; Yeo, A E T; Talaei-Khoei, A

2013-01-01

Effective use of routine data to support integrated chronic disease management (CDM) and population health is dependent on underlying data quality (DQ) and, for cross system use of data, semantic interoperability. An ontological approach to DQ is a potential solution but research in this area is limited and fragmented. Identify mechanisms, including ontologies, to manage DQ in integrated CDM and whether improved DQ will better measure health outcomes. A realist review of English language studies (January 2001-March 2011) which addressed data quality, used ontology-based approaches and is relevant to CDM. We screened 245 papers, excluded 26 duplicates, 135 on abstract review and 31 on full-text review; leaving 61 papers for critical appraisal. Of the 33 papers that examined ontologies in chronic disease management, 13 defined data quality and 15 used ontologies for DQ. Most saw DQ as a multidimensional construct, the most used dimensions being completeness, accuracy, correctness, consistency and timeliness. The majority of studies reported tool design and development (80%), implementation (23%), and descriptive evaluations (15%). Ontological approaches were used to address semantic interoperability, decision support, flexibility of information management and integration/linkage, and complexity of information models. DQ lacks a consensus conceptual framework and definition. DQ and ontological research is relatively immature with little rigorous evaluation studies published. Ontology-based applications could support automated processes to address DQ and semantic interoperability in repositories of routinely collected data to deliver integrated CDM. We advocate moving to ontology-based design of information systems to enable more reliable use of routine data to measure health mechanisms and impacts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Carbon credit of renewable energy projects in Malaysia

NASA Astrophysics Data System (ADS)

Lim, X.; Lam, W. H.; Shamsuddin, A. H.

2013-06-01

The introduction of Clean Development Mechanism (CDM) to Malaysia improves the environment of the country. Besides achieving sustainable development, the carbon credit earned through CDM enhances the financial state of the nation. Both CDM and renewable energy contribute to the society by striving to reduce carbon emission. Most of the CDM projects are related to renewable energy, which recorded 69% out of total CDM projects. This paper presents the energy overview and status of renewable energies in the country. Then, the renewable energy will be related to the CDM.

Fiber Optic Biosensors

DTIC Science & Technology

2006-12-01

CDM Camp Dresser & McKee Inc. CSU Colorado State University DCA dichloroethane DO dissolved oxygen DoD Department of Defense EA EA...Ph.D. (PI), Camp Dresser & McKee Inc. (CDM); John Eisenbeis, Ph.D., CDM; Kristy Warren, CDM; Dan Adams, CDM; Michael Allen, Bangor Naval Submarine Base...alcohol (PVA) using cyanuric chloride, and the resulting product was cross -linked with glutaraldehyde in presence of HCl to form a hydrogel that was

How physician and community pharmacist perceptions of the community pharmacist role in Australian primary care influence the quality of collaborative chronic disease management.

PubMed

Rieck, Allison; Pettigrew, Simone

2013-01-01

Community pharmacists (CPs) have been changing their role to focus on patient-centred services to improve the quality of chronic disease management (CDM) in primary care. However, CPs have not been readily included in collaborative CDM with other primary care professionals such as physicians. There is little understanding of the CP role change and whether it affects the utilisation of CPs in primary care collaborative CDM. To explore physician and CP perceptions of the CP's role in Australian primary care and how these perceptions may influence the quality of physician/CP CDM programmes. Data were collected from physicians and CPs using semi-structured interviews. A qualitative methodology utilising thematic analysis was employed during data analysis. Qualitative methodology trustworthiness techniques, negative case analysis and member checking were utilised to substantiate the resultant themes. A total of 22 physicians and 22 CPs were interviewed. Strong themes emerged regarding the participant perceptions of the CP's CDM role in primary care. The majority of interviewed physicians perceived that CPs did not have the appropriate CDM knowledge to complement physician knowledge to provide improved CDM compared with what they could provide on their own. Most of the interviewed CPs expressed a willingness and capability to undertake CDM; however, they were struggling to provide sustainable CDM in the business setting within which they function in the primary care environment. Role theory was selected as it provided the optimum explanation of the resultant themes. First, physician lack of confidence in the appropriateness of CP CDM knowledge causes physicians to be confused about the role CPs would undertake in a collaborative CDM that would benefit the physicians and their patients. Thus, by increasing physician awareness of CP CDM knowledge, physicians may see CPs as suitable CDM collaborators. Second, CPs are experiencing role conflict and stress in trying to change their role. Strengthening the service business model may reduce these CP role issues and allow CPs to reach their full potential in CDM and improve the quality of collaborative CDM in Australian primary care.

Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010.

PubMed

Abdelhadi, Ruba A; Bouma, Sandra; Bairdain, Sigrid; Wolff, Jodi; Legro, Amanda; Plogsted, Steve; Guenter, Peggi; Resnick, Helaine; Slaughter-Acey, Jaime C; Corkins, Mark R

2016-07-01

Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children <17 years old had a coded diagnosis of malnutrition (CDM). This report summarizes nationally representative, person-level characteristics of hospitalized children with a CDM. Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient-level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD-9-CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. In 2010, 1.3% of hospitalized patients <17 years had a CDM. Since the data include only those with a CDM, malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. © 2016 American Society for Parenteral and Enteral Nutrition.

The Effect of Achievement Test Selection on Identification of Learning Disabilities within a Patterns of Strengths and Weaknesses Framework

PubMed Central

Miciak, Jeremy; Taylor, Pat; Denton, Carolyn A.; Fletcher, Jack M.

2014-01-01

Purpose Few empirical investigations have evaluated learning disabilities (LD) identification methods based on a pattern of cognitive strengths and weaknesses (PSW). This study investigated the reliability of LD classification decisions of the concordance/discordance method (C/DM) across different psychoeducational assessment batteries. Methods C/DM criteria were applied to assessment data from 177 second grade students based on two psychoeducational assessment batteries. The achievement tests were different, but were highly correlated and measured the same latent construct. Resulting LD identifications were then evaluated for agreement across batteries on LD status and the academic domain of eligibility. Results The two batteries identified a similar number of participants as having LD (80 and 74). However, indices of agreement for classification decisions were low (kappa = .29), especially for percent positive agreement (62%). The two batteries demonstrated agreement on the academic domain of eligibility for only 25 participants. Conclusions Cognitive discrepancy frameworks for LD identification are inherently unstable because of imperfect reliability and validity at the observed level. Methods premised on identifying a PSW profile may never achieve high reliability because of these underlying psychometric factors. An alternative is to directly assess academic skills to identify students in need of intervention. PMID:25243467

Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

PubMed

Edelstein, Burton L; Ng, Man Wai

2015-01-01

An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

78 FR 32250 - CDM Smith and Dynamac Corp; Transfer of Data

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-29

... ENVIRONMENTAL PROTECTION AGENCY [EPA-HQ-OPP-2013-0036; FRL-9387-5] CDM Smith and Dynamac Corp... the submitter, will be transferred to CDM Smith and its subcontractor, Dynamac Corp, in accordance with 40 CFR 2.307(h)(3) and 2.308(i)(2). CDM Smith and its subcontractor, Dynamac Corp, have been...

Improvement in diagnostic performance of breast cancer: comparison between conventional digital mammography alone and conventional mammography plus digital breast tomosynthesis.

PubMed

Ohashi, Ryoko; Nagao, Michinobu; Nakamura, Izumi; Okamoto, Takahiro; Sakai, Shuji

2018-04-12

The aim of this study was to determine if the diagnostic performance of breast lesion examinations could be improved using both digital breast tomosynthesis (DBT) and conventional digital mammography (CDM). Our institutional review board approved the protocol, and patients were provided the opportunity to opt out of the study. A total of 628 patients aged 22-91 years with abnormal screening results or clinical symptoms were consecutively enrolled between June 2015 and March 2016. All patients underwent DBT and CDM, and 1164 breasts were retrospectively analyzed by three radiologists who interpreted the results based on the Breast Imaging Reporting and Data System. Categories 4 and 5 were considered positive, and pathological results were the gold standard. The diagnostic performance of CDM and CDM plus DBT was compared using the mean areas under the receiver operating characteristic (ROC) curves. A total of 100 breast cancer cases were identified. The areas under the ROC curves were 0.9160 (95% confidence interval 0.8779-0.9541) for CDM alone and 0.9376 (95% confidence interval 0.9019-0.9733) for CDM plus DBT. The cut-off values for both CDM alone and CDM plus DBT measurements were 4, with sensitivities of 61.0% (61/100) and 83.0% (83/100), respectively, and specificities of 99.1% (1054/1064) and 98.9% (1052/1064), respectively. CDM yielded 39 false-negative diagnoses, while CDM plus DBT identified breast cancer in 22 of those cases (56.4%). The combination of DBT and CDM for the diagnosis of breast cancer in women with abnormal examination findings or clinical symptoms proved effective and should be used to improve the diagnostic performance of breast cancer examinations.

Airspace Technology Demonstration 2 (ATD-2) Technology Description Document (TDD)

NASA Technical Reports Server (NTRS)

Ging, Andrew; Engelland, Shawn; Capps, Al; Eshow, Michelle; Jung, Yoon; Sharma, Shivanjli; Talebi, Ehsan; Downs, Michael; Freedman, Cynthia; Ngo, Tyler;

Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: A randomized controlled trial.

PubMed

Cobbett, Shelley; Snelgrove-Clarke, Erna

2016-10-01

Clinical simulations can provide students with realistic clinical learning environments to increase their knowledge, self-confidence, and decrease their anxiety prior to entering clinical practice settings. To compare the effectiveness of two maternal newborn clinical simulation scenarios; virtual clinical simulation and face-to-face high fidelity manikin simulation. Randomized pretest-posttest design. A public research university in Canada. Fifty-six third year Bachelor of Science in Nursing students. Participants were randomized to either face-to-face or virtual clinical simulation and then to dyads for completion of two clinical simulations. Measures included: (1) Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM) (White, 2011), (2) knowledge pretest and post-test related to preeclampsia and group B strep, and (3) Simulation Completion Questionnaire. Before and after each simulation students completed a knowledge test and the NASC-CDM and the Simulation Completion Questionnaire at study completion. There were no statistically significant differences in student knowledge and self-confidence between face-to-face and virtual clinical simulations. Anxiety scores were higher for students in the virtual clinical simulation than for those in the face-to-face simulation. Students' self-reported preference was face-to-face citing the similarities to practicing in a 'real' situation and the immediate debrief. Students not liking the virtual clinical simulation most often cited technological issues as their rationale. Given the equivalency of knowledge and self-confidence when undergraduate nursing students participate in either maternal newborn clinical scenarios of face-to-face or virtual clinical simulation identified in this trial, it is important to take into the consideration costs and benefits/risks of simulation implementation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Supporting Open Access to European Academic Courses: The ASK-CDM-ECTS Tool

ERIC Educational Resources Information Center

Sampson, Demetrios G.; Zervas, Panagiotis

2013-01-01

Purpose: This paper aims to present and evaluate a web-based tool, namely ASK-CDM-ECTS, which facilitates authoring and publishing on the web descriptions of (open) academic courses in machine-readable format using an application profile of the Course Description Metadata (CDM) specification, namely CDM-ECTS. Design/methodology/approach: The paper…

Use of chronic disease management programs for diabetes: in Alberta's primary care networks.

PubMed

Campbell, David J T; Sargious, Peter; Lewanczuk, Richard; McBrien, Kerry; Tonelli, Marcello; Hemmelgarn, Brenda; Manns, Braden

2013-02-01

To determine the types of chronic disease management (CDM) programs offered for patients with diabetes in Alberta's primary care networks (PCNs). A survey was administered to PCNs to determine the types of CDM programs offered for patients with diabetes; CDM programs were organized into categories by their resource intensity and effectiveness. Results of the survey were reported using frequencies and percentages. Alberta has recently created PCNs-groups of family physicians who receive additional funds to enable them to support activities that fall outside the typical physician-based fee-for-service model, but which address specified objectives including CDM. It is currently unknown what additional programs are being provided through the PCN supplemental funding. A survey was administered to the individual responsible for CDM in each PCN. This included executive directors, chronic disease managers, and CDM nurses. We determined the CDM strategies used in each PCN to care for patients with diabetes, whether they were available to all patients, and whether the services were provided exclusively by the PCN or in conjunction with other agencies. There was considerable variation across PCNs with respect to the CDM programs offered for people with diabetes. Nearly all PCNs used multidisciplinary teams (which could include nurses, dietitians, and pharmacists) and patient education. Fewer than half of the PCNs permitted personnel other than the primary physician to write or alter prescriptions for medications. Alberta's PCNs have successfully established many different types of CDM programs. Multidisciplinary care teams, which are among the most effective CDM strategies, are currently being used by most of Alberta's PCNs.

Use of chronic disease management programs for diabetes

PubMed Central

Campbell, David J.T.; Sargious, Peter; Lewanczuk, Richard; McBrien, Kerry; Tonelli, Marcello; Hemmelgarn, Brenda; Manns, Braden

2013-01-01

Objective To determine the types of chronic disease management (CDM) programs offered for patients with diabetes in Alberta's primary care networks (PCNs). Design A survey was administered to PCNs to determine the types of CDM programs offered for patients with diabetes; CDM programs were organized into categories by their resource intensity and effectiveness. Results of the survey were reported using frequencies and percentages. Setting Alberta has recently created PCNs—groups of family physicians who receive additional funds to enable them to support activities that fall outside the typical physician-based fee-for-service model, but which address specified objectives including CDM. It is currently unknown what additional programs are being provided through the PCN supplemental funding. Participants A survey was administered to the individual responsible for CDM in each PCN. This included executive directors, chronic disease managers, and CDM nurses. Main outcome measures We determined the CDM strategies used in each PCN to care for patients with diabetes, whether they were available to all patients, and whether the services were provided exclusively by the PCN or in conjunction with other agencies. Results There was considerable variation across PCNs with respect to the CDM programs offered for people with diabetes. Nearly all PCNs used multidisciplinary teams (which could include nurses, dietitians, and pharmacists) and patient education. Fewer than half of the PCNs permitted personnel other than the primary physician to write or alter prescriptions for medications. Conclusion Alberta's PCNs have successfully established many different types of CDM programs. Multidisciplinary care teams, which are among the most effective CDM strategies, are currently being used by most of Alberta's PCNs. PMID:23418263

Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.

PubMed

Jansen, Sarah; Ball, Lauren; Lowe, Catherine

2015-04-01

This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.

Courseware Development Model (CDM): The Effects of CDM on Primary School Pre-Service Teachers' Achievements and Attitudes

ERIC Educational Resources Information Center

Efendioglu, Akin

2012-01-01

The main purpose of this study is to design a "Courseware Development Model" (CDM) and investigate its effects on pre-service teachers' academic achievements in the field of geography and attitudes toward computer-based education (ATCBE). The CDM consisted of three components: content (C), learning theory, namely, meaningful learning (ML), and…

The Learning Process and Technological Change in Wind Power: Evidence from China's CDM Wind Projects

ERIC Educational Resources Information Center

Tang, Tian; Popp, David

2016-01-01

The Clean Development Mechanism (CDM) is a project-based carbon trade mechanism that subsidizes the users of climate-friendly technologies and encourages technology transfer. The CDM has provided financial support for a large share of Chinese wind projects since 2002. Using pooled cross-sectional data of 486 registered CDM wind projects in China…

Evidence-Based Practice Empowers Practitioners: A Response to Epstein

ERIC Educational Resources Information Center

Rubin, Allen

2015-01-01

Epstein makes a strong argument for the value of clinical data mining (CDM), although he minimizes some of the potential limitations in that methodology, such as attrition. Epstein's portrayal of evidence-based practice (EBP) as practitioner-bashing and treasuring intervention manuals overlooks the emphasis in the EBP process on the need for…

Parameter Invariance and Skill Attribute Continuity in the DINA Model

ERIC Educational Resources Information Center

Bolt, Daniel M.; Kim, Jee-Seon

2018-01-01

Cognitive diagnosis models (CDMs) typically assume skill attributes with discrete (often binary) levels of skill mastery, making the existence of skill continuity an anticipated form of model misspecification. In this article, misspecification due to skill continuity is argued to be of particular concern for several CDM applications due to the…

Data management in clinical research: An overview

PubMed Central

Krishnankutty, Binny; Bellary, Shantala; Kumar, Naveen B.R.; Moodahadu, Latha S.

2012-01-01

Clinical Data Management (CDM) is a critical phase in clinical research, which leads to generation of high-quality, reliable, and statistically sound data from clinical trials. This helps to produce a drastic reduction in time from drug development to marketing. Team members of CDM are actively involved in all stages of clinical trial right from inception to completion. They should have adequate process knowledge that helps maintain the quality standards of CDM processes. Various procedures in CDM including Case Report Form (CRF) designing, CRF annotation, database designing, data-entry, data validation, discrepancy management, medical coding, data extraction, and database locking are assessed for quality at regular intervals during a trial. In the present scenario, there is an increased demand to improve the CDM standards to meet the regulatory requirements and stay ahead of the competition by means of faster commercialization of product. With the implementation of regulatory compliant data management tools, CDM team can meet these demands. Additionally, it is becoming mandatory for companies to submit the data electronically. CDM professionals should meet appropriate expectations and set standards for data quality and also have a drive to adapt to the rapidly changing technology. This article highlights the processes involved and provides the reader an overview of the tools and standards adopted as well as the roles and responsibilities in CDM. PMID:22529469

Influence of the sex of the transmitting grandparent in congenital myotonic dystrophy.

PubMed

López de Munain, A; Cobo, A M; Poza, J J; Navarrete, D; Martorell, L; Palau, F; Emparanza, J I; Baiget, M

1995-09-01

To analyse the influence of the sex of the transmitting grandparents on the occurrence of the congenital form of myotonic dystrophy (CDM), we have studied complete three generation pedigrees of 49 CDM cases, analysing: (1) the sex distribution in the grandparents' generation, and (2) the intergenerational amplification of the CTG repeat, measured in its absolute and relative values, between grandparents and the mothers of CDM patients and between the latter and their CDM children. The mean relative intergenerational increase in the 32 grandparent-mother pairs was significantly greater than in the 56 mother-CDM pairs (Mann-Whitney U test, p < 0.001). The mean expansion of the grandfathers (103 CTG repeats) was also significantly different from that seen in the grandmothers' group (154 CTG repeats) (Mann-Whitney U test, p < 0.01). This excess of non-manifesting males between the CDM grandparents' generation with a smaller CTG length than the grandmothers could suggest that the premutation has to be transmitted by a male to reach the degree of instability responsible for subsequent intergenerational CTG expansions without size constraints characteristic of the CDM range.

Exploring the clean development mechanism: Malaysian case study.

PubMed

Pedersen, Anne

2008-02-01

During 2006 the CDM market in Malaysia became established and by December 2007 a total of 20 Malaysian projects had registered with the CDM Executive Board. The Kyoto Protocol defines the Annex 1 countries, as countries that are obliged to reduce their greenhouse gas (GHG) emissions and the clean development mechanism (CDM) allows Annex 1 countries to develop projects, which contribute to emission reduction, in non-Annex 1 (developing) countries. Currently, two projects have been corrected due to request for review and there is one project for which review is requested. Two projects have been rejected by the Executive Board. The broad knowledge of CDM in Malaysia and the number of successful projects are partly due to the well-functioning CDM institutional framework in Malaysia. As an illustration this article focuses on a Malaysian-Danish project and describes the implementation of CDM in Malaysia and refers to this specific project. The project was registered with the CDM Executive Board in May 2007 and is a methane avoidance project in which methane is captured from a landfill and used to generate electricity.

The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

PubMed Central

Zweifler, John

2007-01-01

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended. PMID:17893388

A cosmology-independent calibration of type Ia supernovae data

NASA Astrophysics Data System (ADS)

Hauret, C.; Magain, P.; Biernaux, J.

2018-06-01

Recently, the common methodology used to transform type Ia supernovae (SNe Ia) into genuine standard candles has been suffering criticism. Indeed, it assumes a particular cosmological model (namely the flat ΛCDM) to calibrate the standardisation corrections parameters, i.e. the dependency of the supernova peak absolute magnitude on its colour, post-maximum decline rate and host galaxy mass. As a result, this assumption could make the data compliant to the assumed cosmology and thus nullify all works previously conducted on model comparison. In this work, we verify the viability of these hypotheses by developing a cosmology-independent approach to standardise SNe Ia data from the recent JLA compilation. Our resulting corrections turn out to be very close to the ΛCDM-based corrections. Therefore, even if a ΛCDM-based calibration is questionable from a theoretical point of view, the potential compliance of SNe Ia data does not happen in practice for the JLA compilation. Previous works of model comparison based on these data do not have to be called into question. However, as this cosmology-independent standardisation method has the same degree of complexity than the model-dependent one, it is worth using it in future works, especially if smaller samples are considered, such as the superluminous type Ic supernovae.

Code-division-multiplexed readout of large arrays of TES microcalorimeters

NASA Astrophysics Data System (ADS)

Morgan, K. M.; Alpert, B. K.; Bennett, D. A.; Denison, E. V.; Doriese, W. B.; Fowler, J. W.; Gard, J. D.; Hilton, G. C.; Irwin, K. D.; Joe, Y. I.; O'Neil, G. C.; Reintsema, C. D.; Schmidt, D. R.; Ullom, J. N.; Swetz, D. S.

2016-09-01

Code-division multiplexing (CDM) offers a path to reading out large arrays of transition edge sensor (TES) X-ray microcalorimeters with excellent energy and timing resolution. We demonstrate the readout of X-ray TESs with a 32-channel flux-summed code-division multiplexing circuit based on superconducting quantum interference device (SQUID) amplifiers. The best detector has energy resolution of 2.28 ± 0.12 eV FWHM at 5.9 keV and the array has mean energy resolution of 2.77 ± 0.02 eV over 30 working sensors. The readout channels are sampled sequentially at 160 ns/row, for an effective sampling rate of 5.12 μs/channel. The SQUID amplifiers have a measured flux noise of 0.17 μΦ0/√Hz (non-multiplexed, referred to the first stage SQUID). The multiplexed noise level and signal slew rate are sufficient to allow readout of more than 40 pixels per column, making CDM compatible with requirements outlined for future space missions. Additionally, because the modulated data from the 32 SQUID readout channels provide information on each X-ray event at the row rate, our CDM architecture allows determination of the arrival time of an X-ray event to within 275 ns FWHM with potential benefits in experiments that require detection of near-coincident events.

Towards precision constraints on gravity with the Effective Field Theory of Large-Scale Structure

NASA Astrophysics Data System (ADS)

Bose, Benjamin; Koyama, Kazuya; Lewandowski, Matthew; Vernizzi, Filippo; Winther, Hans A.

2018-04-01

We compare analytical computations with numerical simulations for dark-matter clustering, in general relativity and in the normal branch of DGP gravity (nDGP). Our analytical frameword is the Effective Field Theory of Large-Scale Structure (EFTofLSS), which we use to compute the one-loop dark-matter power spectrum, including the resummation of infrared bulk displacement effects. We compare this to a set of 20 COLA simulations at redshifts z = 0, z = 0.5, and z = 1, and fit the free parameter of the EFTofLSS, called the speed of sound, in both ΛCDM and nDGP at each redshift. At one-loop at z = 0, the reach of the EFTofLSS is kreach ≈ 0.14 Mpc‑1 for both ΛCDM and nDGP. Along the way, we compare two different infrared resummation schemes and two different treatments of the time dependence of the perturbative expansion, concluding that they agree to approximately 1% over the scales of interest. Finally, we use the ratio of the COLA power spectra to make a precision measurement of the difference between the speeds of sound in ΛCDM and nDGP, and verify that this is proportional to the modification of the linear coupling constant of the Poisson equation.

Properties of Local Group galaxies in hydrodynamical simulations of sterile neutrino dark matter cosmologies

NASA Astrophysics Data System (ADS)

Lovell, Mark R.; Bose, Sownak; Boyarsky, Alexey; Crain, Robert A.; Frenk, Carlos S.; Hellwing, Wojciech A.; Ludlow, Aaron D.; Navarro, Julio F.; Ruchayskiy, Oleg; Sawala, Till; Schaller, Matthieu; Schaye, Joop; Theuns, Tom

2017-07-01

We study galaxy formation in sterile neutrino dark matter models that differ significantly from both cold and from 'warm thermal relic' models. We use the eagle code to carry out hydrodynamic simulations of the evolution of pairs of galaxies chosen to resemble the Local Group, as part of the APOSTLE simulations project. We compare cold dark matter (CDM) with two sterile neutrino models with 7 keV mass: one, the warmest among all models of this mass (LA120) and the other, a relatively cold case (LA10). We show that the lower concentration of sterile neutrino subhaloes compared to their CDM counterparts makes the inferred inner dark matter content of galaxies like Fornax (or Magellanic Clouds) less of an outlier in the sterile neutrino cosmologies. In terms of the galaxy number counts, the LA10 simulations are indistinguishable from CDM when one takes into account halo-to-halo (or 'simulation-to-simulation') scatter. In order for the LA120 model to match the number of Local Group dwarf galaxies, a higher fraction of low-mass haloes is required to form galaxies than is predicted by the eagle simulations. As the census of the Local Group galaxies nears completion, this population may provide a strong discriminant between cold and warm dark matter models.

The COBE normalization for standard cold dark matter

NASA Technical Reports Server (NTRS)

Bunn, Emory F.; Scott, Douglas; White, Martin

1995-01-01

The Cosmic Background Explorer Satellite (COBE) detection of microwave anisotropies provides the best way of fixing the amplitude of cosmological fluctuations on the largest scales. This normalization is usually given for an n = 1 spectrum, including only the anisotropy caused by the Sachs-Wolfe effect. This is certainly not a good approximation for a model containing any reasonable amount of baryonic matter. In fact, even tilted Sachs-Wolfe spectra are not a good fit to models like cold dark matter (CDM). Here, we normalize standard CDM (sCDM) to the two-year COBE data and quote the best amplitude in terms of the conventionally used measures of power. We also give normalizations for some specific variants of this standard model, and we indicate how the normalization depends on the assumed values on n, Omega(sub B) and H(sub 0). For sCDM we find the mean value of Q = 19.9 +/- 1.5 micro-K, corresponding to sigma(sub 8) = 1.34 +/- 0.10, with the normalization at large scales being B = (8.16 +/- 1.04) x 10(exp 5)(Mpc/h)(exp 4), and other numbers given in the table. The measured rms temperature fluctuation smoothed on 10 deg is a little low relative to this normalization. This is mainly due to the low quadrupole in the data: when the quadrupole is removed, the measured value of sigma(10 deg) is quite consistent with the best-fitting the mean value of Q. The use of the mean value of Q should be preferred over sigma(10 deg), when its value can be determined for a particular theory, since it makes full use of the data.

Investigating the Cosmic Web with Topological Data Analysis

NASA Astrophysics Data System (ADS)

Cisewski-Kehe, Jessi; Wu, Mike; Fasy, Brittany; Hellwing, Wojciech; Lovell, Mark; Rinaldo, Alessandro; Wasserman, Larry

2018-01-01

Data exhibiting complicated spatial structures are common in many areas of science (e.g. cosmology, biology), but can be difficult to analyze. Persistent homology is a popular approach within the area of Topological Data Analysis that offers a new way to represent, visualize, and interpret complex data by extracting topological features, which can be used to infer properties of the underlying structures. In particular, TDA may be useful for analyzing the large-scale structure (LSS) of the Universe, which is an intricate and spatially complex web of matter. In order to understand the physics of the Universe, theoretical and computational cosmologists develop large-scale simulations that allow for visualizing and analyzing the LSS under varying physical assumptions. Each point in the 3D data set represents a galaxy or a cluster of galaxies, and topological summaries ("persistent diagrams") can be obtained summarizing the different ordered holes in the data (e.g. connected components, loops, voids).The topological summaries are interesting and informative descriptors of the Universe on their own, but hypothesis tests using the topological summaries would provide a way to make more rigorous comparisons of LSS under different theoretical models. For example, the received cosmological model has cold dark matter (CDM); however, while the case is strong for CDM, there are some observational inconsistencies with this theory. Another possibility is warm dark matter (WDM). It is of interest to see if a CDM Universe and WDM Universe produce LSS that is topologically distinct.We present several possible test statistics for two-sample hypothesis tests using the topological summaries, carryout a simulation study to investigate the suitableness of the proposed test statistics using simulated data from a variation of the Voronoi foam model, and finally we apply the proposed inference framework to WDM vs. CDM cosmological simulation data.

Developing a Performance Assessment Framework and Indicators for Communicable Disease Management in Natural Disasters.

PubMed

Babaie, Javad; Ardalan, Ali; Vatandoost, Hasan; Goya, Mohammad Mehdi; Akbarisari, Ali

2016-02-01

Communicable disease management (CDM) is an important component of disaster public health response operations. However, there is a lack of any performance assessment (PA) framework and related indicators for the PA. This study aimed to develop a PA framework and indicators in CDM in disasters. In this study, a series of methods were used. First, a systematic literature review (SLR) was performed in order to extract the existing PA frameworks and indicators. Then, using a qualitative approach, some interviews with purposively selected experts were conducted and used in developing the PA framework and indicators. Finally, the analytical hierarchy process (AHP) was used for weighting of the developed indicators. The input, process, products, and outcomes (IPPO) framework was found to be an appropriate framework for CDM PA. Seven main functions were revealed to CDM during disasters. Forty PA indicators were developed for the four categories. There is a lack of any existing PA framework in CDM in disasters. Thus, in this study, a PA framework (IPPO framework) was developed for the PA of CDM in disasters through a series of methods. It can be an appropriate framework and its indicators could measure the performance of CDM in disasters.

Creating a Common Data Model for Comparative Effectiveness with the Observational Medical Outcomes Partnership.

PubMed

FitzHenry, F; Resnic, F S; Robbins, S L; Denton, J; Nookala, L; Meeker, D; Ohno-Machado, L; Matheny, M E

2015-01-01

Adoption of a common data model across health systems is a key infrastructure requirement to allow large scale distributed comparative effectiveness analyses. There are a growing number of common data models (CDM), such as Mini-Sentinel, and the Observational Medical Outcomes Partnership (OMOP) CDMs. In this case study, we describe the challenges and opportunities of a study specific use of the OMOP CDM by two health systems and describe three comparative effectiveness use cases developed from the CDM. The project transformed two health system databases (using crosswalks provided) into the OMOP CDM. Cohorts were developed from the transformed CDMs for three comparative effectiveness use case examples. Administrative/billing, demographic, order history, medication, and laboratory were included in the CDM transformation and cohort development rules. Record counts per person month are presented for the eligible cohorts, highlighting differences between the civilian and federal datasets, e.g. the federal data set had more outpatient visits per person month (6.44 vs. 2.05 per person month). The count of medications per person month reflected the fact that one system's medications were extracted from orders while the other system had pharmacy fills and medication administration records. The federal system also had a higher prevalence of the conditions in all three use cases. Both systems required manual coding of some types of data to convert to the CDM. The data transformation to the CDM was time consuming and resources required were substantial, beyond requirements for collecting native source data. The need to manually code subsets of data limited the conversion. However, once the native data was converted to the CDM, both systems were then able to use the same queries to identify cohorts. Thus, the CDM minimized the effort to develop cohorts and analyze the results across the sites.

Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

PubMed

Rasekaba, T M; Williams, E; Hsu-Hage, B

2009-01-01

Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P < 0.001) 12 months after the introduction of the CDM Program; in contrast, changes in the cumulative indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

Bayesian evidences for dark energy models in light of current observational data

NASA Astrophysics Data System (ADS)

Lonappan, Anto. I.; Kumar, Sumit; Ruchika; Dinda, Bikash R.; Sen, Anjan A.

2018-02-01

We do a comprehensive study of the Bayesian evidences for a large number of dark energy models using a combination of latest cosmological data from SNIa, CMB, BAO, strong lensing time delay, growth measurements, measurements of Hubble parameter at different redshifts and measurements of angular diameter distance by Megamaser Cosmology Project. We consider a variety of scalar field models with different potentials as well as different parametrizations for the dark energy equation of state. Among 21 models that we consider in our study, we do not find strong evidences in favor of any evolving dark energy model compared to Λ CDM . For the evolving dark energy models, we show that purely nonphantom models have much better evidences compared to those models that allow both phantom and nonphantom behaviors. Canonical scalar field with exponential and tachyon field with square potential have highest evidences among all the models considered in this work. We also show that a combination of low redshift measurements decisively favors an accelerating Λ CDM model compared to a nonaccelerating power law model.

CMB constraints on β-exponential inflationary models

NASA Astrophysics Data System (ADS)

Santos, M. A.; Benetti, M.; Alcaniz, J. S.; Brito, F. A.; Silva, R.

2018-03-01

We analyze a class of generalized inflationary models proposed in ref. [1], known as β-exponential inflation. We show that this kind of potential can arise in the context of brane cosmology, where the field describing the size of the extra-dimension is interpreted as the inflaton. We discuss the observational viability of this class of model in light of the latest Cosmic Microwave Background (CMB) data from the Planck Collaboration through a Bayesian analysis, and impose tight constraints on the model parameters. We find that the CMB data alone prefer weakly the minimal standard model (ΛCDM) over the β-exponential inflation. However, when current local measurements of the Hubble parameter, H0, are considered, the β-inflation model is moderately preferred over the ΛCDM cosmology, making the study of this class of inflationary models interesting in the context of the current H0 tension.

Dark interactions and cosmological fine-tuning

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

Quartin, Miguel; Calvao, Mauricio O; Joras, Sergio E

2008-05-15

Cosmological models involving an interaction between dark matter and dark energy have been proposed in order to solve the so-called coincidence problem. Different forms of coupling have been studied, but there have been claims that observational data seem to narrow (some of) them down to something annoyingly close to the {Lambda}CDM (CDM: cold dark matter) model, thus greatly reducing their ability to deal with the problem in the first place. The smallness problem of the initial energy density of dark energy has also been a target of cosmological models in recent years. Making use of a moderately general coupling scheme,more » this paper aims to unite these different approaches and shed some light on whether this class of models has any true perspective in suppressing the aforementioned issues that plague our current understanding of the universe, in a quantitative and unambiguous way.« less

Cosmology with the cosmic microwave background temperature-polarization correlation

NASA Astrophysics Data System (ADS)

Couchot, F.; Henrot-Versillé, S.; Perdereau, O.; Plaszczynski, S.; Rouillé d'Orfeuil, B.; Spinelli, M.; Tristram, M.

2017-06-01

We demonstrate that the cosmic microwave background (CMB) temperature-polarization cross-correlation provides accurate and robust constraints on cosmological parameters. We compare them with the results from temperature or polarization and investigate the impact of foregrounds, cosmic variance, and instrumental noise. This analysis makes use of the Planck high-ℓ HiLLiPOP likelihood based on angular power spectra, which takes into account systematics from the instrument and foreground residuals directly modelled using Planck measurements. The temperature-polarization correlation (TE) spectrum is less contaminated by astrophysical emissions than the temperature power spectrum (TT), allowing constraints that are less sensitive to foreground uncertainties to be derived. For ΛCDM parameters, TE gives very competitive results compared to TT. For basic ΛCDM model extensions (such as AL, ∑mν, or Neff), it is still limited by the instrumental noise level in the polarization maps.

'The onus is on me': primary care patient views of Medicare-funded team care in chronic disease management in Australia.

PubMed

Foster, Michele M; Mitchell, Geoffrey K

2015-10-01

This study investigated the views of primary care patients in receipt of Medicare-funded team care for chronic disease management (CDM) in Australia. A qualitative study using a repeat in-depth interview design. Twenty-three patients (17 female), aged 32-89, were recruited over a six-month period from two purposively selected general practices: one urban and one regional practice in Queensland, Australia. Semi-structured interviews were conducted with participants 6 months apart. An interview guide was used to ensure consistency of topics explored. Interviews were recorded and transcribed, and a thematic analysis was conducted. Patients in this study viewed the combined contributions of a GP and other health professionals in team care as thorough and reassuring. In this case of Medicare-funded team care, patients also saw obligations within the structured care routine which cultivated a personal ethics of CDM. This was further influenced by how patients viewed their role in the health-care relationship. Aside from personal obligations, Medicare funding got patients engaged in team care by providing financial incentives. Indeed, this was a defining factor in seeing allied health professionals. However, team care was also preferential due to patients' valuations of costs and benefits. Patients are likely to engage with a structured team care approach to CDM if there is a sense of personal obligation and sufficient financial incentive. The level of engagement in team care is likely to be optimized if patient expectations and preferences are considered in decisions. © 2013 Blackwell Publishing Ltd.

Canine degenerative myelopathy: a model of human amyotrophic lateral sclerosis.

PubMed

Nardone, Raffaele; Höller, Yvonne; Taylor, Alexandra C; Lochner, Piergiorgio; Tezzon, Frediano; Golaszewski, Stefan; Brigo, Francesco; Trinka, Eugen

2016-02-01

Canine degenerative myelopathy (CDM) represents a unique naturally occurring animal model for human amyotrophic lateral sclerosis (ALS) because of similar clinical signs, neuropathologic findings, and involvement of the superoxide dismutase 1 (SOD1) mutation. A definitive diagnosis can only be made postmortem through microscopic detection of axonal degeneration, demyelination and astroglial proliferation, which is more severe in the dorsal columns of the thoracic spinal cord and in the dorsal portion of the lateral funiculus. Interestingly, the muscle acetylcholine receptor complexes are intact in CDM prior to functional impairment, thus suggesting that muscle atrophy in CDM does not result from physical denervation. Moreover, since sensory involvement seems to play an important role in CDM progression, a more careful investigation of the sensory pathology in ALS is also warranted. The importance of SOD1 expression remains unclear, while oxidative stress and denatured ubiquinated proteins appear to play a crucial role in the pathogenesis of CDM. In this updated narrative review we performed a systematic search of the published studies on CDM that may shed light on the pathophysiological mechanisms of human ALS. A better understanding of the factors that determine the disease progression in CDM may be beneficial for the development of effective treatments for ALS. Copyright © 2015 Elsevier GmbH. All rights reserved.

Computer Assisted Chronic Disease Management: Does It Work? A Pilot Study Using Mixed Methods

PubMed Central

Jones, Kay M.; Biezen, Ruby; Piterman, Leon

2013-01-01

Background. Key factors for the effective chronic disease management (CDM) include the availability of practical and effective computer tools and continuing professional development/education. This study tested the effectiveness of a computer assisted chronic disease management tool, a broadband-based service known as cdmNet in increasing the development of care plans for patients with chronic disease in general practice. Methodology. Mixed methods are the breakthrough series methodology (workshops and plan-do-study-act cycles) and semistructured interviews. Results. Throughout the intervention period a pattern emerged suggesting GPs use of cdmNet initially increased, then plateaued practice nurses' and practice managers' roles expanded as they became more involved in using cdmNet. Seven main messages emerged from the GP interviews. Discussion. The overall use of cdmNet by participating GPs varied from “no change” to “significant change and developing many the GPMPs (general practice management plans) using cdmNet.” The variation may be due to several factors, not the least, allowing GPs adequate time to familiarise themselves with the software and recognising the benefit of the team approach. Conclusion. The breakthrough series methodology facilitated upskilling GPs' management of patients diagnosed with a chronic disease and learning how to use the broadband-based service cdmNet. PMID:24959576

MOSAIC--A Modular Approach to Data Management in Epidemiological Studies.

PubMed

Bialke, M; Bahls, T; Havemann, C; Piegsa, J; Weitmann, K; Wegner, T; Hoffmann, W

2015-01-01

In the context of an increasing number of multi-centric studies providing data from different sites and sources the necessity for central data management (CDM) becomes undeniable. This is exacerbated by a multiplicity of featured data types, formats and interfaces. In relation to methodological medical research the definition of central data management needs to be broadened beyond the simple storage and archiving of research data. This paper highlights typical requirements of CDM for cohort studies and registries and illustrates how orientation for CDM can be provided by addressing selected data management challenges. Therefore in the first part of this paper a short review summarises technical, organisational and legal challenges for CDM in cohort studies and registries. A deduced set of typical requirements of CDM in epidemiological research follows. In the second part the MOSAIC project is introduced (a modular systematic approach to implement CDM). The modular nature of MOSAIC contributes to manage both technical and organisational challenges efficiently by providing practical tools. A short presentation of a first set of tools, aiming for selected CDM requirements in cohort studies and registries, comprises a template for comprehensive documentation of data protection measures, an interactive reference portal for gaining insights and sharing experiences, supplemented by modular software tools for generation and management of generic pseudonyms, for participant management and for sophisticated consent management. Altogether, work within MOSAIC addresses existing challenges in epidemiological research in the context of CDM and facilitates the standardized collection of data with pre-programmed modules and provided document templates. The necessary effort for in-house programming is reduced, which accelerates the start of data collection.

Searching for sterile neutrinos in dynamical dark energy cosmologies

NASA Astrophysics Data System (ADS)

Feng, Lu; Zhang, Jing-Fei; Zhang, Xin

2018-05-01

We investigate how the dark energy properties change the cosmological limits on sterile neutrino parameters by using recent cosmological observations. We consider the simplest dynamical dark energy models, the wCDM model and the holographic dark energy (HDE) model, to make an analysis. The cosmological observations used in this work include the Planck 2015 CMB temperature and polarization data, the baryon acoustic oscillation data, the type Ia supernova data, the Hubble constant direct measurement data, and the Planck CMB lensing data. We find that, m v,terile ff < 0.2675 eV and Ne f f < 3.5718 for ACDM cosmology, m v,terile ff < 0.5313 eV and Ne f f < 3.5008 for wCDM cosmology, and raffterile < 0.1989 eV and Ne f f < 3.6701 for HDE cosmology, from the constraints of the combination of these data. Thus, without the addition of measurements of growth of structure, only upper limits on both m v,terile ff and Ne f f can be derived, indicating that no evidence of the existence of a sterile neutrino species with eV-scale mass is found in this analysis. Moreover, compared to the ACDM model, in the wCDM model the limit on m v,terile ff becomes much looser, but in the HDE model the limit becomes much tighter. Therefore, the dark energy properties could significantly influence the constraint limits of sterile neutrino parameters.

EFFECT OF QUALITY CHRONIC DISEASE MANAGEMENT FOR ALCOHOL AND DRUG DEPENDENCE ON ADDICTION OUTCOMES

PubMed Central

Kim, Theresa W.; Saitz, Richard; Cheng, Debbie M.; Winter, Michael R; Witas, Julie; Samet, Jeffrey H.

2012-01-01

We examinedthe effect ofthe quality of primary care-basedchronic disease management (CDM)for alcohol and/or other drug (AOD) dependenceonaddiction outcomes.We assessed qualityusing 1)avisit frequencybased measure and 2) a self-reported assessment measuring alignment with the chronic care model. The visit frequency based measure had no significant association with addiction outcomes. Theself-reported measure of care - when care was at a CDM clinic - was associated with lower drug addiction severity.The self-reported assessment of care from any healthcare source (CDM clinic or elsewhere)was associated with lower alcoholaddiction severity and abstinence.These findings suggest that high quality CDM for AOD dependence may improve addiction outcomes.Quality measuresbased upon alignment with the chronic care model may better capture features of effective CDM care than a visitfrequency measure. PMID:22840687

The H II galaxy Hubble diagram strongly favours Rh = ct over ΛCDM

NASA Astrophysics Data System (ADS)

Wei, Jun-Jie; Wu, Xue-Feng; Melia, Fulvio

2016-12-01

We continue to build support for the proposal to use H II galaxies (HIIGx) and giant extragalactic H II regions (GEHR) as standard candles to construct the Hubble diagram at redshifts beyond the current reach of Type Ia supernovae. Using a sample of 25 high-redshift HIIGx, 107 local HIIGx, and 24 GEHR, we confirm that the correlation between the emission-line luminosity and ionized-gas velocity dispersion is a viable luminosity indicator, and use it to test and compare the standard model ΛCDM and the Rh = ct universe by optimizing the parameters in each cosmology using a maximization of the likelihood function. For the flat ΛCDM model, the best fit is obtained with Ω _m= 0.40_{-0.09}^{+0.09}. However, statistical tools, such as the Akaike (AIC), Kullback (KIC) and Bayes (BIC) Information Criteria favour Rh = ct over the standard model with a likelihood of ≈94.8-98.8 per cent versus only ≈1.2-5.2 per cent. For wCDM (the version of ΛCDM with a dark-energy equation of state wde ≡ pde/ρde rather than wde = wΛ = -1), a statistically acceptable fit is realized with Ω _m=0.22_{-0.14}^{+0.16} and w_de= -0.51_{-0.25}^{+0.15} which, however, are not fully consistent with their concordance values. In this case, wCDM has two more free parameters than Rh = ct, and is penalized more heavily by these criteria. We find that Rh = ct is strongly favoured over wCDM with a likelihood of ≈92.9-99.6 per cent versus only 0.4-7.1 per cent. The current HIIGx sample is already large enough for the BIC to rule out ΛCDM/wCDM in favour of Rh = ct at a confidence level approaching 3σ.

Adjunctive use of a facial moisturizer SPF 30 containing ceramide precursor improves tolerability of topical tretinoin 0.05%: a randomized, investigator-blinded, split-face study.

PubMed

Schorr, Ethlynn S; Sidou, Farzi; Kerrouche, Nabil

2012-09-01

To assess the benefit of adjunctive use of a SPF 30 moisturizing lotion in reducing local side effects associated with atopical tretinoin cream. This was a randomized, investigator/evaluator-blinded, split-face comparison in subjects with healthy skin. Subjects applied tretinoin cream 0.05% once daily to the whole face and Cetaphil 174; Dermacontrol Moisturizer (CDM) once daily to one side of the face based on randomization. Tolerability, perference and skin hydration were evaluated at each week, and a cosmetic acceptability questionnaire regarding CDM was completed at the end of the study. The majority (about 83% to 86%) of subjects experienced skin irritations on both sides of their face, though predominantly mild for the CDM + tretinoin treated side. Tolerability preferences favored the CDM+tretinoin sides. Adjunctive use of CDM with a topical tretinoin cream improves tolerance of the treatment.

Effect of quality chronic disease management for alcohol and drug dependence on addiction outcomes.

PubMed

Kim, Theresa W; Saitz, Richard; Cheng, Debbie M; Winter, Michael R; Witas, Julie; Samet, Jeffrey H

2012-12-01

We examined the effect of the quality of primary care-based chronic disease management (CDM) for alcohol and/or other drug (AOD) dependence on addiction outcomes. We assessed quality using (1) a visit frequency based measure and (2) a self-reported assessment measuring alignment with the chronic care model. The visit frequency based measure had no significant association with addiction outcomes. The self-reported measure of care-when care was at a CDM clinic-was associated with lower drug addiction severity. The self-reported assessment of care from any healthcare source (CDM clinic or elsewhere) was associated with lower alcohol addiction severity and abstinence. These findings suggest that high quality CDM for AOD dependence may improve addiction outcomes. Quality measures based upon alignment with the chronic care model may better capture features of effective CDM care than a visit frequency measure. Copyright © 2012 Elsevier Inc. All rights reserved.

Where the world stands still: turnaround as a strong test of ΛCDM cosmology

NASA Astrophysics Data System (ADS)

Pavlidou, V.; Tomaras, T. N.

2014-09-01

Our intuitive understanding of cosmic structure formation works best in scales small enough so that isolated, bound, relaxed gravitating systems are no longer adjusting their radius; and large enough so that space and matter follow the average expansion of the Universe. Yet one of the most robust predictions of ΛCDM cosmology concerns the scale that separates these limits: the turnaround radius, which is the non-expanding shell furthest away from the center of a bound structure. We show that the maximum possible value of the turnaround radius within the framework of the ΛCDM model is, for a given mass M, equal to (3GM/Λ c2)1/3, with G Newton's constant and c the speed of light, independently of cosmic epoch, exact nature of dark matter, or baryonic effects. We discuss the possible use of this prediction as an observational test for ΛCDM cosmology. Current data appear to favor ΛCDM over alternatives with local inhomogeneities and no Λ. However there exist several local-universe structures that have, within errors, reached their limiting size. With improved determinations of their turnaround radii and the enclosed mass, these objects may challenge the limit and ΛCDM cosmology.

Engineered cartilage using primary chondrocytes cultured in a porous cartilage-derived matrix

PubMed Central

Cheng, Nai-Chen; Estes, Bradley T; Young, Tai-Horng; Guilak, Farshid

2011-01-01

Aim To investigate the cell growth, matrix accumulation and mechanical properties of neocartilage formed by human or porcine articular chondrocytes on a porous, porcine cartilage-derived matrix (CDM) for use in cartilage tissue engineering. Materials & methods We examined the physical properties, cell infiltration and matrix accumulation in different formulations of CDM and selected a CDM made of homogenized cartilage slurry as an appropriate scaffold for long-term culture of human and porcine articular chondrocytes. Results The CDM scaffold supported growth and proliferation of both human and porcine chondrocytes. Histology and immunohistochemistry showed abundant cartilage-specific macromolecule deposition at day 28. Human chondrocytes migrated throughout the CDM, showing a relatively homogeneous distribution of new tissue accumulation, whereas porcine chondrocytes tended to form a proteoglycan-rich layer primarily on the surfaces of the scaffold. Human chondrocyte-seeded scaffolds had a significantly lower aggregate modulus and hydraulic permeability at day 28. Conclusions These data show that a scaffold derived from native porcine articular cartilage can support neocartilage formation in the absence of exogenous growth factors. The overall characteristics and properties of the constructs depend on factors such as the concentration of CDM used, the porosity of the scaffold, and the species of chondrocytes. PMID:21175289

Consistency of the Planck CMB data and ΛCDM cosmology

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

Shafieloo, Arman; Hazra, Dhiraj Kumar, E-mail: shafieloo@kasi.re.kr, E-mail: dhiraj.kumar.hazra@apc.univ-paris7.fr

We test the consistency between Planck temperature and polarization power spectra and the concordance model of Λ Cold Dark Matter cosmology (ΛCDM) within the framework of Crossing statistics. We find that Planck TT best fit ΛCDM power spectrum is completely consistent with EE power spectrum data while EE best fit ΛCDM power spectrum is not consistent with TT data. However, this does not point to any systematic or model-data discrepancy since in the Planck EE data, uncertainties are much larger compared to the TT data. We also investigate the possibility of any deviation from ΛCDM model analyzing the Planck 2015more » data. Results from TT, TE and EE data analysis indicate that no deviation is required beyond the flexibility of the concordance ΛCDM model. Our analysis thus rules out any strong evidence for beyond the concordance model in the Planck spectra data. We also report a mild amplitude difference comparing temperature and polarization data, where temperature data seems to have slightly lower amplitude than expected (consistently at all multiples), as we assume both temperature and polarization data are realizations of the same underlying cosmology.« less

A tiered quality assurance review process for clinical data management standard operating procedures in an academic health center.

PubMed

Ittenbach, Richard F; Baker, Cynthia L; Corsmo, Jeremy J

2014-05-01

Standard operating procedures (SOPs) were once considered the province of the pharmaceutical industry but are now viewed as a key component of quality assurance programs. To address variability and increase the rigor of clinical data management (CDM) operations, the Cincinnati Children's Hospital Medical Center (CCHMC) decided to create CDM SOPs. In response to this challenge, and as part of a broader institutional initiative, the CCHMC leadership established an executive steering committee to oversee the development and implementation of CDM SOPs. This resulted in the creation of a quality assurance review process with three review panels: an SOP development team (16 clinical data managers and technical staff members), a faculty review panel (8 senior faculty and administrators), and an expert advisory panel (3 national CDM experts). This innovative, tiered review process helped ensure that the new SOPs would be created and implemented in accord with good CDM practices and standards. Twelve fully vetted, institutionally endorsed SOPs and one CDM template resulted from the intensive, iterative 10-month process (December 2011 to early October 2012). Phased implementation, which incoporated the CDM SOPs into the existing audit process for certain types of clinical research studies, was on schedule at the time of this writing. Once CCHMC researchers have had the opportunity to use the SOPs over time and across a broad range of research settings and conditions, the SOPs will be revisited and revalidated.

The nursing contribution to chronic disease management: a discussion paper.

PubMed

Forbes, Angus; While, Alison

2009-01-01

This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit.

Multi-project baselines for potential clean development mechanism projects in the electricity sector in South Africa

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

Winkler, H.; Spalding-Fecher, R.; Sathaye, J.

2002-06-26

The United Nations Framework Convention on Climate Change (UNFCCC) aims to reduce emissions of greenhouse gases (GHGs) in order to ''prevent dangerous anthropogenic interference with the climate system'' and promote sustainable development. The Kyoto Protocol, which was adopted in 1997 and appears likely to be ratified by 2002 despite the US withdrawing, aims to provide means to achieve this objective. The Clean Development Mechanism (CDM) is one of three ''flexibility mechanisms'' in the Protocol, the other two being Joint Implementation (JI) and Emissions Trading (ET). These mechanisms allow flexibility for Annex I Parties (industrialized countries) to achieve reductions by extra-territorialmore » as well as domestic activities. The underlying concept is that trade and transfer of credits will allow emissions reductions at least cost. Since the atmosphere is a global, well-mixed system, it does not matter where greenhouse gas emissions are reduced. The CDM allows Annex I Parties to meet part of their emissions reductions targets by investing in developing countries. CDM projects must also meet the sustainable development objectives of the developing country. Further criteria are that Parties must participate voluntarily, that emissions reductions are ''real, measurable and long-term'', and that they are additional to those that would have occurred anyway. The last requirement makes it essential to define an accurate baseline. The remaining parts of section 1 outline the theory of baselines, emphasizing the balance needed between environmental integrity and reducing transaction costs. Section 2 develops an approach to multi-project baseline for the South African electricity sector, comparing primarily to near future capacity, but also considering recent plants. Five potential CDM projects are briefly characterized in section 3, and compared to the baseline in section 4. Section 5 concludes with a discussion of options and choices for South Africa regarding electricity sector baselines.« less

Effect of Background Luminance Level on the Assessment of Color Visual Acuity Using Colored Landolt Rings in Young Healthy Subjects.

PubMed

Tanaka, Yoshiki; Yokoyama, Sho; Horai, Rie; Kojima, Takashi; Hiroyuki, Sato; Kato, Yukihito; Takagi, Mari; Nakamura, Hideki; Tanaka, Kiyoshi; Ichikawa, Kazuo; Tanabe, Shoko

2018-03-01

To evaluate the color visual acuity (CVA) of young healthy subjects using colored Landolt rings and the effect of background luminance level on the CVA. We measured the CVA of 20 young healthy subjects (age: 23.8 ± 3.8 years) with different colors using a computer and a liquid crystal display, with 15 Landolt ring colors (30 cd/m 2 ) with a background luminance of 30 cd/m 2 , and then 100 cd/m 2 . We then used different background luminance levels (15-50 cd/m 2 ) using four Landolt ring colors (red, green-yellow, green, and blue-green) to evaluate the effect of the background luminance level on CVA. The CVA significantly differed among the colors with a background luminance of 30 cd/m 2 (p < 0.0001). Green-yellow and blue-purple had poor CVA (high LogMAR value; 0.808 ± 0.107 and 0.633 ± 0.150, respectively) with a background luminance of 30 cd/m 2 (same luminance as the Landolt rings). There were no significant differences in the CVAs among the colors with a background luminance of 100 cd/m 2 (p = 0.5999). There were no significant difference in the CVA between background luminance 30 cd/m 2 and other luminance level ranging from 28 to 32 cd/m 2 for colors of red, green-yellow, green, and blue-green. The results reveal that the background luminance of Landolt rings affects the CVA. Distinctive CVAs for each color are measured by equalizing the luminance between the Landolt ring and the background. We consider that the poor CVAs of these colors reflect the visual function of S-cone, because GY and BP are included in the confusion locus of tritan axis on the chromaticity diagram. We believe that CVA assessment may be useful for individuals who have known or suspected ocular dysfunction or color vision deficiencies.

Cosmological implications of different baryon acoustic oscillation data

NASA Astrophysics Data System (ADS)

Wang, Shuang; Hu, YaZhou; Li, Miao

2017-04-01

In this work, we explore the cosmological implications of different baryon acoustic oscillation (BAO) data, including the BAO data extracted by using the spherically averaged one-dimensional galaxy clustering (GC) statistics (hereafter BAO1) and the BAO data obtained by using the anisotropic two-dimensional GC statistics (hereafter BAO2). To make a comparison, we also take into account the case without BAO data (hereafter NO BAO). Firstly, making use of these BAO data, as well as the SNLS3 type Ia supernovae sample and the Planck distance priors data, we give the cosmological constraints of the ΛCDM, the wCDM, and the Chevallier-Polarski-Linder (CPL) model. Then, we discuss the impacts of different BAO data on cosmological consquences, including its effects on parameter space, equation of state (EoS), figure of merit (FoM), deceleration-acceleration transition redshift, Hubble parameter H( z), deceleration parameter q( z), statefinder hierarchy S 3 (1)( z), S 4 (1)( z) and cosmic age t( z). We find that: (1) NO BAO data always give a smallest fractional matter density Ω m0, a largest fractional curvature density Ωk0 and a largest Hubble constant h; in contrast, BAO1 data always give a largest Ω m0, a smallest Ω k0 and a smallest h. (2) For the wCDM and the CPL model, NO BAO data always give a largest EoS w; in contrast, BAO2 data always give a smallest w. (3) Compared with the case of BAO1, BAO2 data always give a slightly larger FoM, and thus can give a cosmological constraint with a slightly better accuracy. (4) The impacts of different BAO data on the cosmic evolution and the comic age are very small, and cannot be distinguished by using various dark energy diagnoses and the cosmic age data.

Constraints on modified gravity from Planck 2015: when the health of your theory makes the difference

NASA Astrophysics Data System (ADS)

Salvatelli, Valentina; Piazza, Federico; Marinoni, Christian

2016-09-01

We use the effective field theory of dark energy (EFT of DE) formalism to constrain dark energy models belonging to the Horndeski class with the recent Planck 2015 CMB data. The space of theories is spanned by a certain number of parameters determining the linear cosmological perturbations, while the expansion history is set to that of a standard ΛCDM model. We always demand that the theories be free of fatal instabilities. Additionally, we consider two optional conditions, namely that scalar and tensor perturbations propagate with subliminal speed. Such criteria severely restrict the allowed parameter space and are thus very effective in shaping the posteriors. As a result, we confirm that no theory performs better than ΛCDM when CMB data alone are analysed. Indeed, the healthy dark energy models considered here are not able to reproduce those phenomenological behaviours of the effective Newton constant and gravitational slip parameters that, according to previous studies, best fit the data.

Constraints on modified gravity from Planck 2015: when the health of your theory makes the difference

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

Salvatelli, Valentina; Piazza, Federico; Marinoni, Christian, E-mail: Valentina.Salvatelli@cpt.univ-mrs.fr, E-mail: Federico.Piazza@cpt.univ-mrs.fr, E-mail: Christian.Marinoni@cpt.univ-mrs.fr

We use the effective field theory of dark energy (EFT of DE) formalism to constrain dark energy models belonging to the Horndeski class with the recent Planck 2015 CMB data. The space of theories is spanned by a certain number of parameters determining the linear cosmological perturbations, while the expansion history is set to that of a standard ΛCDM model. We always demand that the theories be free of fatal instabilities. Additionally, we consider two optional conditions, namely that scalar and tensor perturbations propagate with subliminal speed. Such criteria severely restrict the allowed parameter space and are thus very effectivemore » in shaping the posteriors. As a result, we confirm that no theory performs better than ΛCDM when CMB data alone are analysed. Indeed, the healthy dark energy models considered here are not able to reproduce those phenomenological behaviours of the effective Newton constant and gravitational slip parameters that, according to previous studies, best fit the data.« less

Conversion of National Health Insurance Service-National Sample Cohort (NHIS-NSC) Database into Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM).

PubMed

You, Seng Chan; Lee, Seongwon; Cho, Soo-Yeon; Park, Hojun; Jung, Sungjae; Cho, Jaehyeong; Yoon, Dukyong; Park, Rae Woong

2017-01-01

It is increasingly necessary to generate medical evidence applicable to Asian people compared to those in Western countries. Observational Health Data Sciences a Informatics (OHDSI) is an international collaborative which aims to facilitate generating high-quality evidence via creating and applying open-source data analytic solutions to a large network of health databases across countries. We aimed to incorporate Korean nationwide cohort data into the OHDSI network by converting the national sample cohort into Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM). The data of 1.13 million subjects was converted to OMOP-CDM, resulting in average 99.1% conversion rate. The ACHILLES, open-source OMOP-CDM-based data profiling tool, was conducted on the converted database to visualize data-driven characterization and access the quality of data. The OMOP-CDM version of National Health Insurance Service-National Sample Cohort (NHIS-NSC) can be a valuable tool for multiple aspects of medical research by incorporation into the OHDSI research network.

Control the wettability of poly(n-isopropylacrylamide-co-1-adamantan-1-ylmethyl acrylate) modified surfaces: the more Ada, the bigger impact?

PubMed

Shi, Xiu-Juan; Chen, Gao-Jian; Wang, Yan-Wei; Yuan, Lin; Zhang, Qiang; Haddleton, David M; Chen, Hong

2013-11-19

Surface-initiated SET-LRP was used to synthesize polymer brush containing N-isopropylacrylamide and adamantyl acrylate using Cu(I)Cl/Me6-TREN as precursor catalyst and isopropanol/H2O as solvent. Different reaction conditions were explored to investigate the influence of different parameters (reaction time, catalyst concentration, monomer concentration) on the polymerization. Copolymers with variable 1-adamantan-1-ylmethyl acrylate (Ada) content and comparable thickness were synthesized onto silicon surfaces. Furthermore, the hydrophilic and bioactive molecule β-cyclodextrin-(mannose)7 (CDm) was synthesized and complexed with adamantane via host-guest interaction. The effect of adamantane alone and the effect of CDm together with adamantane on the wettability and thermoresponsive property of surface were investigated in detail. Experimental and molecular structure analysis showed that Ada at certain content together with CDm has the greatest impact on surface wettability. When Ada content was high (20%), copolymer-CDm surfaces showed almost no CDm complexed with Ada as the result of steric hindrance.

The least-action method, cold dark matter, and omega

NASA Technical Reports Server (NTRS)

Dunn, A. M.; Laflamme, R.

1995-01-01

Peebles has suggested an interesting technique, called the least-action method, to trace positions of galaxies back in time. This method applied on the Local Group galaxies seems to indicate that we live in an omega approximately = 0.1 universe. We have studied a cold dark matter (CDM) N-body simulation with omega = 0.2 and H = 50 km/s/Mpc and compared trajectories traced back by the least-action method with the ones given by the center of mass of the CDM halos. We show that the agreement between these sets of trajectories is at best qualitative. We also show that the line-of-sight peculiar velocities of halos are underestimated. This discrepancy is due to orphans, i.e., CDM particles which do not end up in halos. We vary the value of omega in the least-action method until the line-of-sight velocities agree with the CDM ones. The best value for this omega underestimates one of the CDM simulations by a factor of 4-5.

Where the world stands still: turnaround as a strong test of ΛCDM cosmology

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

Pavlidou, V.; Tomaras, T.N., E-mail: pavlidou@physics.uoc.gr, E-mail: tomaras@physics.uoc.gr

Our intuitive understanding of cosmic structure formation works best in scales small enough so that isolated, bound, relaxed gravitating systems are no longer adjusting their radius; and large enough so that space and matter follow the average expansion of the Universe. Yet one of the most robust predictions of ΛCDM cosmology concerns the scale that separates these limits: the turnaround radius, which is the non-expanding shell furthest away from the center of a bound structure. We show that the maximum possible value of the turnaround radius within the framework of the ΛCDM model is, for a given mass M, equalmore » to (3GM/Λ c{sup 2}){sup 1/3}, with G Newton's constant and c the speed of light, independently of cosmic epoch, exact nature of dark matter, or baryonic effects. We discuss the possible use of this prediction as an observational test for ΛCDM cosmology. Current data appear to favor ΛCDM over alternatives with local inhomogeneities and no Λ. However there exist several local-universe structures that have, within errors, reached their limiting size. With improved determinations of their turnaround radii and the enclosed mass, these objects may challenge the limit and ΛCDM cosmology.« less

Growth Media Affect Assessment of Antimicrobial Activity of Plant-Derived Polyphenols.

PubMed

Xu, Xin; Ou, Zhen M; Wu, Christine D

2018-01-01

This study aimed to investigate the effects of different microbial growth media on the laboratory assessment of antimicrobial activity of natural polyphenolic compounds. The inhibition of the tea polyphenol EGCG on growth of selected oral microorganisms was evaluated in complex media and a protein-free chemically defined medium (CDM). Other antimicrobial agents (polyphenolic grape seed extract, plant alkaloid berberine, methyl salicylate, and chlorhexidine gluconate) were also tested in the study. The presence of proteins and their effects on the antimicrobial activity of EGCG were investigated by the addition of BSA to the CDM. The MICs of EGCG against test oral microorganisms were 4 to 64 times higher in complex media than in CDM. The polyphenolic grape seed extract exhibited similar discrepancies. However, the MICs of the nonpolyphenolic compounds (berberine, methyl salicylate, and chlorhexidine) were not significantly different between the two growth media. The MIC of EGCG against S. mutans UA159 in CDM with added BSA was 16 times higher than that in CDM alone. Therefore, nonproteinaceous CDM should be used to avoid interference of proteins with the active ingredients when testing the antimicrobial activity of plant-derived polyphenolic compounds against microorganisms. This will also minimize the discrepancies noted in results obtained by different investigators.

Development and application of a methodology for a clean development mechanism to avoid methane emissions in closed landfills.

PubMed

Janke, Leandro; Lima, André O S; Millet, Maurice; Radetski, Claudemir M

2013-01-01

In Brazil, Solid Waste Disposal Sites have operated without consideration of environmental criteria, these areas being characterized by methane (CH4) emissions during the anaerobic degradation of organic matter. The United Nations organization has made efforts to control this situation, through the United Nations Framework Convention on Climate Change (UNFCCC) and the Kyoto Protocol, where projects that seek to reduce the emissions of greenhouse gases (GHG) can be financially rewarded through Certified Emission Reductions (CERs) if they respect the requirements established by the Clean Development Mechanism (CDM), such as the use of methodologies approved by the CDM Executive Board (CDM-EB). Thus, a methodology was developed according to the CDM standards related to the aeration, excavation and composting of closed Municipal Solid Waste (MSW) landfills, which was submitted to CDM-EB for assessment and, after its approval, applied to a real case study in Maringá City (Brazil) with a view to avoiding negative environmental impacts due the production of methane and leachates even after its closure. This paper describes the establishment of this CDM-EB-approved methodology to determine baseline emissions, project emissions and the resultant emission reductions with the application of appropriate aeration, excavation and composting practices at closed MSW landfills. A further result obtained through the application of the methodology in the landfill case study was that it would be possible to achieve an ex-ante emission reduction of 74,013 tCO2 equivalent if the proposed CDM project activity were implemented.

Cosmological test with the QSO Hubble diagram

NASA Astrophysics Data System (ADS)

López-Corredoira, M.; Melia, F.; Lusso, E.; Risaliti, G.

2016-03-01

A Hubble diagram (HD) has recently been constructed in the redshift range 0 ≲ z ≲ 6.5 using a nonlinear relation between the ultraviolet (UV) and X-ray luminosities of quasi stellar objects (QSOs). The Type Ia Supernovae (SN) HD has already provided a high-precision test of cosmological models, but the fact that the QSO distribution extends well beyond the supernova range (z ≲ 1.8), in principle provides us with an important complementary diagnostic whose significantly greater leverage in z can impose tighter constraints on the distance versus redshift relationship. In this paper, we therefore perform an independent test of nine different cosmological models, among which six are expanding, while three are static. Many of these are disfavored by other kinds of observations (including the aforementioned Type Ia SNe). We wish to examine whether the QSO HD confirms or rejects these earlier conclusions. We find that four of these models (Einstein-de Sitter, the Milne universe, the static universe with simple tired light and the static universe with plasma tired light) are excluded at the > 99% C.L. The quasi-steady state model is excluded at > 95% C.L. The remaining four models (ΛCDM/wCDM, the Rh = ct universe, the Friedmann open universe and a static universe with a linear Hubble law) all pass the test. However, only ΛCDM/wCDM and Rh = ct also pass the Alcock-Paczyński (AP) test. The optimized parameters in ΛCDM/wCDM are Ωm = 0.20-0.20+0.24 and wde = -1.2-∞+1.6 (the dark energy equation-of-state). Combined with the AP test, these values become Ωm = 0.38-0.19+0.20 and wde = -0.28-0.40+0.52. But whereas this optimization of parameters in ΛCDM/wCDM creates some tension with their concordance values, the Rh = ct universe has the advantage of fitting the QSO and AP data without any free parameters.

A tilted cold dark matter cosmological scenario

NASA Technical Reports Server (NTRS)

Cen, Renyue; Gnedin, Nickolay Y.; Kofman, Lev A.; Ostriker, Jeremiah P.

1992-01-01

A new cosmological scenario based on CDM but with a power spectrum index of about 0.7-0.8 is suggested. This model is predicted by various inflationary models with no fine tuning. This tilted CDM model, if normalized to COBE, alleviates many problems of the standard CDM model related to both small-scale and large-scale power. A physical bias of galaxies over dark matter of about two is required to fit spatial observations.

Cosmic string wakes and large-scale structure

NASA Technical Reports Server (NTRS)

Charlton, Jane C.

1988-01-01

The formation of structure from infinite cosmic string wakes is modeled for a universe dominated by cold dark matter (CDM). Cross-sectional slices through the wake distribution tend to outline empty regions with diameters which are not inconsistent with the range of sizes of the voids in the CfA slice of the universe. The topology of the wake distribution is found to be spongy rather than cell-like. Correlations between CDM wakes do not extend much beyond a horizon length, so it is unlikely that CDM wakes are responsible for the correlations between clusters of galaxies. An estimate of the fraction of matter to accrete onto CDM wakes indicates that wakes could be more important in galaxy formation than previously anticipated.

Constraints on Non-flat Cosmologies with Massive Neutrinos after Planck 2015

NASA Astrophysics Data System (ADS)

Chen, Yun; Ratra, Bharat; Biesiada, Marek; Li, Song; Zhu, Zong-Hong

2016-10-01

We investigate two dark energy cosmological models (I.e., the ΛCDM and ϕCDM models) with massive neutrinos assuming two different neutrino mass hierarchies in both the spatially flat and non-flat scenarios, where in the ϕCDM model the scalar field possesses an inverse power-law potential, V(ϕ) ∝ ϕ -α (α > 0). Cosmic microwave background data from Planck 2015, baryon acoustic oscillation data from 6dFGS, SDSS-MGS, BOSS-LOWZ and BOSS CMASS-DR11, the joint light-curve analysis compilation of SNe Ia apparent magnitude observations, and the Hubble Space Telescope H 0 prior, are jointly employed to constrain the model parameters. We first determine constraints assuming three species of degenerate massive neutrinos. In the spatially flat (non-flat) ΛCDM model, the sum of neutrino masses is bounded as Σm ν < 0.165(0.299) eV at 95% confidence level (CL). Correspondingly, in the flat (non-flat) ϕCDM model, we find Σm ν < 0.164(0.301) eV at 95% CL. The inclusion of spatial curvature as a free parameter results in a significant broadening of confidence regions for Σm ν and other parameters. In the scenario where the total neutrino mass is dominated by the heaviest neutrino mass eigenstate, we obtain similar conclusions to those obtained in the degenerate neutrino mass scenario. In addition, the results show that the bounds on Σm ν based on two different neutrino mass hierarchies have insignificant differences in the spatially flat case for both the ΛCDM and ϕCDM models; however, the corresponding differences are larger in the non-flat case.

A Comparison of the Cheater Detection and the Unrelated Question Models: A Randomized Response Survey on Physical and Cognitive Doping in Recreational Triathletes

PubMed Central

Schröter, Hannes; Studzinski, Beatrix; Dietz, Pavel; Ulrich, Rolf; Striegel, Heiko; Simon, Perikles

2016-01-01

Purpose This study assessed the prevalence of physical and cognitive doping in recreational triathletes with two different randomized response models, that is, the Cheater Detection Model (CDM) and the Unrelated Question Model (UQM). Since both models have been employed in assessing doping, the major objective of this study was to investigate whether the estimates of these two models converge. Material and Methods An anonymous questionnaire was distributed to 2,967 athletes at two triathlon events (Frankfurt and Wiesbaden, Germany). Doping behavior was assessed either with the CDM (Frankfurt sample, one Wiesbaden subsample) or the UQM (one Wiesbaden subsample). A generalized likelihood-ratio test was employed to check whether the prevalence estimates differed significantly between models. In addition, we compared the prevalence rates of the present survey with those of a previous study on a comparable sample. Results After exclusion of incomplete questionnaires and outliers, the data of 2,017 athletes entered the final data analysis. Twelve-month prevalence for physical doping ranged from 4% (Wiesbaden, CDM and UQM) to 12% (Frankfurt CDM), and for cognitive doping from 1% (Wiesbaden, CDM) to 9% (Frankfurt CDM). The generalized likelihood-ratio test indicated no differences in prevalence rates between the two methods. Furthermore, there were no significant differences in prevalences between the present (undertaken in 2014) and the previous survey (undertaken in 2011), although the estimates tended to be smaller in the present survey. Discussion The results suggest that the two models can provide converging prevalence estimates. The high rate of cheaters estimated by the CDM, however, suggests that the present results must be seen as a lower bound and that the true prevalence of doping might be considerably higher. PMID:27218830

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

Chen, Yun; Ratra, Bharat; Biesiada, Marek

We investigate two dark energy cosmological models (i.e., the ΛCDM and ϕ CDM models) with massive neutrinos assuming two different neutrino mass hierarchies in both the spatially flat and non-flat scenarios, where in the ϕ CDM model the scalar field possesses an inverse power-law potential, V ( ϕ ) ∝ ϕ {sup −} {sup α} ( α > 0). Cosmic microwave background data from Planck 2015, baryon acoustic oscillation data from 6dFGS, SDSS-MGS, BOSS-LOWZ and BOSS CMASS-DR11, the joint light-curve analysis compilation of SNe Ia apparent magnitude observations, and the Hubble Space Telescope H {sub 0} prior, are jointly employedmore » to constrain the model parameters. We first determine constraints assuming three species of degenerate massive neutrinos. In the spatially flat (non-flat) ΛCDM model, the sum of neutrino masses is bounded as Σ m {sub ν} < 0.165(0.299) eV at 95% confidence level (CL). Correspondingly, in the flat (non-flat) ϕ CDM model, we find Σ m {sub ν} < 0.164(0.301) eV at 95% CL. The inclusion of spatial curvature as a free parameter results in a significant broadening of confidence regions for Σ m {sub ν} and other parameters. In the scenario where the total neutrino mass is dominated by the heaviest neutrino mass eigenstate, we obtain similar conclusions to those obtained in the degenerate neutrino mass scenario. In addition, the results show that the bounds on Σ m {sub ν} based on two different neutrino mass hierarchies have insignificant differences in the spatially flat case for both the ΛCDM and ϕ CDM models; however, the corresponding differences are larger in the non-flat case.« less

Constraints on deviations from ΛCDM within Horndeski gravity

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

Bellini, Emilio; Cuesta, Antonio J.; Jimenez, Raul

2016-02-01

Recent anomalies found in cosmological datasets such as the low multipoles of the Cosmic Microwave Background or the low redshift amplitude and growth of clustering measured by e.g., abundance of galaxy clusters and redshift space distortions in galaxy surveys, have motivated explorations of models beyond standard ΛCDM. Of particular interest are models where general relativity (GR) is modified on large cosmological scales. Here we consider deviations from ΛCDM+GR within the context of Horndeski gravity, which is the most general theory of gravity with second derivatives in the equations of motion. We adopt a parametrization in which the four additional Horndeskimore » functions of time α{sub i}(t) are proportional to the cosmological density of dark energy Ω{sub DE}(t). Constraints on this extended parameter space using a suite of state-of-the art cosmological observations are presented for the first time. Although the theory is able to accommodate the low multipoles of the Cosmic Microwave Background and the low amplitude of fluctuations from redshift space distortions, we find no significant tension with ΛCDM+GR when performing a global fit to recent cosmological data and thus there is no evidence against ΛCDM+GR from an analysis of the value of the Bayesian evidence ratio of the modified gravity models with respect to ΛCDM, despite introducing extra parameters. The posterior distribution of these extra parameters that we derive return strong constraints on any possible deviations from ΛCDM+GR in the context of Horndeski gravity. We illustrate how our results can be applied to a more general frameworks of modified gravity models.« less

Airway Delivery of Soluble Factors from Plastic-Adherent Bone Marrow Cells Prevents Murine Asthma

PubMed Central

Ionescu, Lavinia I.; Alphonse, Rajesh S.; Arizmendi, Narcy; Morgan, Beverly; Abel, Melanie; Eaton, Farah; Duszyk, Marek; Vliagoftis, Harissios; Aprahamian, Tamar R.; Walsh, Kenneth

2012-01-01

Asthma affects an estimated 300 million people worldwide and accounts for 1 of 250 deaths and 15 million disability-adjusted life years lost annually. Plastic-adherent bone marrow–derived cell (BMC) administration holds therapeutic promise in regenerative medicine. However, given the low cell engraftment in target organs, including the lung, cell replacement cannot solely account for the reported therapeutic benefits. This suggests that BMCs may act by secreting soluble factors. BMCs also possess antiinflammatory and immunomodulatory properties and may therefore be beneficial for asthma. Our objective was to investigate the therapeutic potential of BMC-secreted factors in murine asthma. In a model of acute and chronic asthma, intranasal instillation of BMC conditioned medium (CdM) prevented airway hyperresponsiveness (AHR) and inflammation. In the chronic asthma model, CdM prevented airway smooth muscle thickening and peribronchial inflammation while restoring blunted salbutamol-induced bronchodilation. CdM reduced lung levels of the TH2 inflammatory cytokines IL-4 and IL-13 and increased levels of IL-10. CdM up-regulated an IL-10–induced and IL-10–secreting subset of T regulatory lymphocytes and promoted IL-10 expression by lung macrophages. Adiponectin (APN), an antiinflammatory adipokine found in CdM, prevented AHR, airway smooth muscle thickening, and peribronchial inflammation, whereas the effect of CdM in which APN was neutralized or from APN knock-out mice was attenuated compared with wild-type CdM. Our study provides evidence that BMC-derived soluble factors prevent murine asthma and suggests APN as one of the protective factors. Further identification of BMC-derived factors may hold promise for novel approaches in the treatment of asthma. PMID:21903873

Airway delivery of soluble factors from plastic-adherent bone marrow cells prevents murine asthma.

PubMed

Ionescu, Lavinia I; Alphonse, Rajesh S; Arizmendi, Narcy; Morgan, Beverly; Abel, Melanie; Eaton, Farah; Duszyk, Marek; Vliagoftis, Harissios; Aprahamian, Tamar R; Walsh, Kenneth; Thébaud, Bernard

2012-02-01

Asthma affects an estimated 300 million people worldwide and accounts for 1 of 250 deaths and 15 million disability-adjusted life years lost annually. Plastic-adherent bone marrow-derived cell (BMC) administration holds therapeutic promise in regenerative medicine. However, given the low cell engraftment in target organs, including the lung, cell replacement cannot solely account for the reported therapeutic benefits. This suggests that BMCs may act by secreting soluble factors. BMCs also possess antiinflammatory and immunomodulatory properties and may therefore be beneficial for asthma. Our objective was to investigate the therapeutic potential of BMC-secreted factors in murine asthma. In a model of acute and chronic asthma, intranasal instillation of BMC conditioned medium (CdM) prevented airway hyperresponsiveness (AHR) and inflammation. In the chronic asthma model, CdM prevented airway smooth muscle thickening and peribronchial inflammation while restoring blunted salbutamol-induced bronchodilation. CdM reduced lung levels of the T(H)2 inflammatory cytokines IL-4 and IL-13 and increased levels of IL-10. CdM up-regulated an IL-10-induced and IL-10-secreting subset of T regulatory lymphocytes and promoted IL-10 expression by lung macrophages. Adiponectin (APN), an antiinflammatory adipokine found in CdM, prevented AHR, airway smooth muscle thickening, and peribronchial inflammation, whereas the effect of CdM in which APN was neutralized or from APN knock-out mice was attenuated compared with wild-type CdM. Our study provides evidence that BMC-derived soluble factors prevent murine asthma and suggests APN as one of the protective factors. Further identification of BMC-derived factors may hold promise for novel approaches in the treatment of asthma.

Experimental search for hidden photon CDM in the eV mass range with a dish antenna

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

Suzuki, J.; Horie, T.; Inoue, Y.

2015-09-15

A search for hidden photon cold dark matter (HP CDM) using a new technique with a dish antenna is reported. From the result of the measurement, we found no evidence for the existence of HP CDM and set an upper limit on the photon-HP mixing parameter χ of ∼6×10{sup −12} for the hidden photon mass m{sub γ}=3.1±1.2 eV.

MATTER IN THE BEAM: WEAK LENSING, SUBSTRUCTURES, AND THE TEMPERATURE OF DARK MATTER

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

Mahdi, Hareth S.; Elahi, Pascal J.; Lewis, Geraint F.

2016-08-01

Warm dark matter (WDM) models offer an attractive alternative to the current cold dark matter (CDM) cosmological model. We present a novel method to differentiate between WDM and CDM cosmologies, namely, using weak lensing; this provides a unique probe as it is sensitive to all of the “matter in the beam,” not just dark matter haloes and the galaxies that reside in them, but also the diffuse material between haloes. We compare the weak lensing maps of CDM clusters to those in a WDM model corresponding to a thermally produced 0.5 keV dark matter particle. Our analysis clearly shows thatmore » the weak lensing magnification, convergence, and shear distributions can be used to distinguish between CDM and WDM models. WDM models increase the probability of weak magnifications, with the differences being significant to ≳5 σ , while leaving no significant imprint on the shear distribution. WDM clusters analyzed in this work are more homogeneous than CDM ones, and the fractional decrease in the amount of material in haloes is proportional to the average increase in the magnification. This difference arises from matter that would be bound in compact haloes in CDM being smoothly distributed over much larger volumes at lower densities in WDM. Moreover, the signature does not solely lie in the probability distribution function but in the full spatial distribution of the convergence field.« less

Crystalline lens thickness determines the perceived chromatic difference in magnification.

PubMed

Chen, Yun; Schaeffel, Frank

2014-03-01

Since the origin of the high interindividual variability of the chromatic difference in retinal image magnification (CDM) in the human eye is not well understood, optical parameters that might determine its magnitude were studied in 21 healthy subjects with ages ranging from 21 to 58 years. Two psychophysical procedures were used to quantify CDM. They produced highly correlated results. First, a red and a blue square, presented on a black screen, had to be matched in size by the subjects with their right eyes. Second, a filled red and blue square, flickering on top of each other at 2 Hz, had to be adjusted in perceived brightness and then in size to minimize the impression of flicker. CDM varied widely among subjects from 0.0% to 3.6%. Biometric ocular parameters were measured with low coherence interferometry and crystalline lens tilt and decentration with a custom-built Purkinjemeter. Correlations were studied between CDM and corneal power, anterior chamber depth, lens thickness, lens tilt and lens decentration, and vitreous chamber depths. Lens thickness was found significantly correlated with CDM and accounted for 64% of its variance. Vertical lens tilt and decentration were also significantly correlated. It was also found that CDM increased by 3.5% per year, and part of this change can be attributed to the age-related increase in lens thickness.

Spectral slopes of the absorption coefficient of colored dissolved and detrital material inverted from UV-visible remote sensing reflectance.

PubMed

Wei, Jianwei; Lee, Zhongping; Ondrusek, Michael; Mannino, Antonio; Tzortziou, Maria; Armstrong, Roy

2016-03-01

The spectral slope of the absorption coefficient of colored dissolved and detrital material (CDM), S cdm (units: nm -1 ), is an important optical parameter for characterizing the absorption spectral shape of CDM. Although highly variable in natural waters, in most remote sensing algorithms, this slope is either kept as a constant or empirically modeled with multiband ocean color in the visible domain. In this study, we explore the potential of semianalytically retrieving S cdm with added ocean color information in the ultraviolet (UV) range between 360 and 400 nm. Unique features of hyperspectral remote sensing reflectance in the UV-visible wavelengths (360-500 nm) have been observed in various waters across a range of coastal and open ocean environments. Our data and analyses indicate that ocean color in the UV domain is particularly sensitive to the variation of the CDM spectral slope. Here, we used a synthesized data set to show that adding UV wavelengths to the ocean color measurements will improve the retrieval of S cdm from remote sensing reflectance considerably, while the spectral band settings of past and current satellite ocean color sensors cannot fully account for the spectral variation of remote sensing reflectance. Results of this effort support the concept to include UV wavelengths in the next generation of satellite ocean color sensors.

Consistency of the nonflat Λ CDM model with the new result from BOSS

NASA Astrophysics Data System (ADS)

Kumar, Suresh

2015-11-01

Using 137,562 quasars in the redshift range 2.1 ≤z ≤3.5 from the data release 11 (DR11) of the baryon oscillation spectroscopic survey (BOSS) of Sloan Digital Sky Survey (SDSS)-III, the BOSS-SDSS collaboration estimated the expansion rate H (z =2.34 )=222 ±7 km /s /Mpc of the Universe, and reported that this value is in tension with the predictions of flat Λ CDM model at around a 2.5 σ level. In this paper, we briefly describe some attempts made in the literature to relieve the tension, and show that the tension can naturally be alleviated in a nonflat Λ CDM model with positive curvature. We also perform the observational consistency check by considering the constraints on the nonflat Λ CDM model from Planck, WP and BAO data. We find that the nonflat Λ CDM model constrained with Planck+WP data fits better to the line of sight measurement H (z =2.34 )=222 ±7 km /s /Mpc , but only at the expense of still having a poor fit to the BAO transverse measurements.

Experimental search for hidden photon CDM in the eV mass range with a dish antenna

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

Suzuki, J.; Horie, T.; Minowa, M.

2015-09-01

A search for hidden photon cold dark matter (HP CDM) using a new technique with a dish antenna is reported. From the result of the measurement, we found no evidence for the existence of HP CDM and set an upper limit on the photon-HP mixing parameter χ of ∼ 6× 10{sup −12} for the hidden photon mass m{sub γ} = 3.1 ± 1.2 eV.

Integrated Information Support System (IISS). Volume 4. IISS System. Part 1. System Requirements Document

DTIC Science & Technology

1990-09-30

audit trail for unauthorized entries. B.6.3.3 Manage CDM Resources B.6.3.3.1 Measure CDM Performance 1. Keep running log of CDM accesses by user types...SYSTEM SPPCIFIA OMA8MSTRTO Figure B-12. System Administrator Role B-3 1 SRD620340000 30 September 1990 4. Audit IISS hardware performance (LAN...SRD620340000 30 September 1990 7. Assist IISS service specifier and application specifier in implementing standards recommendation. 8. Perform audit of IISS

Clinical data miner: an electronic case report form system with integrated data preprocessing and machine-learning libraries supporting clinical diagnostic model research.

PubMed

Installé, Arnaud Jf; Van den Bosch, Thierry; De Moor, Bart; Timmerman, Dirk

2014-10-20

Using machine-learning techniques, clinical diagnostic model research extracts diagnostic models from patient data. Traditionally, patient data are often collected using electronic Case Report Form (eCRF) systems, while mathematical software is used for analyzing these data using machine-learning techniques. Due to the lack of integration between eCRF systems and mathematical software, extracting diagnostic models is a complex, error-prone process. Moreover, due to the complexity of this process, it is usually only performed once, after a predetermined number of data points have been collected, without insight into the predictive performance of the resulting models. The objective of the study of Clinical Data Miner (CDM) software framework is to offer an eCRF system with integrated data preprocessing and machine-learning libraries, improving efficiency of the clinical diagnostic model research workflow, and to enable optimization of patient inclusion numbers through study performance monitoring. The CDM software framework was developed using a test-driven development (TDD) approach, to ensure high software quality. Architecturally, CDM's design is split over a number of modules, to ensure future extendability. The TDD approach has enabled us to deliver high software quality. CDM's eCRF Web interface is in active use by the studies of the International Endometrial Tumor Analysis consortium, with over 4000 enrolled patients, and more studies planned. Additionally, a derived user interface has been used in six separate interrater agreement studies. CDM's integrated data preprocessing and machine-learning libraries simplify some otherwise manual and error-prone steps in the clinical diagnostic model research workflow. Furthermore, CDM's libraries provide study coordinators with a method to monitor a study's predictive performance as patient inclusions increase. To our knowledge, CDM is the only eCRF system integrating data preprocessing and machine-learning libraries. This integration improves the efficiency of the clinical diagnostic model research workflow. Moreover, by simplifying the generation of learning curves, CDM enables study coordinators to assess more accurately when data collection can be terminated, resulting in better models or lower patient recruitment costs.

Chronic disease management interventions for people with chronic kidney disease in primary care: a systematic review and meta-analysis.

PubMed

Galbraith, Lauren; Jacobs, Casey; Hemmelgarn, Brenda R; Donald, Maoliosa; Manns, Braden J; Jun, Min

2018-01-01

Primary care providers manage the majority of patients with chronic kidney disease (CKD), although the most effective chronic disease management (CDM) strategies for these patients are unknown. We assessed the efficacy of CDM interventions used by primary care providers managing patients with CKD. The Medline, Embase and Cochrane Central databases were systematically searched (inception to November 2014) for randomized controlled trials (RCTs) assessing education-based and computer-assisted CDM interventions targeting primary care providers managing patients with CKD in the community. The efficacy of CDM interventions was assessed using quality indicators [use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), proteinuria measurement and achievement of blood pressure (BP) targets] and clinical outcomes (change in BP and glomerular filtration rate). Two independent reviewers evaluated studies for inclusion, quality and extracted data. Random effects models were used to estimate pooled odds ratios (ORs) and weighted mean differences for outcomes of interest. Five studies (188 clinics; 494 physicians; 42 852 patients with CKD) were included. Two studies compared computer-assisted intervention strategies with usual care, two studies compared education-based intervention strategies with computer-assisted intervention strategies and one study compared both these intervention strategies with usual care. Compared with usual care, computer-assisted CDM interventions did not increase the likelihood of ACEI/ARB use among patients with CKD {pooled OR 1.00 [95% confidence interval (CI) 0.83-1.21]; I2 = 0.0%}. Similarly, education-related CDM interventions did not increase the likelihood of ACEI/ARB use compared with computer-assisted CDM interventions [pooled OR 1.12 (95% CI 0.77-1.64); I2 = 0.0%]. Inconsistencies in reporting methods limited further pooling of data. To date, there have been very few randomized trials testing CDM interventions targeting primary care providers with the goal of improving care of people with CKD. Those conducted to date have shown minimal impact, suggesting that other strategies, or multifaceted interventions, may be required to enhance care for patients with CKD in the community. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Simulating cosmologies beyond ΛCDM with PINOCCHIO

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

Rizzo, Luca A.; Villaescusa-Navarro, Francisco; Monaco, Pierluigi

2017-01-01

We present a method that extends the capabilities of the PINpointing Orbit-Crossing Collapsed HIerarchical Objects (PINOCCHIO) code, allowing it to generate accurate dark matter halo mock catalogues in cosmological models where the linear growth factor and the growth rate depend on scale. Such cosmologies comprise, among others, models with massive neutrinos and some classes of modified gravity theories. We validate the code by comparing the halo properties from PINOCCHIO against N-body simulations, focusing on cosmologies with massive neutrinos: νΛCDM. We analyse the halo mass function, halo two-point correlation function and halo power spectrum, showing that PINOCCHIO reproduces the results frommore » simulations with the same level of precision as the original code (∼ 5–10%). We demonstrate that the abundance of halos in cosmologies with massless and massive neutrinos from PINOCCHIO matches very well the outcome of simulations, and point out that PINOCCHIO can reproduce the Ω{sub ν}–σ{sub 8} degeneracy that affects the halo mass function. We finally show that the clustering properties of the halos from PINOCCHIO matches accurately those from simulations both in real and redshift-space, in the latter case up to k = 0.3 h Mpc{sup −1}. We emphasize that the computational time required by PINOCCHIO to generate mock halo catalogues is orders of magnitude lower than the one needed for N-body simulations. This makes this tool ideal for applications like covariance matrix studies within the standard ΛCDM model but also in cosmologies with massive neutrinos or some modified gravity theories.« less

Galaxy formation with BECDM - I. Turbulence and relaxation of idealized haloes

NASA Astrophysics Data System (ADS)

Mocz, Philip; Vogelsberger, Mark; Robles, Victor H.; Zavala, Jesús; Boylan-Kolchin, Michael; Fialkov, Anastasia; Hernquist, Lars

2017-11-01

We present a theoretical analysis of some unexplored aspects of relaxed Bose-Einstein condensate dark matter (BECDM) haloes. This type of ultralight bosonic scalar field dark matter is a viable alternative to the standard cold dark matter (CDM) paradigm, as it makes the same large-scale predictions as CDM and potentially overcomes CDM's small-scale problems via a galaxy-scale de Broglie wavelength. We simulate BECDM halo formation through mergers, evolved under the Schrödinger-Poisson equations. The formed haloes consist of a soliton core supported against gravitational collapse by the quantum pressure tensor and an asymptotic r-3 NFW-like profile. We find a fundamental relation of the core-to-halo mass with the dimensionless invariant Ξ ≡ |E|/M3/(Gm/ℏ)2 or Mc/M ≃ 2.6Ξ1/3, linking the soliton to global halo properties. For r ≥ 3.5 rc core radii, we find equipartition between potential, classical kinetic and quantum gradient energies. The haloes also exhibit a conspicuous turbulent behaviour driven by the continuous reconnection of vortex lines due to wave interference. We analyse the turbulence 1D velocity power spectrum and find a k-1.1 power law. This suggests that the vorticity in BECDM haloes is homogeneous, similar to thermally-driven counterflow BEC systems from condensed matter physics, in contrast to a k-5/3 Kolmogorov power law seen in mechanically-driven quantum systems. The mode where the power spectrum peaks is approximately the soliton width, implying that the soliton-sized granules carry most of the turbulent energy in BECDM haloes.

Galaxy formation with BECDM - I. Turbulence and relaxation of idealized haloes.

PubMed

Mocz, Philip; Vogelsberger, Mark; Robles, Victor H; Zavala, Jesús; Boylan-Kolchin, Michael; Fialkov, Anastasia; Hernquist, Lars

2017-11-01

We present a theoretical analysis of some unexplored aspects of relaxed Bose-Einstein condensate dark matter (BECDM) haloes. This type of ultralight bosonic scalar field dark matter is a viable alternative to the standard cold dark matter (CDM) paradigm, as it makes the same large-scale predictions as CDM and potentially overcomes CDM's small-scale problems via a galaxy-scale de Broglie wavelength. We simulate BECDM halo formation through mergers, evolved under the Schrödinger-Poisson equations. The formed haloes consist of a soliton core supported against gravitational collapse by the quantum pressure tensor and an asymptotic r -3 NFW-like profile. We find a fundamental relation of the core-to-halo mass with the dimensionless invariant Ξ ≡ | E |/ M 3 /( Gm/ħ ) 2 or M c / M ≃ 2.6Ξ 1/3 , linking the soliton to global halo properties. For r ≥ 3.5 r c core radii, we find equipartition between potential, classical kinetic and quantum gradient energies. The haloes also exhibit a conspicuous turbulent behaviour driven by the continuous reconnection of vortex lines due to wave interference. We analyse the turbulence 1D velocity power spectrum and find a k -1.1 power law. This suggests that the vorticity in BECDM haloes is homogeneous, similar to thermally-driven counterflow BEC systems from condensed matter physics, in contrast to a k -5/3 Kolmogorov power law seen in mechanically-driven quantum systems. The mode where the power spectrum peaks is approximately the soliton width, implying that the soliton-sized granules carry most of the turbulent energy in BECDM haloes.

Can a void mimic the Λ in ΛCDM?

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

Sundell, Peter; Vilja, Iiro; Mörtsell, Edvard, E-mail: pgsund@utu.fi, E-mail: edvard@fysik.su.se, E-mail: iiro.vilja@utu.fi

2015-08-01

We investigate Lemaítre-Tolman-Bondi (LTB) models, whose early time evolution and bang time are homogeneous and the distance-redshift relation and local Hubble parameter are inherited from the ΛCDM model. We show that the obtained LTB models and the ΛCDM model predict different relative local expansion rates and that the Hubble functions of the models diverge increasingly with redshift. The LTB models show tension between low redshift baryon acoustic oscillation and supernova observations and including Lyman-α forest or cosmic microwave background observations only accentuates the better fit of the ΛCDM model compared to the LTB model. The result indicates that additional degreesmore » of freedom are needed to explain the observations, for example by renouncing spherical symmetry, homogeneous bang time, negligible effects of pressure, or the early time homogeneity assumption.« less

Bayesian correction of H(z) data uncertainties

NASA Astrophysics Data System (ADS)

Jesus, J. F.; Gregório, T. M.; Andrade-Oliveira, F.; Valentim, R.; Matos, C. A. O.

2018-07-01

We compile 41 H(z) data from literature and use them to constrain OΛCDM and flat ΛCDM parameters. We show that the available H(z) suffers from uncertainties overestimation and propose a Bayesian method to reduce them. As a result of this method, using H(z) only, we find, in the context of OΛCDM, H0 = 69.5 ± 2.5 km s-1 Mpc-1, Ωm = 0.242 ± 0.036, and Ω _Λ =0.68± 0.14. In the context of flat ΛCDM model, we have found H0 = 70.4 ± 1.2 km s-1 Mpc-1 and Ωm = 0.256 ± 0.014. This corresponds to an uncertainty reduction of up to ≈ 30 per cent when compared to the uncorrected analysis in both cases.

Decellularized cartilage-derived matrix as substrate for endochondral bone regeneration.

PubMed

Gawlitta, Debby; Benders, Kim E M; Visser, Jetze; van der Sar, Anja S; Kempen, Diederik H R; Theyse, Lars F H; Malda, Jos; Dhert, Wouter J A

2015-02-01

Following an endochondral approach to bone regeneration, multipotent stromal cells (MSCs) can be cultured on a scaffold to create a cartilaginous callus that is subsequently remodeled into bone. An attractive scaffold material for cartilage regeneration that has recently regained attention is decellularized cartilage-derived matrix (CDM). Since this material has shown potential for cartilage regeneration, we hypothesized that CDM could be a potent material for endochondral bone regeneration. In addition, since decellularized matrices are known to harbor bioactive cues for tissue formation, we evaluated the need for seeded MSCs in CDM scaffolds. In this study, ectopic bone formation in rats was evaluated for CDM scaffolds seeded with human MSCs and compared with unseeded controls. The MSC-seeded samples were preconditioned in chondrogenic medium for 37 days. After 8 weeks of subcutaneous implantation, the extent of mineralization was significantly higher in the MSC-seeded constructs versus unseeded controls. The mineralized areas corresponded to bone formation with bone marrow cavities. In addition, rat-specific bone formation was confirmed by collagen type I immunohistochemistry. Finally, fluorochrome incorporation at 3 and 6 weeks revealed that the bone formation had an inwardly directed progression. Taken together, our results show that decellularized CDM is a promising biomaterial for endochondral bone regeneration when combined with MSCs at ectopic locations. Modification of current decellularization protocols may lead to enhanced functionality of CDM scaffolds, potentially offering the prospect of generation of cell-free off-the-shelf bone regenerative substitutes.

Electrical Stimulation of the Suprahyoid Muscles in Brain-injured Patients with Dysphagia: A Pilot Study

PubMed Central

Beom, Jaewon; Kim, Sang Jun

2011-01-01

Objective To investigate the therapeutic effects of repetitive electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia. Method Twenty-eight brain-injured patients who showed reduced laryngeal elevation and supraglottic penetration or subglottic aspiration during a videofluoroscopic swallowing study (VFSS) were selected. The patients received either conventional dysphagia management (CDM) or CDM with repetitive electrical stimulation of the suprahyoid muscles (ESSM) for 4 weeks. The videofluoroscopic dysphagia scale (VDS) using the VFSS and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale (ASHA level) was used to determine swallowing function before and after treatment. Results VDS scores decreased from 29.8 to 17.9 in the ESSM group, and from 29.2 to 16.6 in the CDM group. However, there was no significant difference between the groups (p=0.796). Six patients (85.7%) in the ESSM group and 14 patients (66.7%) in the CDM group showed improvement according to the ASHA level with no significant difference between the ESSM and CDM groups (p=0.633). Conclusion Although repetitive neuromuscular electrical stimulation of the suprahyoid muscles did not further improve the swallowing function of dysphagia patients with reduced laryngeal elevation, more patients in the ESSM group showed improvement in the ASHA level than those in the CDM group. Further studies with concurrent controls and a larger sample group are required to fully establish the effects of repetitive neuromuscular electrical stimulation of the suprahyoid muscles in dysphagia patients. PMID:22506140

1-Cinnamoyl-3,11-dihydroxymeliacarpin is a natural bioactive compound with antiviral and nuclear factor-{kappa}B modulating properties

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

Barquero, Andrea A.; Michelini, Flavia M.; Alche, Laura E.

2006-06-09

We have reported the isolation of the tetranortriterpenoid 1-cinnamoyl-3,11-dihydroxymeliacarpin (CDM) from partially purified leaf extracts of Melia azedarach L. (MA) that reduced both, vesicular stomatitis virus (VSV) and Herpes simplex virus type 1 (HSV-1) multiplication. CDM blocks VSV entry and the intracellular transport of VSV-G protein, confining it to the Golgi apparatus, by pre- or post-treatment, respectively. Here, we report that HSV-1 glycoproteins were also confined to the Golgi apparatus independently of the nature of the host cell. Considering that MA could be acting as an immunomodulator preventing the development of herpetic stromal keratitis in mice, we also examined anmore » eventual effect of CDM on NF-{kappa}B signaling pathway. CDM is able to impede NF-{kappa}B activation in HSV-1-infected conjunctival cells and leads to the accumulation of p65 NF-{kappa}B subunit in the cytoplasm of uninfected treated Vero cells. In conclusion, CDM is a pleiotropic agent that not only inhibits the multiplication of DNA and RNA viruses by the same mechanism of action but also modulates the NF-{kappa}B signaling pathway.« less

A gamma-ray constraint on the nature of dark matter

NASA Technical Reports Server (NTRS)

Silk, Joseph; Bloemen, Hans

1987-01-01

If even a small component of the Galactic spheroid consists of the weakly interacting majorana fermions that are cold-dark-matter candidate particles for the Galactic halo, there should be a substantial flux of annihilation gamma rays from a source of about 1-deg extent at the Galactic center. COS B observations already constrain the halo cold-dark-matter (CDM) content entrained in the inner spheroid to be less than about 10 percent. A somewhat weaker constraint applies to the CDM believed to be present in the Galactic disk, but still only about 15 percent can be in such particles. Monochromatic line photons of energy 3-10 GeV are also predicted, and future experiments may be capable of improving these limits. Since both theoretical models of galaxy formation in a CDM-dominated universe and mass models for the rotation curve in the inner Galaxy suggest that a substantial fraction of the spheroid component should be nonluminous and incorporate entrained halo CDM, the hypothesis that the halo CDM consists predominantly of weakly interacting fermions such as photinos or heavy majorana mass neutrinos or higgsinos may already be subject to observational test.

Interactive mixture of inhomogeneous dark fluids driven by dark energy: a dynamical system analysis

NASA Astrophysics Data System (ADS)

Izquierdo, Germán; Blanquet-Jaramillo, Roberto C.; Sussman, Roberto A.

2018-03-01

We examine the evolution of an inhomogeneous mixture of non-relativistic pressureless cold dark matter (CDM), coupled to dark energy (DE) characterised by the equation of state parameter w<-1/3, with the interaction term proportional to the DE density. This coupled mixture is the source of a spherically symmetric Lemaître-Tolman-Bondi (LTB) metric admitting an asymptotic Friedman-Lemaître-Robertson-Walker (FLRW) background. Einstein's equations reduce to a 5-dimensional autonomous dynamical system involving quasi-local variables related to suitable averages of covariant scalars and their fluctuations. The phase space evolution around the critical points (past/future attractors and five saddles) is examined in detail. For all parameter values and both directions of energy flow (CDM to DE and DE to CDM) the phase space trajectories are compatible with a physically plausible early cosmic times behaviour near the past attractor. This result compares favourably with mixtures with interaction driven by the CDM density, whose past evolution is unphysical for DE to CDM energy flow. Numerical examples are provided describing the evolution of an initial profile that can be associated with idealised structure formation scenarios.

Bulgeless dwarf galaxies and dark matter cores from supernova-driven outflows.

PubMed

Governato, F; Brook, C; Mayer, L; Brooks, A; Rhee, G; Wadsley, J; Jonsson, P; Willman, B; Stinson, G; Quinn, T; Madau, P

2010-01-14

For almost two decades the properties of 'dwarf' galaxies have challenged the cold dark matter (CDM) model of galaxy formation. Most observed dwarf galaxies consist of a rotating stellar disk embedded in a massive dark-matter halo with a near-constant-density core. Models based on the dominance of CDM, however, invariably form galaxies with dense spheroidal stellar bulges and steep central dark-matter profiles, because low-angular-momentum baryons and dark matter sink to the centres of galaxies through accretion and repeated mergers. Processes that decrease the central density of CDM halos have been identified, but have not yet reconciled theory with observations of present-day dwarfs. This failure is potentially catastrophic for the CDM model, possibly requiring a different dark-matter particle candidate. Here we report hydrodynamical simulations (in a framework assuming the presence of CDM and a cosmological constant) in which the inhomogeneous interstellar medium is resolved. Strong outflows from supernovae remove low-angular-momentum gas, which inhibits the formation of bulges and decreases the dark-matter density to less than half of what it would otherwise be within the central kiloparsec. The analogues of dwarf galaxies-bulgeless and with shallow central dark-matter profiles-arise naturally in these simulations.

Non-linear structure formation in the `Running FLRW' cosmological model

NASA Astrophysics Data System (ADS)

Bibiano, Antonio; Croton, Darren J.

2016-07-01

We present a suite of cosmological N-body simulations describing the `Running Friedmann-Lemaïtre-Robertson-Walker' (R-FLRW) cosmological model. This model is based on quantum field theory in a curved space-time and extends Lambda cold dark matter (ΛCDM) with a time-evolving vacuum density, Λ(z), and time-evolving gravitational Newton's coupling, G(z). In this paper, we review the model and introduce the necessary analytical treatment needed to adapt a reference N-body code. Our resulting simulations represent the first realization of the full growth history of structure in the R-FLRW cosmology into the non-linear regime, and our normalization choice makes them fully consistent with the latest cosmic microwave background data. The post-processing data products also allow, for the first time, an analysis of the properties of the halo and sub-halo populations. We explore the degeneracies of many statistical observables and discuss the steps needed to break them. Furthermore, we provide a quantitative description of the deviations of R-FLRW from ΛCDM, which could be readily exploited by future cosmological observations to test and further constrain the model.

The Effect of Shared Information on Pilot/Controller And Controller/Controller Interactions

NASA Technical Reports Server (NTRS)

Hansman, R. John

1999-01-01

In order to respond to the increasing demand on limited airspace system resources, a number of applications of information technology have been proposed, or are under investigation, to improve the efficiency, capacity and reliability of ATM (Asynchronous Transfer Mode) operations. Much of the attention in advanced ATM technology has focused on advanced automation systems or decision aiding systems to improve the performance of individual Pilots or Controllers. However, the most significant overall potential for information technology appears to he in increasing the shared information between human agents such as Pilots, Controllers or between interacting Controllers or traffic flow managers. Examples of proposed shared information systems in the US include; Controller Pilot Databank Communication (CPDLC), Traffic Management Advisor (TMA); Automatic Dependent Surveillance (ADS); Collaborative Decision Making (CDM) and NAS Level Common Information Exchange. Air Traffic Management is fundamentally a human centered process consisting of the negotiation, execution and monitoring of contracts between human agents for the allocation of limited airspace, runway and airport surface resources. The decision processes within ATM tend to be Semistructured. Many of the routine elements in ATM decision making on the part of the Controllers or Pilots are well Structured and can be represented by well defined rules or procedures. However in disrupted conditions, the ATM decision processes are often Unstructured and cannot be reduced to a set of discrete rules. As a consequence, the ability to automate ATM processes will be limited and ATM will continue to be a human centric process where the responsibility and the authority for the negotiation will continue to rest with human Controllers and Pilots. The use of information technology to support the human decision process will therefore be an important aspect of ATM modernization. The premise of many of the proposed shared information systems is that the performance of ATM operations will improve with an increase in Shared Situation Awareness between agents (Pilots, Controller, Dispatchers). This will allow better informed control decisions and an improved ability to negotiate between agents. A common information basis may reduce communication load and may increase the level of collaboration in the decision process. In general, information sharing is expected to have advantages for all agents within the system. However there are important questions which remain to be,addressed. For example: What shared information is most important for developing effective Shared Situation Awareness? Are there issues of information saturation? Does information parity create ambiguity in control authority? Will information sharing induce undesirable or unstable gaming behavior between agents? This paper will explore the effect of current and proposed information sharing between different ATM agents. The paper will primarily concentrate on bilateral tactical interactions between specific agents (Pilot/Controller; Controller/Controller; Pilot/Dispatcher; Controller/Dispatcher) however it will also briefly discuss multilateral interaction and more strategic interactions.

Is there a concordance value for H0?

NASA Astrophysics Data System (ADS)

Luković, Vladimir V.; D'Agostino, Rocco; Vittorio, Nicola

2016-11-01

Context. We test the theoretical predictions of several cosmological models against different observables to compare the indirect estimates of the current expansion rate of the Universe determined from model fitting with the direct measurements based on Cepheids data published recently. Aims: We perform a statistical analysis of type Ia supernova (SN Ia), Hubble parameter, and baryon acoustic oscillation data. A joint analysis of these datasets allows us to better constrain cosmological parameters, but also to break the degeneracy that appears in the distance modulus definition between H0 and the absolute B-band magnitude of SN Ia, M0. Methods: From the theoretical side, we considered spatially flat and curvature-free ΛCDM, wCDM, and inhomogeneous Lemaître-Tolman-Bondi (LTB) models. To analyse SN Ia we took into account the distributions of SN Ia intrinsic parameters. Results: For the ΛCDM model we find that Ωm = 0.35 ± 0.02, H0 = (67.8 ± 1.0) km s-1 Mpc-1, while the corrected SN absolute magnitude has a normal distribution N(19.13,0.11). The wCDM model provides the same value for Ωm, while H0 = (66.5 ± 1.8) km s-1 Mpc-1 and w = -0.93 ± 0.07. When an inhomogeneous LTB model is considered, the combined fit provides H0 = (64.2 ± 1.9) km s-1 Mpc-1. Conclusions: Both the Akaike information criterion and the Bayes factor analysis cannot clearly distinguish between ΛCDM and wCDM cosmologies, while they clearly disfavour the LTB model. For the ΛCDM, our joint analysis of the SN Ia, the Hubble parameter, and the baryon acoustic oscillation datasets provides H0 values that are consistent with cosmic microwave background (CMB)-only Planck measurements, but they differ by 2.5σ from the value based on Cepheids data.

Is ΛCDM an effective CCDM cosmology?

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

Lima, J.A.S.; Santos, R.C.; Cunha, J.V., E-mail: limajas@astro.iag.usp.br, E-mail: cliviars@gmail.com, E-mail: jvcunha@ufpa.br

We show that a cosmology driven by gravitationally induced particle production of all non-relativistic species existing in the present Universe mimics exactly the observed flat accelerating ΛCDM cosmology with just one dynamical free parameter. This kind of scenario includes the creation cold dark matter (CCDM) model [1] as a particular case and also provides a natural reduction of the dark sector since the vacuum component is not needed to accelerate the Universe. The new cosmic scenario is equivalent to ΛCDM both at the background and perturbative levels and the associated creation process is also in agreement with the universality ofmore » the gravitational interaction and equivalence principle. Implicitly, it also suggests that the present day astronomical observations cannot be considered the ultimate proof of cosmic vacuum effects in the evolved Universe because ΛCDM may be only an effective cosmology.« less

Model-independent limits and constraints on extended theories of gravity from cosmic reconstruction techniques

NASA Astrophysics Data System (ADS)

de la Cruz-Dombriz, Álvaro; Dunsby, Peter K. S.; Luongo, Orlando; Reverberi, Lorenzo

2016-12-01

The onset of dark energy domination depends on the particular gravitational theory driving the cosmic evolution. Model independent techniques are crucial to test the both the present ΛCDM cosmological paradigm and alternative theories, making the least possible number of assumptions about the Universe. In this paper we investigate whether cosmography is able to distinguish between different gravitational theories, by determining bounds on model parameters for three different extensions of General Relativity, namely quintessence, F(𝒯) and f(R) gravitational theories. We expand each class of theories in powers of redshift z around the present time, making no additional assumptions. This procedure is an extension of previous work and can be seen as the most general approach for testing extended theories of gravity through the use of cosmography. In the case of F(𝒯) and f(R) theories, we show that some assumptions on model parameters often made in previous works are superfluous or even unjustified. We use data from the Union 2.1 supernovae catalogue, baryonic acoustic oscillation data and H(z) differential age compilations, which probe cosmology on different scales of the cosmological evolution. We perform a Monte Carlo analysis using a Metropolis-Hastings algorithm with a Gelman-Rubin convergence criterion, reporting 1-σ and 2-σ confidence levels. To do so, we perform two distinct fits, assuming only data within z < 1 first and then without limitations in redshift. We obtain the corresponding numerical intervals in which coefficients span, and find that the data is compatible the ΛCDM limit of all three theories at the 1-σ level, while still compatible with quite a large portion of parameter space. We compare our results to the truncated ΛCDM paradigm, demonstrating that our bounds divert from the expectations of previous works, showing that the permitted regions of coefficients are significantly modified and in general widened with respect to values usually reported in the existing literature. Finally, we test the extended theories through the Bayesian selection criteria AIC and BIC.

Model-independent limits and constraints on extended theories of gravity from cosmic reconstruction techniques

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

Cruz-Dombriz, Álvaro de la; Dunsby, Peter K.S.; Luongo, Orlando

The onset of dark energy domination depends on the particular gravitational theory driving the cosmic evolution. Model independent techniques are crucial to test the both the present ΛCDM cosmological paradigm and alternative theories, making the least possible number of assumptions about the Universe. In this paper we investigate whether cosmography is able to distinguish between different gravitational theories, by determining bounds on model parameters for three different extensions of General Relativity, namely quintessence, F (Τ) and f ( R ) gravitational theories. We expand each class of theories in powers of redshift z around the present time, making no additionalmore » assumptions. This procedure is an extension of previous work and can be seen as the most general approach for testing extended theories of gravity through the use of cosmography. In the case of F (Τ) and f ( R ) theories, we show that some assumptions on model parameters often made in previous works are superfluous or even unjustified. We use data from the Union 2.1 supernovae catalogue, baryonic acoustic oscillation data and H ( z ) differential age compilations, which probe cosmology on different scales of the cosmological evolution. We perform a Monte Carlo analysis using a Metropolis-Hastings algorithm with a Gelman-Rubin convergence criterion, reporting 1-σ and 2-σ confidence levels. To do so, we perform two distinct fits, assuming only data within z < 1 first and then without limitations in redshift. We obtain the corresponding numerical intervals in which coefficients span, and find that the data is compatible the ΛCDM limit of all three theories at the 1-σ level, while still compatible with quite a large portion of parameter space. We compare our results to the truncated ΛCDM paradigm, demonstrating that our bounds divert from the expectations of previous works, showing that the permitted regions of coefficients are significantly modified and in general widened with respect to values usually reported in the existing literature. Finally, we test the extended theories through the Bayesian selection criteria AIC and BIC.« less

Testing Viable f(T) Models with Current Observations

NASA Astrophysics Data System (ADS)

Xu, Bing; Yu, Hongwei; Wu, Puxun

2018-03-01

We perform observational tests on the f(T) gravity with the BAO data (including the BOSS DR 12 galaxy sample, the DR12 Lyα-Forests measurement, the new eBOSS DR14 quasar sample, the 6dFGS, and the SDSS), the CMB distance priors from the Planck 2015, the SNIa data from the joint light-curve analysis, the latest H(z) data, and the local value of the Hubble constant. Six different f(T) models are investigated. Furthermore, the ΛCDM is also considered. All models are compared by using the Akaike information criteria (AIC) and the Bayesian information criteria (BIC). Our results show that the ΛCDM remains to be the most favored model by current observations. However, there are also the Hubble constant tension between the Planck measurements and the local Universe observations and the tension between the CMB data and the H(z) data in the ΛCDM. For f(T) models considered in this paper, half, which can reduce to the ΛCDM, have values of {{χ }2}\\min smaller than that of the ΛCDM and can relieve the tensions existing in the ΛCDM. However, they are punished slightly by the BIC due to one extra parameter. Two of six f(T) models, in which the crossing of the phantom divide line can be realized for the equation of state of the effective dark energy and this crossing is shown in this paper to be favored by current observations, are punished by the information criteria. In addition, we find that the logarithmic f(T) model is excluded by cosmological observations.

Research Progress on Dark Matter Model Based on Weakly Interacting Massive Particles

NASA Astrophysics Data System (ADS)

He, Yu; Lin, Wen-bin

2017-04-01

The cosmological model of cold dark matter (CDM) with the dark energy and a scale-invariant adiabatic primordial power spectrum has been considered as the standard cosmological model, i.e. the ΛCDM model. Weakly interacting massive particles (WIMPs) become a prominent candidate for the CDM. Many models extended from the standard model can provide the WIMPs naturally. The standard calculations of relic abundance of dark matter show that the WIMPs are well in agreement with the astronomical observation of ΩDM h2 ≈0.11. The WIMPs have a relatively large mass, and a relatively slow velocity, so they are easy to aggregate into clusters, and the results of numerical simulations based on the WIMPs agree well with the observational results of cosmic large-scale structures. In the aspect of experiments, the present accelerator or non-accelerator direct/indirect detections are mostly designed for the WIMPs. Thus, a wide attention has been paid to the CDM model based on the WIMPs. However, the ΛCDM model has a serious problem for explaining the small-scale structures under one Mpc. Different dark matter models have been proposed to alleviate the small-scale problem. However, so far there is no strong evidence enough to exclude the CDM model. We plan to introduce the research progress of the dark matter model based on the WIMPs, such as the WIMPs miracle, numerical simulation, small-scale problem, and the direct/indirect detection, to analyze the criterion for discriminating the ;cold;, ;hot;, and ;warm; dark matter, and present the future prospects for the study in this field.

Child-directed marketing inside and on the exterior of fast food restaurants.

PubMed

Ohri-Vachaspati, Punam; Isgor, Zeynep; Rimkus, Leah; Powell, Lisa M; Barker, Dianne C; Chaloupka, Frank J

2015-01-01

Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption. To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants. Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014. More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had significantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012. CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?

PubMed

Wang, Zhaoxin; Shi, Jianwei; Wu, Zhigui; Xie, Huiling; Yu, Yifan; Li, Ping; Liu, Rui; Jing, Limei

2017-07-01

Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large-scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas. Copyright © 2017 John Wiley & Sons, Ltd.

Large-scale structure in superfluid Chaplygin gas cosmology

NASA Astrophysics Data System (ADS)

Yang, Rongjia

2014-03-01

We investigate the growth of the large-scale structure in the superfluid Chaplygin gas (SCG) model. Both linear and nonlinear growth, such as σ8 and the skewness S3, are discussed. We find the growth factor of SCG reduces to the Einstein-de Sitter case at early times while it differs from the cosmological constant model (ΛCDM) case in the large a limit. We also find there will be more stricture growth on large scales in the SCG scenario than in ΛCDM and the variations of σ8 and S3 between SCG and ΛCDM cannot be discriminated.

Correlated perturbations from inflation and the cosmic microwave background.

PubMed

Amendola, Luca; Gordon, Christopher; Wands, David; Sasaki, Misao

2002-05-27

We compare the latest cosmic microwave background data with theoretical predictions including correlated adiabatic and cold dark matter (CDM) isocurvature perturbations with a simple power-law dependence. We find that there is a degeneracy between the amplitude of correlated isocurvature perturbations and the spectral tilt. A negative (red) tilt is found to be compatible with a larger isocurvature contribution. Estimates of the baryon and CDM densities are found to be almost independent of the isocurvature amplitude. The main result is that current microwave background data do not exclude a dominant contribution from CDM isocurvature fluctuations on large scales.

Control-display mapping in brain-computer interfaces.

PubMed

Thurlings, Marieke E; van Erp, Jan B F; Brouwer, Anne-Marie; Blankertz, Benjamin; Werkhoven, Peter

2012-01-01

Event-related potential (ERP) based brain-computer interfaces (BCIs) employ differences in brain responses to attended and ignored stimuli. When using a tactile ERP-BCI for navigation, mapping is required between navigation directions on a visual display and unambiguously corresponding tactile stimuli (tactors) from a tactile control device: control-display mapping (CDM). We investigated the effect of congruent (both display and control horizontal or both vertical) and incongruent (vertical display, horizontal control) CDMs on task performance, the ERP and potential BCI performance. Ten participants attended to a target (determined via CDM), in a stream of sequentially vibrating tactors. We show that congruent CDM yields best task performance, enhanced the P300 and results in increased estimated BCI performance. This suggests a reduced availability of attentional resources when operating an ERP-BCI with incongruent CDM. Additionally, we found an enhanced N2 for incongruent CDM, which indicates a conflict between visual display and tactile control orientations. Incongruency in control-display mapping reduces task performance. In this study, brain responses, task and system performance are related to (in)congruent mapping of command options and the corresponding stimuli in a brain-computer interface (BCI). Directional congruency reduces task errors, increases available attentional resources, improves BCI performance and thus facilitates human-computer interaction.

The mass discrepancy acceleration relation in a ΛCDM context

NASA Astrophysics Data System (ADS)

Di Cintio, Arianna; Lelli, Federico

2016-02-01

The mass discrepancy acceleration relation (MDAR) describes the coupling between baryons and dark matter (DM) in galaxies: the ratio of total-to-baryonic mass at a given radius anticorrelates with the acceleration due to baryons. The MDAR has been seen as a challenge to the Λ cold dark matter (ΛCDM) galaxy formation model, while it can be explained by Modified Newtonian Dynamics. In this Letter, we show that the MDAR arises in a ΛCDM cosmology once observed galaxy scaling relations are taken into account. We build semi-empirical models based on ΛCDM haloes, with and without the inclusion of baryonic effects, coupled to empirically motivated structural relations. Our models can reproduce the MDAR: specifically, a mass-dependent density profile for DM haloes can fully account for the observed MDAR shape, while a universal profile shows a discrepancy with the MDAR of dwarf galaxies with M⋆ < 109.5 M⊙, a further indication suggesting the existence of DM cores. Additionally, we reproduce slope and normalization of the baryonic Tully-Fisher relation (BTFR) with 0.17 dex scatter. These results imply that in ΛCDM (I) the MDAR is driven by structural scaling relations of galaxies and DM density profile shapes, and (II) the baryonic fractions determined by the BTFR are consistent with those inferred from abundance-matching studies.

Implementing model-based system engineering for the whole lifecycle of a spacecraft

NASA Astrophysics Data System (ADS)

Fischer, P. M.; Lüdtke, D.; Lange, C.; Roshani, F.-C.; Dannemann, F.; Gerndt, A.

2017-09-01

Design information of a spacecraft is collected over all phases in the lifecycle of a project. A lot of this information is exchanged between different engineering tasks and business processes. In some lifecycle phases, model-based system engineering (MBSE) has introduced system models and databases that help to organize such information and to keep it consistent for everyone. Nevertheless, none of the existing databases approached the whole lifecycle yet. Virtual Satellite is the MBSE database developed at DLR. It has been used for quite some time in Phase A studies and is currently extended for implementing it in the whole lifecycle of spacecraft projects. Since it is unforeseeable which future use cases such a database needs to support in all these different projects, the underlying data model has to provide tailoring and extension mechanisms to its conceptual data model (CDM). This paper explains the mechanisms as they are implemented in Virtual Satellite, which enables extending the CDM along the project without corrupting already stored information. As an upcoming major use case, Virtual Satellite will be implemented as MBSE tool in the S2TEP project. This project provides a new satellite bus for internal research and several different payload missions in the future. This paper explains how Virtual Satellite will be used to manage configuration control problems associated with such a multi-mission platform. It discusses how the S2TEP project starts using the software for collecting the first design information from concurrent engineering studies, then making use of the extension mechanisms of the CDM to introduce further information artefacts such as functional electrical architecture, thus linking more and more processes into an integrated MBSE approach.

Object detectability at increased ambient lighting conditions.

PubMed

Pollard, Benjamin J; Chawla, Amarpreet S; Delong, David M; Hashimoto, Noriyuki; Samei, Ehsan

2008-06-01

Under typical dark conditions encountered in diagnostic reading rooms, a reader's pupils will contract and dilate as the visual focus intermittently shifts between the high luminance display and the darker background wall, resulting in increased visual fatigue and the degradation of diagnostic performance. A controlled increase of ambient lighting may, however, reduce the severity of these pupillary adjustments by minimizing the difference between the luminance level to which the eyes adapt while viewing an image (L(adp)) and the luminance level of diffusely reflected light from the area surrounding the display (L(s)). Although ambient lighting in reading rooms has conventionally been kept at a minimum to maintain the perceived contrast of film images, proper Digital Imaging and Communications in Medicine (DICOM) calibration of modern medical-grade liquid crystal displays can compensate for minor lighting increases with very little loss of image contrast. This paper describes two psychophysical studies developed to evaluate and refine optimum reading room ambient lighting conditions through the use of observational tasks intended to simulate real clinical practices. The first study utilized the biologic contrast response of the human visual system to determine a range of representative L(adp) values for typical medical images. Readers identified low contrast horizontal objects in circular foregrounds of uniform luminance (5, 12, 20, and 30 cd/m2) embedded within digitized mammograms. The second study examined the effect of increased ambient lighting on the detection of subtle objects embedded in circular foregrounds of uniform luminance (5, 12, and 35 cd/m2) centered within a constant background of 12 cd/m2 luminance. The images were displayed under a dark room condition (1 lux) and an increased ambient lighting level (50 lux) such that the luminance level of the diffusely reflected light from the background wall was approximately equal to the image L(adp) value of 12 cd/m2. Results from the first study demonstrated that observer true positive and false positive detection rates and true positive detection times were considerably better while viewing foregrounds at 12 and 20 cd/m2 than at the other foreground luminance levels. Results from the second study revealed that under increased room illuminance, the average true positive detection rate improved a statistically significant amount from 39.3% to 55.6% at 5 cd/m2 foreground luminance. Additionally, the true positive rate increased from 46.4% to 56.6% at 35 cd/m2 foreground luminance, and decreased slightly from 90.2% to 87.5% at 12 cd/m2 foreground luminance. False positive rates at all foreground luminance levels remained approximately constant with increased ambient lighting. Furthermore, under increased room illuminance, true positive detection times declined at every foreground luminance level, with the most considerable decrease (approximately 500 ms) at the 5 cd/m2 foreground luminance. The first study suggests that L(adp) of typical mammograms lies between 12 and 20 cd/m2, leading to an optimum reading room illuminance of approximately 50-80 lux. Findings from the second study provide psychophysical evidence that ambient lighting may be increased to a level within this range, potentially improving radiologist comfort, without deleterious effects on diagnostic performance.

SIDM on FIRE: hydrodynamical self-interacting dark matter simulations of low-mass dwarf galaxies

NASA Astrophysics Data System (ADS)

Robles, Victor H.; Bullock, James S.; Elbert, Oliver D.; Fitts, Alex; González-Samaniego, Alejandro; Boylan-Kolchin, Michael; Hopkins, Philip F.; Faucher-Giguère, Claude-André; Kereš, Dušan; Hayward, Christopher C.

2017-12-01

We compare a suite of four simulated dwarf galaxies formed in 1010 M⊙ haloes of collisionless cold dark matter (CDM) with galaxies simulated in the same haloes with an identical galaxy formation model but a non-zero cross-section for DM self-interactions. These cosmological zoom-in simulations are part of the Feedback In Realistic Environments (FIRE) project and utilize the FIRE-2 model for hydrodynamics and galaxy formation physics. We find the stellar masses of the galaxies formed in self-interacting dark matter (SIDM) with σ/m = 1 cm2 g-1 are very similar to those in CDM (spanning M⋆ ≈ 105.7-7.0M⊙) and all runs lie on a similar stellar mass-size relation. The logarithmic DM density slope (α = d log ρ/d log r) in the central 250-500 pc remains steeper than α = -0.8 for the CDM-Hydro simulations with stellar mass M⋆ ∼ 106.6 M⊙ and core-like in the most massive galaxy. In contrast, every SIDM hydrodynamic simulation yields a flatter profile, with α > -0.4. Moreover, the central density profiles predicted in SIDM runs without baryons are similar to the SIDM runs that include FIRE-2 baryonic physics. Thus, SIDM appears to be much more robust to the inclusion of (potentially uncertain) baryonic physics than CDM on this mass scale, suggesting that SIDM will be easier to falsify than CDM using low-mass galaxies. Our FIRE simulations predict that galaxies less massive than M⋆ ≲ 3 × 106 M⊙ provide potentially ideal targets for discriminating models, with SIDM producing substantial cores in such tiny galaxies and CDM producing cusps.

A remarkable adsorbent for removal of contaminants of emerging concern from water: Porous carbon derived from metal azolate framework-6.

PubMed

Bhadra, Biswa Nath; Jhung, Sung Hwa

2017-10-15

A series of metal-azolate frameworks or MAFs-MAF-4, -5, and -6-were synthesized and pyrolyzed to prepare porous carbons derived from MAFs (CDM-4, -5, -6, respectively). Not only the obtained carbons but also MAFs were characterized and applied for the adsorption of organic contaminants of emerging concern (CECs, including pharmaceuticals and personal care products) such as salicylic acid, clofibric acid, diclofenac sodium, bisphenol-A, and oxybenzone (OXB) from water. CDM-6 was found to be the most remarkable adsorbent among the tested ones (including activated carbon) for all the adsorbates. OXB was taken as a representative adsorbate for detailed adsorption studies as well as understanding the adsorption mechanism. H-bonding (H-acceptor: CDM; H-donor: CECs) was suggested as the principal mechanism for the adsorption of tested adsorbates. Finally, CDMs, especially CDM-6, were suggested as highly efficient and easily recyclable adsorbents for water purification. Copyright © 2017 Elsevier B.V. All rights reserved.

Non-local gravity and comparison with observational datasets. II. Updated results and Bayesian model comparison with ΛCDM

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

Dirian, Yves; Foffa, Stefano; Kunz, Martin

We present a comprehensive and updated comparison with cosmological observations of two non-local modifications of gravity previously introduced by our group, the so called RR and RT models. We implement the background evolution and the cosmological perturbations of the models in a modified Boltzmann code, using CLASS. We then test the non-local models against the Planck 2015 TT, TE, EE and Cosmic Microwave Background (CMB) lensing data, isotropic and anisotropic Baryonic Acoustic Oscillations (BAO) data, JLA supernovae, H {sub 0} measurements and growth rate data, and we perform Bayesian parameter estimation. We then compare the RR, RT and ΛCDM models,more » using the Savage-Dickey method. We find that the RT model and ΛCDM perform equally well, while the performance of the RR model with respect to ΛCDM depends on whether or not we include a prior on H {sub 0} based on local measurements.« less

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

Simard, G.; et al.

We report constraints on cosmological parameters from the angular power spectrum of a cosmic microwave background (CMB) gravitational lensing potential map created using temperature data from 2500 degmore » $^2$ of South Pole Telescope (SPT) data supplemented with data from Planck in the same sky region, with the statistical power in the combined map primarily from the SPT data. We fit the corresponding lensing angular power spectrum to a model including cold dark matter and a cosmological constant ($$\\Lambda$$CDM), and to models with single-parameter extensions to $$\\Lambda$$CDM. We find constraints that are comparable to and consistent with constraints found using the full-sky Planck CMB lensing data. Specifically, we find $$\\sigma_8 \\Omega_{\\rm m}^{0.25}=0.598 \\pm 0.024$$ from the lensing data alone with relatively weak priors placed on the other $$\\Lambda$$CDM parameters. In combination with primary CMB data from Planck, we explore single-parameter extensions to the $$\\Lambda$$CDM model. We find $$\\Omega_k = -0.012^{+0.021}_{-0.023}$$ or $$M_{\

A review of instruments to measure interprofessional collaboration for chronic disease management for community-living older adults.

PubMed

Bookey-Bassett, Sue; Markle-Reid, Maureen; McKey, Colleen; Akhtar-Danesh, Noori

2016-01-01

It is acknowledged internationally that chronic disease management (CDM) for community-living older adults (CLOA) is an increasingly complex process. CDM for older adults, who are often living with multiple chronic conditions, requires coordination of various health and social services. Coordination is enabled through interprofessional collaboration (IPC) among individual providers, community organizations, and health sectors. Measuring IPC is complicated given there are multiple conceptualisations and measures of IPC. A literature review of several healthcare, psychological, and social science electronic databases was conducted to locate instruments that measure IPC at the team level and have published evidence of their reliability and validity. Five instruments met the criteria and were critically reviewed to determine their strengths and limitations as they relate to CDM for CLOA. A comparison of the characteristics, psychometric properties, and overall concordance of each instrument with salient attributes of IPC found the Collaborative Practice Assessment Tool to be the most appropriate instrument for measuring IPC for CDM in CLOA.

Theoretical implications of the galactic radial acceleration relation of McGaugh, Lelli, and Schombert

NASA Astrophysics Data System (ADS)

Nesbet, Robert K.

2018-05-01

Velocities in stable circular orbits about galaxies, a measure of centripetal gravitation, exceed the expected Kepler/Newton velocity as orbital radius increases. Standard Λ cold dark matter (ΛCDM) attributes this anomaly to galactic dark matter. McGaugh et al. have recently shown for 153 disc galaxies that observed radial acceleration is an apparently universal function of classical acceleration computed for observed galactic baryonic mass density. This is consistent with the empirical modified Newtonian dynamics (MOND) model, not requiring dark matter. It is shown here that suitably constrained ΛCDM and conformal gravity (CG) also produce such a universal correlation function. ΛCDM requires a very specific dark matter distribution, while the implied CG non-classical acceleration must be independent of galactic mass. All three constrained radial acceleration functions agree with the empirical baryonic v4 Tully-Fisher relation. Accurate rotation data in the nominally flat velocity range could distinguish between MOND, ΛCDM, and CG.

Mortality of patients with COPD participating in chronic disease management programmes: a happy end?

PubMed

Peytremann-Bridevaux, I; Taffe, P; Burnand, B; Bridevaux, P O; Puhan, M A

2014-09-01

Concerns about increased mortality could question the role of COPD chronic disease management (CDM) programmes. We aimed at extending a recent Cochrane review to assess the effects of CDM on mortality in patients with COPD. Mortality data were available for 25 out of 29 trials identified in a COPD integrated care systematic review. Meta-analysis using random-effects models was performed, followed by subgroup analyses according to study length (3-12 months vs >12 months), main intervention component (exercise, self-management, structured follow-up) and use of an action plan. The meta-analysis showed no impact of CDM on mortality (pooled OR: 1.00, 95% CI 0.79 to 1.28). These results do not suggest that CDM programmes expose patients with COPD to excessive mortality risk. 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.

Ocular Chromatic Aberrations and Their Effects on Polychromatic Retinal Image Quality

NASA Astrophysics Data System (ADS)

Zhang, Xiaoxiao

Previous studies of ocular chromatic aberrations have concentrated on chromatic difference of focus (CDF). Less is known about the chromatic difference of image position (CDP) in the peripheral retina and no experimental attempt has been made to measure the ocular chromatic difference of magnification (CDM). Consequently, theoretical modelling of human eyes is incomplete. The insufficient knowledge of ocular chromatic aberrations is partially responsible for two unsolved applied vision problems: (1) how to improve vision by correcting ocular chromatic aberration? (2) what is the impact of ocular chromatic aberration on the use of isoluminance gratings as a tool in spatial-color vision?. Using optical ray tracing methods, MTF analysis methods of image quality, and psychophysical methods, I have developed a more complete model of ocular chromatic aberrations and their effects on vision. The ocular CDM was determined psychophysically by measuring the tilt in the apparent frontal parallel plane (AFPP) induced by interocular difference in image wavelength. This experimental result was then used to verify a theoretical relationship between the ocular CDM, the ocular CDF and the entrance pupil of the eye. In the retinal image after correcting the ocular CDF with existing achromatizing methods, two forms of chromatic aberration (CDM and chromatic parallax) were examined. The CDM was predicted by theoretical ray tracing and measured with the same method used to determine ocular CDM. The chromatic parallax was predicted with a nodal ray model and measured with the two-color vernier alignment method. The influence of these two aberrations on polychromatic MTF were calculated. Using this improved model of ocular chromatic aberration, luminance artifacts in the images of isoluminance gratings were calculated. The predicted luminance artifacts were then compared with experimental data from previous investigators. The results show that: (1) A simple relationship exists between two major chromatic aberrations and the location of the pupil; (2) The ocular CDM is measurable and varies among individuals; (3) All existing methods to correct ocular chromatic aberration face another aberration, chromatic parallax, which is inherent in the methodology; (4) Ocular chromatic aberrations have the potential to contaminate psychophysical experimental results on human spatial-color vision.

Testing cold dark matter models using Hubble flow variations

NASA Astrophysics Data System (ADS)

Shi, Xiangdong

1999-05-01

COBE-normalized flat (matter plus cosmological constant) and open cold dark matter (CDM) models are tested by comparing their expected Hubble flow variations and the observed variations in a Type Ia supernova sample and a Tully-Fisher cluster sample. The test provides a probe of the CDM power spectrum on scales of 0.02h Mpc^-1<~ k<~ 0.2h Mpc^-1, free of the bias factor b. The results favour a low matter content universe, or a flat matter-dominated universe with a very low Hubble constant and/or a very small spectral index n^ps, with the best fits having Ο_0~ 0.3 to 0.4. The test is found to be more discriminative to the open CDM models than to the flat CDM models. For example, the test results are found to be compatible with those from the X-ray cluster abundance measurements at smaller length-scales, and consistent with the galaxy and cluster correlation analysis of Peacock & Dodds at similar length-scales, if our universe is flat; but the results are marginally incompatible with the X-ray cluster abundance measurements if our universe is open. The open CDM results are consistent with that of Peacock & Dodds only if the matter density of the universe is less than about 60 per cent of the critical density. The shortcoming of the test is discussed, so are ways to minimize it.

Constraints on Dark Energy from Baryon Acoustic Peak and Galaxy Cluster Gas Mass Measurements

NASA Astrophysics Data System (ADS)

Samushia, Lado; Ratra, Bharat

2009-10-01

We use baryon acoustic peak measurements by Eisenstein et al. and Percival et al., together with the Wilkinson Microwave Anisotropy Probe (WMAP) measurement of the apparent acoustic horizon angle, and galaxy cluster gas mass fraction measurements of Allen et al., to constrain a slowly rolling scalar field dark energy model, phiCDM, in which dark energy's energy density changes in time. We also compare our phiCDM results with those derived for two more common dark energy models: the time-independent cosmological constant model, ΛCDM, and the XCDM parameterization of dark energy's equation of state. For time-independent dark energy, the Percival et al. measurements effectively constrain spatial curvature and favor a close to the spatially flat model, mostly due to the WMAP cosmic microwave background prior used in the analysis. In a spatially flat model the Percival et al. data less effectively constrain time-varying dark energy. The joint baryon acoustic peak and galaxy cluster gas mass constraints on the phiCDM model are consistent with but tighter than those derived from other data. A time-independent cosmological constant in a spatially flat model provides a good fit to the joint data, while the α parameter in the inverse power-law potential phiCDM model is constrained to be less than about 4 at 3σ confidence level.

CDM analysis

NASA Technical Reports Server (NTRS)

Larson, Robert E.; Mcentire, Paul L.; Oreilly, John G.

1993-01-01

The C Data Manager (CDM) is an advanced tool for creating an object-oriented database and for processing queries related to objects stored in that database. The CDM source code was purchased and will be modified over the course of the Arachnid project. In this report, the modified CDM is referred to as MCDM. Using MCDM, a detailed series of experiments was designed and conducted on a Sun Sparcstation. The primary results and analysis of the CDM experiment are provided in this report. The experiments involved creating the Long-form Faint Source Catalog (LFSC) database and then analyzing it with respect to following: (1) the relationships between the volume of data and the time required to create a database; (2) the storage requirements of the database files; and (3) the properties of query algorithms. The effort focused on defining, implementing, and analyzing seven experimental scenarios: (1) find all sources by right ascension--RA; (2) find all sources by declination--DEC; (3) find all sources in the right ascension interval--RA1, RA2; (4) find all sources in the declination interval--DEC1, DEC2; (5) find all sources in the rectangle defined by--RA1, RA2, DEC1, DEC2; (6) find all sources that meet certain compound conditions; and (7) analyze a variety of query algorithms. Throughout this document, the numerical results obtained from these scenarios are reported; conclusions are presented at the end of the document.

Myotonic dystrophy type 1: clinical manifestations in children and adolescents.

PubMed

Ho, Genevieve; Carey, Kate A; Cardamone, Michael; Farrar, Michelle A

2018-06-05

Myotonic dystrophy type 1 (DM1) is an autosomal-dominant neuromuscular disease with variable severity affecting all ages; however, current care guidelines are adult-focused. The objective of the present study was to profile DM1 in childhood and propose a framework to guide paediatric-focused management. 40 children with DM1 (mean age 12.8 years; range 2-19) were studied retrospectively for a total of 513 follow-up years at Sydney Children's Hospital. 143 clinical parameters were recorded. The clinical spectrum of disease in childhood differs from adults, with congenital myotonic dystrophy (CDM1) having more severe health issues than childhood-onset/juvenile patients (JDM1). Substantial difficulties with intellectual (CDM1 25/26 96.2%; JDM1 9/10, 90.0%), fine motor (CDM1 23/30, 76.6%; JDM1 6/10, 60.0%), gastrointestinal (CDM1 17/30, 70.0%; JDM1 3/10, 30.0%) and neuromuscular function (CDM1 30/30, 100.0%; JDM1 25/30, 83.3%) were evident. The health consequences of DM1 in childhood are diverse, highlighting the need for paediatric multidisciplinary management approaches that encompass key areas of cognition, musculoskeletal, gastrointestinal, respiratory, cardiac and sleep issues. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The planes of satellite galaxies problem, suggested solutions, and open questions

NASA Astrophysics Data System (ADS)

Pawlowski, Marcel S.

2018-02-01

Satellite galaxies of the Milky Way and of the Andromeda galaxy have been found to preferentially align in significantly flattened planes of satellite galaxies, and available velocity measurements are indicative of a preference of satellites in those structures to co-orbit. There is an increasing evidence that such kinematically correlated satellite planes are also present around more distant hosts. Detailed comparisons show that similarly anisotropic phase-space distributions of sub-halos are exceedingly rare in cosmological simulations based on the ΛCDM paradigm. Analogs to the observed systems have frequencies of ≤ 0.5% in such simulations. In contrast to other small-scale problems, the satellite planes issue is not strongly affected by baryonic processes because the distribution of sub-halos on scales of hundreds of kpc is dominated by gravitational effects. This makes the satellite planes one of the most serious small-scale problems for ΛCDM. This review summarizes the observational evidence for planes of satellite galaxies in the Local Group and beyond, and provides an overview of how they compare to cosmological simulations. It also discusses scenarios which aim at explaining the coherence of satellite positions and orbits, and why they all are currently unable to satisfactorily resolve the issue.

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

Couth, R.; Trois, C., E-mail: troisc@ukzn.ac.za

Highlights: Black-Right-Pointing-Pointer This is a compendium on GHG reductions via improved waste strategies in Africa. Black-Right-Pointing-Pointer This note provides a strategic framework for Local Authorities in Africa. Black-Right-Pointing-Pointer Assists LAs to select Zero Waste scenarios and achieve sustained GHG reduction. - Abstract: Only few Clean Development Mechanism (CDM) projects (traditionally focussed on landfill gas combustion) have been registered in Africa if compared to similar developing countries. The waste hierarchy adopted by many African countries clearly shows that waste recycling and composting projects are generally the most sustainable. This paper undertakes a sustainability assessment for practical waste treatment and disposal scenariosmore » for Africa and makes recommendations for consideration. The appraisal in this paper demonstrates that mechanical biological treatment of waste becomes more financially attractive if established through the CDM process. Waste will continue to be dumped in Africa with increasing greenhouse gas emissions produced, unless industrialised countries (Annex 1) fund carbon emission reduction schemes through a replacement to the Kyoto Protocol. Such a replacement should calculate all of the direct and indirect carbon emission savings and seek to promote public-private partnerships through a concerted support of the informal sector.« less

MODULATING EFFECT OF BODY TEMPERATURE ON THE TOXIC RESPONSE PRODUCED BY THE PESTICIDE CHLORIDEMEFORM IN RATS

EPA Science Inventory

Previous studies from this laboratory have demonstrated significant deficits in cardiovascular function in rats exposed to the pesticide chlordimeform (CDM) when body core temperature (Tco) was maintained at 37oC. o investigate the role of Tco on CDM toxicity, similar experiments...

Enhanced Emission Efficiency in Organic Light-Emitting Diodes Using Deoxyribonucleic Acid Complex as an Electron Blocking Layer

DTIC Science & Technology

2006-04-28

1. Color online Photographs of EL emission from several devices: a green Alq3 baseline OLED at 25 V 707 mA/cm2—590 cd/m2, 0.35 cd/A; b green... Alq3 BioLED with DNA EBL at 25 V 308 mA/cm2—21 100 cd/m2, 6.56 cd/A; c blue NPB baseline OLED at 20 V 460 mA/cm2—700 cd/m2, 0.14 cd/A; d blue...al. Appl. Phys. Lett. 88, 171109 2006NPB N ,N-bisnaphthalene-1-yl-N ,N-bisphenyl benzi- dine hole transport layer HTL; Alq3 tris-8

CDM: Teaching Discrete Mathematics to Computer Science Majors

ERIC Educational Resources Information Center

Sutner, Klaus

2005-01-01

CDM, for computational discrete mathematics, is a course that attempts to teach a number of topics in discrete mathematics to computer science majors. The course abandons the classical definition-theorem-proof model, and instead relies heavily on computation as a source of motivation and also for experimentation and illustration. The emphasis on…

GDINA and CDM Packages in R

ERIC Educational Resources Information Center

Rupp, André A.; van Rijn, Peter W.

2018-01-01

We review the GIDNA and CDM packages in R for fitting cognitive diagnosis/diagnostic classification models. We first provide a summary of their core capabilities and then use both simulated and real data to compare their functionalities in practice. We found that the most relevant routines in the two packages appear to be more similar than…

Higgs-dilaton cosmology: An inflation-dark-energy connection and forecasts for future galaxy surveys

NASA Astrophysics Data System (ADS)

Casas, Santiago; Pauly, Martin; Rubio, Javier

2018-02-01

The Higgs-dilaton model is a scale-invariant extension of the Standard Model nonminimally coupled to gravity and containing just one additional degree of freedom on top of the Standard Model particle content. This minimalistic scenario predicts a set of measurable consistency relations between the inflationary observables and the dark-energy equation-of-state parameter. We present an alternative derivation of these consistency relations that highlights the connections and differences with the α -attractor scenario. We study how far these constraints allow one to distinguish the Higgs-dilaton model from Λ CDM and w CDM cosmologies. To this end we first analyze existing data sets using a Markov chain Monte Carlo approach. Second, we perform forecasts for future galaxy surveys using a Fisher matrix approach, both for galaxy clustering and weak lensing probes. Assuming that the best fit values in the different models remain comparable to the present ones, we show that both Euclid- and SKA2-like missions will be able to discriminate a Higgs-dilaton cosmology from Λ CDM and w CDM .

The formation of cosmic structure in a texture-seeded cold dark matter cosmogony

NASA Technical Reports Server (NTRS)

Gooding, Andrew K.; Park, Changbom; Spergel, David N.; Turok, Neil; Gott, Richard, III

1992-01-01

The growth of density fluctuations induced by global texture in an Omega = 1 cold dark matter (CDM) cosmogony is calculated. The resulting power spectra are in good agreement with each other, with more power on large scales than in the standard inflation plus CDM model. Calculation of related statistics (two-point correlation functions, mass variances, cosmic Mach number) indicates that the texture plus CDM model compares more favorably than standard CDM with observations of large-scale structure. Texture produces coherent velocity fields on large scales, as observed. Excessive small-scale velocity dispersions, and voids less empty than those observed may be remedied by including baryonic physics. The topology of the cosmic structure agrees well with observation. The non-Gaussian texture induced density fluctuations lead to earlier nonlinear object formation than in Gaussian models and may also be more compatible with recent evidence that the galaxy density field is non-Gaussian on large scales. On smaller scales the density field is strongly non-Gaussian, but this appears to be primarily due to nonlinear gravitational clustering. The velocity field on smaller scales is surprisingly Gaussian.

The Case for Chronic Disease Management for Addiction

PubMed Central

Saitz, Richard; Larson, Mary Jo; LaBelle, Colleen; Richardson, Jessica; Samet, Jeffrey H.

2009-01-01

Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care—elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective. PMID:19809579

Constraints on Cosmological Parameters from the Angular Power Spectrum of a Combined 2500 deg$^2$ SPT-SZ and Planck Gravitational Lensing Map

DOE PAGES

Simard, G.; et al.

2018-06-20

We report constraints on cosmological parameters from the angular power spectrum of a cosmic microwave background (CMB) gravitational lensing potential map created using temperature data from 2500 degmore » $^2$ of South Pole Telescope (SPT) data supplemented with data from Planck in the same sky region, with the statistical power in the combined map primarily from the SPT data. We fit the corresponding lensing angular power spectrum to a model including cold dark matter and a cosmological constant ($$\\Lambda$$CDM), and to models with single-parameter extensions to $$\\Lambda$$CDM. We find constraints that are comparable to and consistent with constraints found using the full-sky Planck CMB lensing data. Specifically, we find $$\\sigma_8 \\Omega_{\\rm m}^{0.25}=0.598 \\pm 0.024$$ from the lensing data alone with relatively weak priors placed on the other $$\\Lambda$$CDM parameters. In combination with primary CMB data from Planck, we explore single-parameter extensions to the $$\\Lambda$$CDM model. We find $$\\Omega_k = -0.012^{+0.021}_{-0.023}$$ or $$M_{\

Influence of confinement layers in the emitting layer of the blue phosphorescent organic light-emitting diodes

NASA Astrophysics Data System (ADS)

Ji, Chang-Yan; Gu, Zheng-Tian; Kou, Zhi-Qi

2016-10-01

The electrical and optical properties of the blue phosphorescent organic light-emitting diodes (PHOLEDs) can be affected by the various structure of confinement layer in the emitting layer (EML). A series of devices with different electron or hole confinement layer (TCTA or Bphen) are fabricated, it is more effective to balance charge carriers injection for the device with the double electron confinement layers structure, the power efficiency and luminance can reach 17.7 lm/W (at 103 cd/m2) and 3536 cd/m2 (at 8 V). In case of the same double electron confinement layers, another series of devices with different profile of EML are fabricated by changing the confinement layers position, the power efficiency and luminance can be improved to 21.7 lm/W (at 103 cd/m2) and 7674 cd/m2 (at 8 V) when the thickness of EML separated by confinement layers increases gradually from the hole injection side to the electron injection side, the driving voltage can also be reduced.

Constraints on Cosmological Parameters from the Angular Power Spectrum of a Combined 2500 deg$^2$ SPT-SZ and Planck Gravitational Lensing Map

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

Simard, G.; et al.

We report constraints on cosmological parameters from the angular power spectrum of a cosmic microwave background (CMB) gravitational lensing potential map created using temperature data from 2500 degmore » $^2$ of South Pole Telescope (SPT) data supplemented with data from Planck in the same sky region, with the statistical power in the combined map primarily from the SPT data. We fit the corresponding lensing angular power spectrum to a model including cold dark matter and a cosmological constant ($$\\Lambda$$CDM), and to models with single-parameter extensions to $$\\Lambda$$CDM. We find constraints that are comparable to and consistent with constraints found using the full-sky Planck CMB lensing data. Specifically, we find $$\\sigma_8 \\Omega_{\\rm m}^{0.25}=0.598 \\pm 0.024$$ from the lensing data alone with relatively weak priors placed on the other $$\\Lambda$$CDM parameters. In combination with primary CMB data from Planck, we explore single-parameter extensions to the $$\\Lambda$$CDM model. We find $$\\Omega_k = -0.012^{+0.021}_{-0.023}$$ or $$M_{\

Can the Λ CDM model reproduce MOND-like behavior?

NASA Astrophysics Data System (ADS)

Dai, De-Chang; Lu, Chunyu

2017-12-01

It is usually believed that MOND can describe the galactic rotational curves with only baryonic matter and without any dark matter very well, while the Λ CDM model is expected to have difficulty in reproducing MOND-like behavior. Here, we use EAGLE's data to learn whether the Λ CDM model can reproduce MOND-like behavior. EAGLE's simulation result clearly reproduces the MOND-like behavior for ab⪆10-12 m/s 2 at z =0 , although the acceleration constant, a0, is a little larger than the observational data indicate. We find that a0 increases with the redshift in a way different from what Milgrom proposed (a0∝H ). Therefore, while galaxy rotation curves can be fitted by MOND's empirical function in the Λ CDM model, there is no clear connection between a0 and the Hubble constant. We also find that a0 at z ⪆1 is well separated from a0 at z =0 . Once we have enough galaxies observed at high redshifts, we will be able to rule out the modified gravity model based on MOND-like empirical function with a z -independent a0.

Benefits of clean development mechanism application on the life cycle assessment perspective: a case study in the palm oil industry.

PubMed

Chuen, Onn Chiu; Yusoff, Sumiani

2012-03-01

This study performed an assessment on the beneficial of the Clean Development Mechanism (CDM) application on waste treatment system in a local palm oil industry in Malaysia. Life cycle assessment (LCA) was conducted to assess the environmental impacts of the greenhouse gas (GHG) reduction from the CDM application. Calculations on the emission reduction used the methodology based on AM002 (Avoided Wastewater and On-site Energy Use Emissions in the Industrial Sector) Version 4 published by United Nations Framework Convention on Climate Change (UNFCC). The results from the studies showed that the introduction of CDM in the palm oil mill through conversion of the captured biogas from palm oil mill effluent (POME) treatment into power generation were able to reduce approximate 0.12 tonnes CO2 equivalent concentration (tCO2e) emission and 30 kW x hr power generation per 1 tonne of fresh fruit bunch processed. Thus, the application of CDM methodology on palm oil mill wastewater treatment was able to reduce up to 1/4 of the overall environment impact generated in palm oil mill.

Modeling of Stone-impact Resistance of Monolithic Glass Ply Using Continuum Damage Mechanics

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

Sun, Xin; Khaleel, Mohammad A.; Davies, Richard W.

2005-04-01

We study the stone-impact resistance of a monolithic glass ply using a combined experimental and computational approach. Instrumented stone impact tests were first carried out in controlled environment. Explicit finite element analyses were then used to simulate the interactions of the indentor and the glass layer during the impact event, and a continuum damage mechanics (CDM) model was used to describe the constitutive behavior of glass. The experimentally measured strain histories for low velocity impact served as validation of the modeling procedures. Next, stair-stepping impact experiments were performed with two indentor sizes on two glass ply thickness, and the testmore » results were used to calibrate the critical stress parameters used in the CDM constitutive model. The purpose of this study is to establish the modeling procedures and the CDM critical stress parameters under impact loading conditions. The modeling procedures and the CDM model will be used in our future studies to predict through-thickness damage evolution patterns for different laminated windshield designs in automotive applications.« less

Validation of a common data model for active safety surveillance research

PubMed Central

Ryan, Patrick B; Reich, Christian G; Hartzema, Abraham G; Stang, Paul E

2011-01-01

Objective Systematic analysis of observational medical databases for active safety surveillance is hindered by the variation in data models and coding systems. Data analysts often find robust clinical data models difficult to understand and ill suited to support their analytic approaches. Further, some models do not facilitate the computations required for systematic analysis across many interventions and outcomes for large datasets. Translating the data from these idiosyncratic data models to a common data model (CDM) could facilitate both the analysts' understanding and the suitability for large-scale systematic analysis. In addition to facilitating analysis, a suitable CDM has to faithfully represent the source observational database. Before beginning to use the Observational Medical Outcomes Partnership (OMOP) CDM and a related dictionary of standardized terminologies for a study of large-scale systematic active safety surveillance, the authors validated the model's suitability for this use by example. Validation by example To validate the OMOP CDM, the model was instantiated into a relational database, data from 10 different observational healthcare databases were loaded into separate instances, a comprehensive array of analytic methods that operate on the data model was created, and these methods were executed against the databases to measure performance. Conclusion There was acceptable representation of the data from 10 observational databases in the OMOP CDM using the standardized terminologies selected, and a range of analytic methods was developed and executed with sufficient performance to be useful for active safety surveillance. PMID:22037893

Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

PubMed

Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

2017-01-01

Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P =0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P =0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P =0.014, and R 2 =0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Estimating the Recurrence Rate of Gestational Diabetes Mellitus (GDM) in Massachusetts 1998-2007: Methods and Findings.

PubMed

England, Lucinda; Kotelchuck, Milton; Wilson, Hoyt G; Diop, Hafsatou; Oppedisano, Paul; Kim, Shin Y; Cui, Xiaohui; Shapiro-Mendoza, Carrie K

2015-10-01

Women with gestational diabetes mellitus (GDM) may be able to reduce their risk of recurrent GDM and progression to type 2 diabetes mellitus through lifestyle change; however, there is limited population-based information on GDM recurrence rates. We used data from a population of women delivering two sequential live singleton infants in Massachusetts (1998-2007) to estimate the prevalence of chronic diabetes mellitus (CDM) and GDM in parity one pregnancies and recurrence of GDM and progression from GDM to CDM in parity two pregnancies. We examined four diabetes classification approaches; birth certificate (BC) data alone, hospital discharge (HD) data alone, both sources hierarchically combined with a diagnosis of CDM from either source taking priority over a diagnosis of GDM, and both sources combined including only pregnancies with full agreement in diagnosis. Descriptive statistics were used to describe population characteristics, prevalence of CDM and GDM, and recurrence of diabetes in successive pregnancies. Diabetes classification agreement was assessed using the Kappa statistic. Associated maternal characteristics were examined through adjusted model-based t tests and Chi square tests. A total of 134,670 women with two sequential deliveries of parities one and two were identified. While there was only slight agreement on GDM classification across HD and BC records, estimates of GDM recurrence were fairly consistent; nearly half of women with GDM in their parity one pregnancy developed GDM in their subsequent pregnancy. While estimates of progression from GDM to CDM across sequential pregnancies were more variable, all approaches yielded estimates of ≤5 %. The development of either GDM or CDM following a parity one pregnancy with no diagnosis of diabetes was <3 % across approaches. Women with recurrent GDM were disproportionately older and foreign born. Recurrent GDM is a serious life course public health issue; the inter-pregnancy interval provides an important window for diabetes prevention.

WHAT ARE THE Omh {sup 2} ( z {sub 1}, z {sub 2}) AND Om ( z {sub 1}, z {sub 2}) DIAGNOSTICS TELLING US IN LIGHT OF H ( z ) DATA?

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

Zheng, Xiaogang; Ding, Xuheng; Biesiada, Marek

2016-07-01

The two-point diagnostics Om ( z {sub i} , z {sub j} ) and Omh {sup 2}( z {sub i} , z {sub j} ) have been introduced as an interesting tool for testing the validity of the Λ cold dark matter (ΛCDM) model. Recently, Sahni et al. combined two independent measurements of H ( z ) from baryon acoustic oscillation (BAO) data with the value of the Hubble constant H {sub 0}, and used the second of these diagnostics to test the ΛCDM (a constant equation-of-state parameter for dark energy) model. Their result indicated a considerable tension between observationsmore » and predictions of the ΛCDM model. Since reliable data concerning the expansion rates of the universe at different redshifts H ( z ) are crucial for the successful application of this method, we investigate both two-point diagnostics on the most comprehensive set of N = 36 measurements of H ( z ) from BAOs and the differential ages (DAs) of passively evolving galaxies. We discuss the uncertainties of the two-point diagnostics and find that they are strongly non-Gaussian and follow the patterns deeply rooted in their very construction. Therefore we propose that non-parametric median statistics is the most appropriate way of treating this problem. Our results support the claims that ΛCDM is in tension with H ( z ) data according to the two-point diagnostics developed by Shafieloo, Sahni, and Starobinsky. However, other alternatives to the ΛCDM model, such as the wCDM or Chevalier–Polarski–Linder models, perform even worse. We also note that there are serious systematic differences between the BAO and DA methods that ought to be better understood before H ( z ) measurements can compete with other probes methods.« less

Dark Energy Survey Year 1 Results: Cosmological Constraints from Galaxy Clustering and Weak Lensing

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

Abbott, T.M.C.; et al.

We present cosmological results from a combined analysis of galaxy clustering and weak gravitational lensing, using 1321 degmore » $^2$ of $griz$ imaging data from the first year of the Dark Energy Survey (DES Y1). We combine three two-point functions: (i) the cosmic shear correlation function of 26 million source galaxies in four redshift bins, (ii) the galaxy angular autocorrelation function of 650,000 luminous red galaxies in five redshift bins, and (iii) the galaxy-shear cross-correlation of luminous red galaxy positions and source galaxy shears. To demonstrate the robustness of these results, we use independent pairs of galaxy shape, photometric redshift estimation and validation, and likelihood analysis pipelines. To prevent confirmation bias, the bulk of the analysis was carried out while blind to the true results; we describe an extensive suite of systematics checks performed and passed during this blinded phase. The data are modeled in flat $$\\Lambda$$CDM and $w$CDM cosmologies, marginalizing over 20 nuisance parameters, varying 6 (for $$\\Lambda$$CDM) or 7 (for $w$CDM) cosmological parameters including the neutrino mass density and including the 457 $$\\times$$ 457 element analytic covariance matrix. We find consistent cosmological results from these three two-point functions, and from their combination obtain $$S_8 \\equiv \\sigma_8 (\\Omega_m/0.3)^{0.5} = 0.783^{+0.021}_{-0.025}$$ and $$\\Omega_m = 0.264^{+0.032}_{-0.019}$$ for $$\\Lambda$$CDM for $w$CDM, we find $$S_8 = 0.794^{+0.029}_{-0.027}$$, $$\\Omega_m = 0.279^{+0.043}_{-0.022}$$, and $$w=-0.80^{+0.20}_{-0.22}$$ at 68% CL. The precision of these DES Y1 results rivals that from the Planck cosmic microwave background measurements, allowing a comparison of structure in the very early and late Universe on equal terms. Although the DES Y1 best-fit values for $$S_8$$ and $$\\Omega_m$$ are lower than the central values from Planck ...« less

Regulation of decellularized tissue remodeling via scaffold-mediated lentiviral delivery in anatomically-shaped osteochondral constructs.

PubMed

Rowland, Christopher R; Glass, Katherine A; Ettyreddy, Adarsh R; Gloss, Catherine C; Matthews, Jared R L; Huynh, Nguyen P T; Guilak, Farshid

2018-05-30

Cartilage-derived matrix (CDM) has emerged as a promising scaffold material for tissue engineering of cartilage and bone due to its native chondroinductive capacity and its ability to support endochondral ossification. Because it consists of native tissue, CDM can undergo cellular remodeling, which can promote integration with host tissue and enables it to be degraded and replaced by neotissue over time. However, enzymatic degradation of decellularized tissues can occur unpredictably and may not allow sufficient time for mechanically competent tissue to form, especially in the harsh inflammatory environment of a diseased joint. The goal of the current study was to engineer cartilage and bone constructs with the ability to inhibit aberrant inflammatory processes caused by the cytokine interleukin-1 (IL-1), through scaffold-mediated delivery of lentiviral particles containing a doxycycline-inducible IL-1 receptor antagonist (IL-1Ra) transgene on anatomically-shaped CDM constructs. Additionally, scaffold-mediated lentiviral gene delivery was used to facilitate spatial organization of simultaneous chondrogenic and osteogenic differentiation via site-specific transduction of a single mesenchymal stem cell (MSC) population to overexpress either chondrogenic, transforming growth factor-beta 3 (TGF-β3), or osteogenic, bone morphogenetic protein-2 (BMP-2), transgenes. Controlled induction of IL-1Ra expression protected CDM hemispheres from inflammation-mediated degradation, and supported robust bone and cartilage tissue formation even in the presence of IL-1. In the absence of inflammatory stimuli, controlled cellular remodeling was exploited as a mechanism for fusing concentric CDM hemispheres overexpressing BMP-2 and TGF-β3 into a single bi-layered osteochondral construct. Our findings demonstrate that site-specific delivery of inducible and tunable transgenes confers spatial and temporal control over both CDM scaffold remodeling and neotissue composition. Furthermore, these constructs provide a microphysiological in vitro joint organoid model with site-specific, tunable, and inducible protein delivery systems for examining the spatiotemporal response to pro-anabolic and/or inflammatory signaling across the osteochondral interface. Copyright © 2018 Elsevier Ltd. All rights reserved.

CMB-S4 and the hemispherical variance anomaly

NASA Astrophysics Data System (ADS)

O'Dwyer, Márcio; Copi, Craig J.; Knox, Lloyd; Starkman, Glenn D.

2017-09-01

Cosmic microwave background (CMB) full-sky temperature data show a hemispherical asymmetry in power nearly aligned with the Ecliptic. In real space, this anomaly can be quantified by the temperature variance in the Northern and Southern Ecliptic hemispheres, with the Northern hemisphere displaying an anomalously low variance while the Southern hemisphere appears unremarkable [consistent with expectations from the best-fitting theory, Lambda Cold Dark Matter (ΛCDM)]. While this is a well-established result in temperature, the low signal-to-noise ratio in current polarization data prevents a similar comparison. This will change with a proposed ground-based CMB experiment, CMB-S4. With that in mind, we generate realizations of polarization maps constrained by the temperature data and predict the distribution of the hemispherical variance in polarization considering two different sky coverage scenarios possible in CMB-S4: full Ecliptic north coverage and just the portion of the North that can be observed from a ground-based telescope at the high Chilean Atacama plateau. We find that even in the set of realizations constrained by the temperature data, the low Northern hemisphere variance observed in temperature is not expected in polarization. Therefore, observing an anomalously low variance in polarization would make the hypothesis that the temperature anomaly is simply a statistical fluke more unlikely and thus increase the motivation for physical explanations. We show, within ΛCDM, how variance measurements in both sky coverage scenarios are related. We find that the variance makes for a good statistic in cases where the sky coverage is limited, however, full northern coverage is still preferable.

Cosmological perturbation theory for baryons and dark matter: One-loop corrections in the renormalized perturbation theory framework

NASA Astrophysics Data System (ADS)

Somogyi, Gábor; Smith, Robert E.

2010-01-01

We generalize the renormalized perturbation theory (RPT) formalism of Crocce and Scoccimarro [M. Crocce and R. Scoccimarro, Phys. Rev. DPRVDAQ1550-7998 73, 063519 (2006)10.1103/PhysRevD.73.063519] to deal with multiple fluids in the Universe and here we present the complete calculations up to the one-loop level in the RPT. We apply this approach to the problem of following the nonlinear evolution of baryon and cold dark matter (CDM) perturbations, evolving from the distinct sets of initial conditions, from the high redshift post-recombination Universe right through to the present day. In current theoretical and numerical models of structure formation, it is standard practice to treat baryons and CDM as an effective single matter fluid—the so-called dark matter only modeling. In this approximation, one uses a weighed sum of late-time baryon and CDM transfer functions to set initial mass fluctuations. In this paper we explore whether this approach can be employed for high precision modeling of structure formation. We show that, even if we only follow the linear evolution, there is a large-scale scale-dependent bias between baryons and CDM for the currently favored WMAP5 ΛCDM model. This time evolving bias is significant (>1%) until the present day, when it is driven towards unity through gravitational relaxation processes. Using the RPT formalism we test this approximation in the nonlinear regime. We show that the nonlinear CDM power spectrum in the two-component fluid differs from that obtained from an effective mean-mass one-component fluid by ˜3% on scales of order k˜0.05hMpc-1 at z=10, and by ˜0.5% at z=0. However, for the case of the nonlinear evolution of the baryons the situation is worse and we find that the power spectrum is suppressed, relative to the total matter, by ˜15% on scales k˜0.05hMpc-1 at z=10, and by ˜3%-5% at z=0. Importantly, besides the suppression of the spectrum, the baryonic acoustic oscillation (BAO) features are amplified for baryon and slightly damped for CDM spectra. If we compare the total matter power spectra in the two- and one-component fluid approaches, then we find excellent agreement, with deviations being <0.5% throughout the evolution. Consequences: high precision modeling of the large-scale distribution of baryons in the Universe cannot be achieved through an effective mean-mass one-component fluid approximation; detection significance of BAO will be amplified in probes that study baryonic matter, relative to probes that study the CDM or total mass only. The CDM distribution can be modeled accurately at late times and the total matter at all times. This is good news for probes that are sensitive to the total mass, such as gravitational weak lensing as existing modeling techniques are good enough. Lastly, we identify an analytic approximation that greatly simplifies the evaluation of the full PT expressions, and it is better than <1% over the full range of scales and times considered.

Bioavailable Ferric Iron (BAFelll) Assay

DTIC Science & Technology

2007-02-01

citrate dithionite bicarbonate CDBFe citrate dithionite bicarbonate extractable iron cDCE cis-Dichloroethene CDM Camp Dresser & McKee Inc...Defense (DoD) installations. Camp Dresser & McKee Inc. (CDM), in cooperation with the Naval Facilities Engineering Services Center (NFESC), was the...several upgradient and/or cross - gradient background soil samples. Duplicate analysis of samples is recommended. While these recommendations are not

Application of a Cognitive Diagnostic Model to a High-Stakes Reading Comprehension Test

ERIC Educational Resources Information Center

Ravand, Hamdollah

2016-01-01

General cognitive diagnostic models (CDM) such as the generalized deterministic input, noisy, "and" gate (G-DINA) model are flexible in that they allow for both compensatory and noncompensatory relationships among the subskills within the same test. Most of the previous CDM applications in the literature have been add-ons to simulation…

Is a massive tau neutrino just what cold dark matter needs?

NASA Technical Reports Server (NTRS)

Dodelson, Scott; Gyuk, Geza; Turner, Michael S.

1994-01-01

The cold dark matter (CDM) scenario for structure formation in the Universe is very attractive and has many successes; however, when its spectrum of density perturbations is normalized to the COBE anisotropy measurement the level of inhomogeneity predicted on small scales is too large. This can be remedied by a tau neutrino of mass 1 MeV - 10MeV and lifetime 0.1 sec - 100 sec whose decay products include electron neutrinos because it allows the total energy density in relativistic particles to be doubled without interfering with nucleosynthesis. The anisotropies predicted on the degree scale for 'tau CDM' are larger than standard CDM. Experiments at e(sup +/-) collides may be able to probe such a mass range.

Galaxy Cluster Bulk Flows and Collision Velocities in QUMOND

NASA Astrophysics Data System (ADS)

Katz, Harley; McGaugh, Stacy; Teuben, Peter; Angus, G. W.

2013-07-01

We examine the formation of clusters of galaxies in numerical simulations of a QUMOND cosmogony with massive sterile neutrinos. Clusters formed in these exploratory simulations develop higher velocities than those found in ΛCDM simulations. The bulk motions of clusters attain ~1000 km s-1 by low redshift, comparable to observations whereas ΛCDM simulated clusters tend to fall short. Similarly, high pairwise velocities are common in cluster-cluster collisions like the Bullet Cluster. There is also a propensity for the most massive clusters to be larger in QUMOND and to appear earlier than in ΛCDM, potentially providing an explanation for "pink elephants" like El Gordo. However, it is not obvious that the cluster mass function can be recovered.

A model for the distribution of dark matter, galaxies, and the intergalactic medium in a cold dark matter-dominated universe

NASA Technical Reports Server (NTRS)

Ryu, Dongsu; Vishniac, Ethan T.; Chiang, Wei-Hwan

1989-01-01

The spatial distribution of the cold-dark-matter (CDM) and baryonic components of CDM-dominated cosmological models are characterized, summarizing the results of recent theoretical investigations. The evolution and distribution of matter in an Einstein-de Sitter universe on length scales small enough so that the Newtonian approximation is valid is followed chronologically, assuming (1) that the galaxies, CDM, and the intergalactic medium (IGM) are coupled by gravity, (2) that galaxies form by taking mass and momentum from the IGM, and (3) that the IGM responds to the energy input from the galaxies. The results of the numerical computations are presented in extensive graphs and discussed in detail.

A non-parametric consistency test of the ΛCDM model with Planck CMB data

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

Aghamousa, Amir; Shafieloo, Arman; Hamann, Jan, E-mail: amir@aghamousa.com, E-mail: jan.hamann@unsw.edu.au, E-mail: shafieloo@kasi.re.kr

Non-parametric reconstruction methods, such as Gaussian process (GP) regression, provide a model-independent way of estimating an underlying function and its uncertainty from noisy data. We demonstrate how GP-reconstruction can be used as a consistency test between a given data set and a specific model by looking for structures in the residuals of the data with respect to the model's best-fit. Applying this formalism to the Planck temperature and polarisation power spectrum measurements, we test their global consistency with the predictions of the base ΛCDM model. Our results do not show any serious inconsistencies, lending further support to the interpretation ofmore » the base ΛCDM model as cosmology's gold standard.« less

Updated reduced CMB data and constraints on cosmological parameters

NASA Astrophysics Data System (ADS)

Cai, Rong-Gen; Guo, Zong-Kuan; Tang, Bo

2015-07-01

We obtain the reduced CMB data {lA, R, z∗} from WMAP9, WMAP9+BKP, Planck+WP and Planck+WP+BKP for the ΛCDM and wCDM models with or without spatial curvature. We then use these reduced CMB data in combination with low-redshift observations to put constraints on cosmological parameters. We find that including BKP results in a higher value of the Hubble constant especially when the equation of state (EOS) of dark energy and curvature are allowed to vary. For the ΛCDM model with curvature, the estimate of the Hubble constant with Planck+WP+Lensing is inconsistent with the one derived from Planck+WP+BKP at about 1.2σ confidence level (CL).

Around the Way: Testing ΛCDM with Milky Way Stellar Stream Constraints

NASA Astrophysics Data System (ADS)

Dai, Biwei; Robertson, Brant E.; Madau, Piero

2018-05-01

Recent analyses of the Pal 5 and GD-1 tidal streams suggest that the inner dark matter halo of the Milky Way is close to spherical, in tension with predictions from collisionless N-body simulations of cosmological structure formation. We use the Eris simulation to test whether the combination of dissipative physics and hierarchical structure formation can produce Milky Way–like galaxies whose dark matter halos match the tidal stream constraints from the GD-1 and Pal 5 clusters. We use a dynamical model of the simulated Eris galaxy to generate many realizations of the GD-1 and Pal 5 tidal streams, marginalize over observational uncertainties in the cluster galactocentric positions and velocities, and compare with the observational constraints. We find that the total density and potential of Eris contributed by baryons and dark matter satisfies constraints from the existing Milky Way stellar stream data, as the baryons both round and redistribute the dark matter during the dissipative formation of the galaxy, and provide a centrally concentrated mass distribution that rounds the inner potential. The Eris dark matter halo or a spherical Navarro–Frenk–White dark matter work comparably well in modeling the stream data. In contrast, the equivalent dark matter–only ErisDark simulation produces a prolate halo that cannot reproduce the observed stream data. The ongoing Gaia mission will provide decisive tests of the consistency between {{Λ }}{CDM} and Milky Way streams, and should distinguish between models like Eris and more spherical halos.

Feasibility and utility of applications of the common data model to multiple, disparate observational health databases

PubMed Central

Makadia, Rupa; Matcho, Amy; Ma, Qianli; Knoll, Chris; Schuemie, Martijn; DeFalco, Frank J; Londhe, Ajit; Zhu, Vivienne; Ryan, Patrick B

2015-01-01

Objectives To evaluate the utility of applying the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) across multiple observational databases within an organization and to apply standardized analytics tools for conducting observational research. Materials and methods Six deidentified patient-level datasets were transformed to the OMOP CDM. We evaluated the extent of information loss that occurred through the standardization process. We developed a standardized analytic tool to replicate the cohort construction process from a published epidemiology protocol and applied the analysis to all 6 databases to assess time-to-execution and comparability of results. Results Transformation to the CDM resulted in minimal information loss across all 6 databases. Patients and observations excluded were due to identified data quality issues in the source system, 96% to 99% of condition records and 90% to 99% of drug records were successfully mapped into the CDM using the standard vocabulary. The full cohort replication and descriptive baseline summary was executed for 2 cohorts in 6 databases in less than 1 hour. Discussion The standardization process improved data quality, increased efficiency, and facilitated cross-database comparisons to support a more systematic approach to observational research. Comparisons across data sources showed consistency in the impact of inclusion criteria, using the protocol and identified differences in patient characteristics and coding practices across databases. Conclusion Standardizing data structure (through a CDM), content (through a standard vocabulary with source code mappings), and analytics can enable an institution to apply a network-based approach to observational research across multiple, disparate observational health databases. PMID:25670757

Universal subhalo accretion in cold and warm dark matter cosmologies

NASA Astrophysics Data System (ADS)

Kubik, Bogna; Libeskind, Noam I.; Knebe, Alexander; Courtois, Hélène; Yepes, Gustavo; Gottlöber, Stefan; Hoffman, Yehuda

2017-12-01

The influence of the large-scale structure on host haloes may be studied by examining the angular infall pattern of subhaloes. In particular, since warm dark matter (WDM) and cold dark matter (CDM) cosmologies predict different abundances and internal properties for haloes at the low-mass end of the mass function, it is interesting to examine if there are differences in how these low-mass haloes are accreted. The accretion events are defined as the moment a halo becomes a substructure, namely when it crosses its host's virial radius. We quantify the cosmic web at each point by the shear tensor and examine where, with respect to its eigenvectors, such accretion events occur in ΛCDM and ΛWDM (1 keV sterile neutrino) cosmological models. We find that the CDM and WDM subhaloes are preferentially accreted along the principal axis of the shear tensor corresponding to the direction of weakest collapse. The beaming strength is modulated by the host and subhalo masses and by the redshift at which the accretion event occurs. Although strongest for the most massive hosts and subhaloes at high redshift, the preferential infall is found to be always aligned with the axis of weakest collapse, thus we say that it has universal nature. We compare the strength of beaming in the ΛWDM cosmology with the one found in the ΛCDM scenario. While the main findings remain the same, the accretion in the ΛWDM model for the most massive host haloes appears more beamed than in ΛCDM cosmology across all the redshifts.

Improving decision making in crisis.

PubMed

Higgins, Guy; Freedman, Jennifer

2013-01-01

The most critical activity during emergencies or crises is making decisions about what to do next. This paper provides insights into the challenges that people face in making decisions at any time, but particularly during emergencies and crises. It also introduces the reader to the concept of different sense-making/decision-making domains, the human behaviours that can adversely affect decision making - decision derailers - and ways in which emergency responders can leverage this knowledge to make better decisions. While the literature on decision making is extensive, this paper is focused on those aspects that apply particularly to decision making in emergencies or times of crisis.

Beyond Ethnic Tidbits: Toward a Critical and Dialogical Model in Multicultural Social Justice Teacher Preparation

ERIC Educational Resources Information Center

Convertino, Christina

2016-01-01

This praxis article outlines the value of using a critical and dialogical model (CDM) to teach multicultural social justice education to preservice teachers. Based on practitioner research, the article draws on the author's own teaching experiences to highlight how key features of CDM can be used to help pre-service teachers move beyond thinking…

Isotropic vs. anisotropic components of BAO data: a tool for model selection

NASA Astrophysics Data System (ADS)

Haridasu, Balakrishna S.; Luković, Vladimir V.; Vittorio, Nicola

2018-05-01

We conduct a selective analysis of the isotropic (DV) and anisotropic (AP) components of the most recent Baryon Acoustic Oscillations (BAO) data. We find that these components provide significantly different constraints and could provide strong diagnostics for model selection, also in view of more precise data to arrive. For instance, in the ΛCDM model we find a mild tension of ~ 2 σ for the Ωm estimates obtained using DV and AP separately. Considering both Ωk and w as free parameters, we find that the concordance model is in tension with the best-fit values provided by the BAO data alone at 2.2σ. We complemented the BAO data with the Supernovae Ia (SNIa) and Observational Hubble datasets to perform a joint analysis on the ΛCDM model and its standard extensions. By assuming ΛCDM scenario, we find that these data provide H0 = 69.4 ± 1.7 km/s Mpc‑1 as the best-fit value for the present expansion rate. In the kΛCDM scenario we find that the evidence for acceleration using the BAO data alone is more than ~ 5.8σ, which increases to 8.4 σ in our joint analysis.

Enhanced peculiar velocities in brane-induced gravity

NASA Astrophysics Data System (ADS)

Wyman, Mark; Khoury, Justin

2010-08-01

The mounting evidence for anomalously large peculiar velocities in our Universe presents a challenge for the ΛCDM paradigm. The recent estimates of the large-scale bulk flow by Watkins et al. are inconsistent at the nearly 3σ level with ΛCDM predictions. Meanwhile, Lee and Komatsu have recently estimated that the occurrence of high-velocity merging systems such as the bullet cluster (1E0657-57) is unlikely at a 6.5-5.8σ level, with an estimated probability between 3.3×10-11 and 3.6×10-9 in ΛCDM cosmology. We show that these anomalies are alleviated in a broad class of infrared-modifed gravity theories, called brane-induced gravity, in which gravity becomes higher-dimensional at ultralarge distances. These theories include additional scalar forces that enhance gravitational attraction and therefore speed up structure formation at late times and on sufficiently large scales. The peculiar velocities are enhanced by 24-34% compared to standard gravity, with the maximal enhancement nearly consistent at the 2σ level with bulk flow observations. The occurrence of the bullet cluster in these theories is ≈104 times more probable than in ΛCDM cosmology.

Enhanced peculiar velocities in brane-induced gravity

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

Wyman, Mark; Khoury, Justin

The mounting evidence for anomalously large peculiar velocities in our Universe presents a challenge for the {Lambda}CDM paradigm. The recent estimates of the large-scale bulk flow by Watkins et al. are inconsistent at the nearly 3{sigma} level with {Lambda}CDM predictions. Meanwhile, Lee and Komatsu have recently estimated that the occurrence of high-velocity merging systems such as the bullet cluster (1E0657-57) is unlikely at a 6.5-5.8{sigma} level, with an estimated probability between 3.3x10{sup -11} and 3.6x10{sup -9} in {Lambda}CDM cosmology. We show that these anomalies are alleviated in a broad class of infrared-modifed gravity theories, called brane-induced gravity, in which gravitymore » becomes higher-dimensional at ultralarge distances. These theories include additional scalar forces that enhance gravitational attraction and therefore speed up structure formation at late times and on sufficiently large scales. The peculiar velocities are enhanced by 24-34% compared to standard gravity, with the maximal enhancement nearly consistent at the 2{sigma} level with bulk flow observations. The occurrence of the bullet cluster in these theories is {approx_equal}10{sup 4} times more probable than in {Lambda}CDM cosmology.« less

Commensurate 4a0-period charge density modulations throughout the Bi2Sr2CaCu2O8+x pseudogap regime

PubMed Central

Mesaros, Andrej; Fujita, Kazuhiro; Edkins, Stephen D.; Hamidian, Mohammad H.; Eisaki, Hiroshi; Uchida, Shin-ichi; Davis, J. C. Séamus; Lawler, Michael J.; Kim, Eun-Ah

2016-01-01

Theories based upon strong real space (r-space) electron–electron interactions have long predicted that unidirectional charge density modulations (CDMs) with four-unit-cell (4a0) periodicity should occur in the hole-doped cuprate Mott insulator (MI). Experimentally, however, increasing the hole density p is reported to cause the conventionally defined wavevector QA of the CDM to evolve continuously as if driven primarily by momentum-space (k-space) effects. Here we introduce phase-resolved electronic structure visualization for determination of the cuprate CDM wavevector. Remarkably, this technique reveals a virtually doping-independent locking of the local CDM wavevector at |Q0|=2π/4a0 throughout the underdoped phase diagram of the canonical cuprate Bi2Sr2CaCu2O8. These observations have significant fundamental consequences because they are orthogonal to a k-space (Fermi-surface)–based picture of the cuprate CDMs but are consistent with strong-coupling r-space–based theories. Our findings imply that it is the latter that provides the intrinsic organizational principle for the cuprate CDM state. PMID:27791157

What do parameterized Om(z) diagnostics tell us in light of recent observations?

NASA Astrophysics Data System (ADS)

Qi, Jing-Zhao; Cao, Shuo; Biesiada, Marek; Xu, Teng-Peng; Wu, Yan; Zhang, Si-Xuan; Zhu, Zong-Hong

2018-06-01

In this paper, we propose a new parametrization for Om(z) diagnostics and show how the most recent and significantly improved observations concerning the H(z) and SN Ia measurements can be used to probe the consistency or tension between the ΛCDM model and observations. Our results demonstrate that H 0 plays a very important role in the consistency test of ΛCDM with H(z) data. Adopting the Hubble constant priors from Planck 2013 and Riess, one finds considerable tension between the current H(z) data and ΛCDM model and confirms the conclusions obtained previously by others. However, with the Hubble constant prior taken from WMAP9, the discrepancy between H(z) data and ΛCDM disappears, i.e., the current H(z) observations still support the cosmological constant scenario. This conclusion is also supported by the results derived from the Joint Light-curve Analysis (JLA) SN Ia sample. The best-fit Hubble constant from the combination of H(z)+JLA ({H}0={68.81}-1.49+1.50 km s‑1 Mpc‑1) is very consistent with results derived both by Planck 2013 and WMAP9, but is significantly different from the recent local measurement by Riess.

Copper and zinc uptake by rice and accumulation in soil amended with municipal solid waste compost

NASA Astrophysics Data System (ADS)

Bhattacharyya, P.; Chakraborty, A.; Chakrabarti, K.; Tripathy, S.; Powell, M. A.

2006-04-01

Effect of addition of municipal solid waste compost (MSWC) on two metals viz. copper (Cu) and zinc (Zn) contents of submerged rice paddies were studied. Experiments were conducted during the three consecutive wet seasons from 1997 to 1999 on rice grown under submergence, at the Experimental Farm of Calcutta University, India. A sequential extraction method was used to determine the metal (Cu and Zn) fractions in MSWC and cow dung manure (CDM). Both metals were significantly bound to the organic matter and Fe and Mn oxides in MSWC and CDM. Metal content in rice straw was higher than in rice grain. Metal bound with Fe and Mn oxides in MSWC and CDM best correlated with straw and grain metal followed by exchangeable and water soluble fractions. Carbonate, organic matter bound and residual fractions in MSWC and CDM did not significantly correlate with rice straw and grain metal. The MSWC would be a valuable resource for agriculture if it can be used safely, but long-term field experiments with MSWC are needed to assess by regular monitoring of the metal loads and accumulation in soil and plants.

Small scale clustering of late forming dark matter

NASA Astrophysics Data System (ADS)

Agarwal, S.; Corasaniti, P.-S.; Das, S.; Rasera, Y.

2015-09-01

We perform a study of the nonlinear clustering of matter in the late-forming dark matter (LFDM) scenario in which dark matter results from the transition of a nonminimally coupled scalar field from radiation to collisionless matter. A distinct feature of this model is the presence of a damped oscillatory cutoff in the linear matter power spectrum at small scales. We use a suite of high-resolution N-body simulations to study the imprints of LFDM on the nonlinear matter power spectrum, the halo mass and velocity functions and the halo density profiles. The model largely satisfies high-redshift matter power spectrum constraints from Lyman-α forest measurements, while it predicts suppressed abundance of low-mass halos (˜109- 1010 h-1 M⊙ ) at all redshifts compared to a vanilla Λ CDM model. The analysis of the LFDM halo velocity function shows a better agreement than the Λ CDM prediction with the observed abundance of low-velocity galaxies in the local volume. Halos with mass M ≳1011 h-1 M⊙ show minor departures of the density profiles from Λ CDM expectations, while smaller-mass halos are less dense, consistent with the fact that they form later than their Λ CDM counterparts.

High-z objects and cold dark matter cosmogonies - Constraints on the primordial power spectrum on small scales

NASA Technical Reports Server (NTRS)

Kashlinsky, A.

1993-01-01

Modified cold dark matter (CDM) models were recently suggested to account for large-scale optical data, which fix the power spectrum on large scales, and the COBE results, which would then fix the bias parameter, b. We point out that all such models have deficit of small-scale power where density fluctuations are presently nonlinear, and should then lead to late epochs of collapse of scales M between 10 exp 9 - 10 exp 10 solar masses and (1-5) x 10 exp 14 solar masses. We compute the probabilities and comoving space densities of various scale objects at high redshifts according to the CDM models and compare these with observations of high-z QSOs, high-z galaxies and the protocluster-size object found recently by Uson et al. (1992) at z = 3.4. We show that the modified CDM models are inconsistent with the observational data on these objects. We thus suggest that in order to account for the high-z objects, as well as the large-scale and COBE data, one needs a power spectrum with more power on small scales than CDM models allow and an open universe.

[Infrastructure and contents of clinical data management plan].

PubMed

Shen, Tong; Xu, Lie-dong; Fu, Hai-jun; Liu, Yan; He, Jia; Chen, Ping-yan; Song, Yu-fei

2015-11-01

Establishment of quality management system (QMS) plays a critical role in the clinical data management (CDM). The objectives of CDM are to ensure the quality and integrity of the trial data. Thus, every stage or element that may impact the quality outcomes of clinical studies should be in the controlled manner, which is referred to the full life cycle of CDM associated with the data collection, handling and statistical analysis of trial data. Based on the QMS, this paper provides consensus on how to develop a compliant clinical data management plan (CDMP). According to the essential requirements of the CDM, the CDMP should encompass each process of data collection, data capture and cleaning, medical coding, data verification and reconciliation, database monitoring and management, external data transmission and integration, data documentation and data quality assurance and so on. Creating and following up data management plan in each designed data management steps, dynamically record systems used, actions taken, parties involved will build and confirm regulated data management processes, standard operational procedures and effective quality metrics in all data management activities. CDMP is one of most important data management documents that is the solid foundation for clinical data quality.

Commensurate 4 a 0 -period charge density modulations throughout the Bi 2 Sr 2 CaCu 2 O 8+x pseudogap regime

DOE PAGES

Mesaros, Andrej; Fujita, Kazuhiro; Edkins, Stephen D.; ...

2016-10-20

Theories based upon strong real space (r-space) electron–electron interactions have long predicted that unidirectional charge density modulations (CDMs) with four-unit-cell (4 a0) periodicity should occur in the hole-doped cuprate Mott insulator (MI). But, increasing the hole density p is reported to cause the conventionally defined wavevector Q A of the CDM to evolve continuously as if driven primarily by momentum-space (k-space) effects. We introduce phase-resolved electronic structure visualization for determination of the cuprate CDM wavevector. Remarkably, this technique reveals a virtually doping-independent locking of the local CDM wavevector at |Q 0|=2π/4 a0 throughout the underdoped phase diagram of the canonicalmore » cuprate Bi 2Sr 2CaCu 2O 8. Our observations have significant fundamental consequences because they are orthogonal to a k-space (Fermi-surface)–based picture of the cuprate CDMs but are consistent with strong-coupling r-space–based theories. Our findings imply that it is the latter that provides the intrinsic organizational principle for the cuprate CDM state.« less

Dark energy constraints in light of Pantheon SNe Ia, BAO, cosmic chronometers and CMB polarization and lensing data

NASA Astrophysics Data System (ADS)

Wang, Deng

2018-06-01

To explore whether there is new physics going beyond the standard cosmological model or not, we constrain seven cosmological models by combining the latest and largest Pantheon Type Ia supernovae sample with the data combination of baryonic acoustic oscillations, cosmic microwave background radiation, Planck lensing and cosmic chronometers. We find that a spatially flat universe is preferred in the framework of Λ CDM cosmology, that the constrained equation of state of dark energy is very consistent with the cosmological constant hypothesis in the ω CDM model, that there is no evidence of dynamical dark energy in the dark energy density-parametrization model, that there is no hint of interaction between dark matter and dark energy in the dark sector of the universe in the decaying vacuum model, and that there does not exist the sterile neutrino in the neutrino sector of the universe in the Λ CDM model. We also give the 95% upper limit of the total mass of three active neutrinos Σ mν<0.178 eV under the assumption of Λ CDM scenario. It is clear that there is no any departure from the standard cosmological model based on current observational datasets.

A hydrodynamic approach to cosmology: The mixed dark matter cosmological scenario

NASA Technical Reports Server (NTRS)

Cen, Renyue; Ostriker, Jeremiah P.

1994-01-01

We compute the evolution of spatially flat, mixed cold and hot dark matter models containing both baryonic matter and two kinds of dark matter. Hydrodynamics is treated with a highly developed Eulerian hydrodynamic code (see Cen 1992). A standard particle-mesh (PM) code is also used in parallel to calculate the motion of the dark matter components. We adopt the following parameters: h equivalent to (sub 0)/100 km/s Mpc(exp -1) = 0.5, OMEGA(sub C) = 0.3, and OMEGA(sub B) = 0.06, with amplitude of the perturbation spectrum fixed by the Cosmic Background Explorer Satellite (COBE) Dark Matter Radiation (DMR) measurements (Smoot et al. 1992) being sigma (sub 8) = 0.67. Four different boxes are simulated with box sizes of L = (64, 16, 4, 1) h(exp -1) Mpc, respectively, the two small boxes providing good resolution but little valid information due to absence of large-scale power. We use 128(exp 3) approximate 10(exp 6.3) baryonic cells, 128(exp .3) cold dark matter particles, and 2 x 128(exp 3) hot dark matter particles. In addition to the dark matter we follow separately six baryonic species (H, H(+), He, He(+), He(++), e(-)) with allowance for both (nonequilibrium) collisional and radiative ionization in every cell. The background radiation field is also followed in detail with allowance made for both continuum and line processes, to allow nonequilibrium heating and cooling processes to be followed in detail. The mean final Zeldovich-Sunyaev y parameter is estimated to be y Bar = (5.4 + or - 2.7) x 10(exp -7) below currently attainable observations, with a rms fluctuation of approximately delta bar y = (0.6 + or - 3.0) x 10(exp -7) on arcminute scales. The rate of galaxy formation peaks at an even later epoch (z approximate 0.3) than in the standard (OMEGA = 1, sigma sub 8 = 0.67) cold dark matter (CDM) model (z approximate 0.5) and, at a redshift of z = 4, is nearly a factor of 100 lower than for the CDM model with the same value of sigma sub 8. With regard to mass function, the smallest objects are stabilized against collapse by thermal energy: the mass-weighted mass spectrum has a broad peak in the vicinity of M(sub B) = 10(exp 9.5) solar mass with a reasonable fit to the Schechter luminosity function if the ratio of baryon mass to blue light is approximately 4. In addition, one very large PM simulation was made in a box with size (320 h(exp - 1) Mpc) containing 3 x 200(exp 3) = 10(exp 7.4) particles. Utilizing this simulation we find that the model yields a cluster mass function which is about a factor of 4 higher than observed, but a cluster-cluster correlation length marginally lower than observed, but that both are closer to observations than in the (COBE) normalized CDM model. The one-dimensional pairwise velocity dispersion is 605 + or - 8 km/s at 1/h separation, lower than that of the DCM model normalized to COBE, but still significant higher than observations (Davis & Peebles 1983). A plausible velocity bias b(sub v) = 0.8 + or - 0.1 on this scale will reduce but not remove the discrepancy. The velocity auto-correlat ion function has a coherence length of 40/h Mpc, which is somewhat lower than the observed counterpart. In all these respects the model would be improved by decreasing the cold fraction of the dark OMEGA(sub CDM)/ (OMEGA(sub CDM) + OMEGA(sub HDB). But formation of galaxies and clusters of galaxies is much later in this model than in COBE-normalized CDM, perhaps too late. To improve on these constraints a larger ratio of OMEGA(sub CDM)/ (OMEGA(sub CDM) + OMEGA(sub HDM)) is required than the value of 0.67 adopted here. It does not seem possible to find a value for this ratio which would satisfy all tests. Overall, the model is similar both on large and intermediate scales to the standard CDM model normalized to the same value of sigma(sub B), but the problem with regard to late formation of galaxies is more severe in this model than in that CDM model. Adding hot dark matter, significantly improves the ability of the COBE-normalized CDM scenario to fit existing observations, but the model is in fact not as good as the CDM model with the same sigma(sub 8) and is still probably unsatisfactory with regard to several critical tests.

Decision-making in nursing practice: An integrative literature review.

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes. © 2017 John Wiley & Sons Ltd.

Shared Decision-Making in the Management of Congenital Vascular Malformations.

PubMed

Horbach, Sophie E R; Ubbink, Dirk T; Stubenrouch, Fabienne E; Koelemay, Mark J W; van der Vleuten, Carine J M; Verhoeven, Bas H; Reekers, Jim A; Schultze Kool, Leo J; van der Horst, Chantal M A M

2017-03-01

In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

PubMed

Gregory, Megan E; Sonesh, Shirley C; Feitosa, Jennifer; Benishek, Lauren E; Hughes, Ashley M; Salas, Eduardo

2017-09-01

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

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

PubMed

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

2016-04-01

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

The expansion rate of the intermediate universe in light of Planck

NASA Astrophysics Data System (ADS)

Verde, Licia; Protopapas, Pavlos; Jimenez, Raul

2014-12-01

We use cosmology-independent measurements of the expansion history in the redshift range 0.1 ≲ z < 1.2 and compare them with the Cosmic Microwave Background-derived expansion history predictions. The motivation is to investigate if the tension between the local (cosmology independent) Hubble constant H0 value and the Planck-derived H0 is also present at other redshifts. We conclude that there is no tension between Planck and cosmology independent-measurements of the Hubble parameter H(z) at 0.1 ≲ z < 1.2 for the ΛCDM model (odds of tension are only 1:15, statistically not significant). Considering extensions of the ΛCDM model does not improve these odds (actually makes them worse), thus favouring the simpler model over its extensions. On the other hand the H(z) data are also not in tension with the local H0 measurements but the combination of all three data-sets shows a highly significant tension (odds ∼1:400). Thus the new data deepen the mystery of the mismatch between Planck and local H0 measurements, and cannot univocally determine whether it is an effect localised at a particular redshift. Having said this, we find that assuming the NGC4258 maser distance as the correct anchor for H0, brings the odds to comfortable values. Further, using only the expansion history measurements we constrain, within the ΛCDM model, H0 = 68.5 ± 3.5 and Ωm = 0.32 ± 0.05 (at 68% confidence) without relying on any CMB prior. We also address the question of how smooth the expansion history of the Universe is given the cosmology independent data and conclude that there is no evidence for deviations from smoothness on the expansion history, neither variations with time in the value of the equation of state of dark energy.

Massive Structures of Galaxies at High Redshifts in the Great Observatories Origins Deep Survey Fields

NASA Astrophysics Data System (ADS)

Kang, Eugene; Im, Myungshin

2015-02-01

If the Universe is dominated by cold dark matter and dark energy as in the currently popular ΛCDM cosmology, it is expected that large scale structures form gradually, with galaxy clusters of mass M & 1014M? appearing at around 6 Gy rs after the Big Bang (z ? 1). Here, we report the discovery of 59 massive structures of galaxies with masses greater than a few times 1013M? at redshifts between z = 0.6 and 4.5 in the Great Observatories Origins Deep Survey fields. The massive structures are identified by running top-hat filters on the two dimensional spatial distribution of magnitude-limited samples of galaxies using a combination of spectroscopic and photometric redshifts. We analyze the Millennium simulation data in a similar way to the analysis of the observational data in order to test the ΛCDM cosmology. We find that there are too many massive structures (M > 7?1013M?) observed at z > 2 in comparison with the simulation predictions by a factor of a few, giving a probability of < 1/2500 of the observed data being consistent with the simulation. Our result suggests that massive structures have emerged early, but the reason for the discrepancy with the simulation is unclear. It could be due to the limitation of the simulation such as the lack of key, unrecognized ingredients (strong non-Gaussianity or other baryonic physics), or simply a difficulty in the halo mass estimation from observation, or a fundamental problem of the ΛCDM cosmology. On the other hand, the over-abundance of massive structures at high redshifts does not favor heavy neutrino mass of ? 0.3 eV or larger, as heavy neutrinos make the discrepancy between the observation and the simulation more pronounced by a factor of 3 or more.

Linear perturbation theory for tidal streams and the small-scale CDM power spectrum

NASA Astrophysics Data System (ADS)

Bovy, Jo; Erkal, Denis; Sanders, Jason L.

2017-04-01

Tidal streams in the Milky Way are sensitive probes of the population of low-mass dark matter subhaloes predicted in cold dark matter (CDM) simulations. We present a new calculus for computing the effect of subhalo fly-bys on cold streams based on the action-angle representation of streams. The heart of this calculus is a line-of-parallel-angle approach that calculates the perturbed distribution function of a stream segment by undoing the effect of all relevant impacts. This approach allows one to compute the perturbed stream density and track in any coordinate system in minutes for realizations of the subhalo distribution down to 105 M⊙, accounting for the stream's internal dispersion and overlapping impacts. We study the statistical properties of density and track fluctuations with large suites of simulations of the effect of subhalo fly-bys. The one-dimensional density and track power spectra along the stream trace the subhalo mass function, with higher mass subhaloes producing power only on large scales, while lower mass subhaloes cause structure on smaller scales. We also find significant density and track bispectra that are observationally accessible. We further demonstrate that different projections of the track all reflect the same pattern of perturbations, facilitating their observational measurement. We apply this formalism to data for the Pal 5 stream and make a first rigorous determination of 10^{+11}_{-6} dark matter subhaloes with masses between 106.5 and 109 M⊙ within 20 kpc from the Galactic centre [corresponding to 1.4^{+1.6}_{-0.9} times the number predicted by CDM-only simulations or to fsub(r < 20 kpc) ≈ 0.2 per cent] assuming that the Pal 5 stream is 5 Gyr old. Improved data will allow measurements of the subhalo mass function down to 105 M⊙, thus definitively testing whether dark matter is clumpy on the smallest scales relevant for galaxy formation.

GALAXY CLUSTER BULK FLOWS AND COLLISION VELOCITIES IN QUMOND

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

Katz, Harley; McGaugh, Stacy; Teuben, Peter

We examine the formation of clusters of galaxies in numerical simulations of a QUMOND cosmogony with massive sterile neutrinos. Clusters formed in these exploratory simulations develop higher velocities than those found in {Lambda}CDM simulations. The bulk motions of clusters attain {approx}1000 km s{sup -1} by low redshift, comparable to observations whereas {Lambda}CDM simulated clusters tend to fall short. Similarly, high pairwise velocities are common in cluster-cluster collisions like the Bullet Cluster. There is also a propensity for the most massive clusters to be larger in QUMOND and to appear earlier than in {Lambda}CDM, potentially providing an explanation for ''pink elephants''more » like El Gordo. However, it is not obvious that the cluster mass function can be recovered.« less

Implications for the missing low-mass galaxies (satellites) problem from cosmic shear

NASA Astrophysics Data System (ADS)

Jimenez, Raul; Verde, Licia; Kitching, Thomas D.

2018-06-01

The number of observed dwarf galaxies, with dark matter mass ≲ 1011 M⊙ in the Milky Way or the Andromeda galaxy does not agree with predictions from the successful ΛCDM paradigm. To alleviate this problem a suppression of dark matter clustering power on very small scales has been conjectured. However, the abundance of dark matter halos outside our immediate neighbourhood (the Local Group) seem to agree with the ΛCDM-expected abundance. Here we connect these problems to observations of weak lensing cosmic shear, pointing out that cosmic shear can make significant statements about the missing satellites problem in a statistical way. As an example and pedagogical application we use recent constraints on small-scales power suppression from measurements of the CFHTLenS data. We find that, on average, in a region of ˜Gpc3 there is no significant small-scale power suppression. This implies that suppression of small-scale power is not a viable solution to the `missing satellites problem' or, alternatively, that on average in this volume there is no `missing satellites problem' for dark matter masses ≳ 5 × 109 M⊙. Further analysis of current and future weak lensing surveys will probe much smaller scales, k > 10h Mpc-1 corresponding roughly to masses M < 109M⊙.

Creation of a Mock Universe: Photometric Astronomy on Simulation

NASA Astrophysics Data System (ADS)

Nene, Ajinkya; Rodriguez, Aldo; Primack, Joel R.

2016-01-01

A major focus in astronomy is to understand how galaxies form and evolve in the Universe. The current model known as ΛCDM explains that galaxies form and evolve in halos composed of cold dark matter. In an effort to understand galactic processes in relation to halos, researchers have developed statistical methods to connect galaxies to their halos. One of these approaches is abundance matching: a technique in which the galaxy number density of a property is connected to a theoretical halo number density. In this study, we exploit the abundance matching technique and create a massive photometric mock catalog. We populate millions of dark matter halos in the Bolshoi-Planck Simulation with highly defined galaxies that each has: luminosities, magnitudes, fluxes, masses, and Sérsic profiles. Our catalog acts as an interface between cold dark matter theory and observations: astronomers can use this mock galaxy catalog to compare ΛCDM predictions to observations as well as constrain galaxy formation models. Using our catalog, we can make powerful predictions about both theoretical data and about future astronomical surveys. We demonstrate the usability of our catalog through angular power spectra. Specifically, we shed light on the controversial intrahalo light phenomena. We emphasize that this is the first catalog of this accuracy and size and has incredible potential for application.

Decision-making on shared sanitation in the informal settlements of Kisumu, Kenya.

PubMed

Simiyu, Sheillah; Swilling, Mark; Cairncross, Sandy

2017-10-01

Unlike most quantitative studies that investigate decision-making on investing in sanitation, this study adopted a qualitative approach to investigate decision-making on shared sanitation in the informal settlements of Kisumu city, in Kenya. Using a grounded theory approach, landlords and tenants were interviewed to identify sanitation decisions, individuals involved in decision-making and factors influencing decision-making. The results indicate that the main sanitation decisions are on investment, emptying, repair and cleaning. Landlords make investment, emptying and repair decisions, while tenants make cleaning decisions. Absentee landlords are less involved in most decision-making compared to live-in landlords, who rarely consult tenants in decision-making. Tenants make decisions after consultations with a third party and often collectively with other tenants. Sanitation interventions in informal settlements should thus, target landlords and tenants, with investment efforts being directed at landlords and maintenance efforts at tenants.

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

PubMed

Gillespie, Mary

2010-11-01

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

[Decision Making and Electrodermal Activity].

PubMed

Kobayakawa, Mutsutaka

2016-08-01

Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.

Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data.

PubMed

Lowrie, Richard; McConnachie, Alex; Williamson, Andrea E; Kontopantelis, Evangelos; Forrest, Marie; Lannigan, Norman; Mercer, Stewart W; Mair, Frances S

2017-04-11

The inverse equity hypothesis asserts that new health policies initially widen inequality, then attenuate inequalities over time. Since 2004, the UK's pay-for-performance scheme for chronic disease management (CDM) in primary care general practices (the Quality and Outcomes Framework) has permitted practices to except (exclude) patients from attending annual CDM reviews, without financial penalty. Informed dissent (ID) is one component of exception rates, applied to patients who have not attended due to refusal or non-response to invitations. 'Population achievement' describes the proportion receiving care, in relation to those eligible to receive it, including excepted patients. Examination of exception reporting (including ID) and population achievement enables the equity impact of the UK pay-for-performance contract to be assessed. We conducted a longitudinal analysis of practice-level rates and of predictors of ID, overall exceptions and population achievement for CDM to examine whether the inverse equity hypothesis holds true. We carried out a retrospective, longitudinal study using routine primary care data, analysed by multilevel logistic regression. Data were extracted from 793 practices (83% of Scottish general practices) serving 4.4 million patients across Scotland from 2010/2011 to 2012/2013, for 29 CDM indicators covering 11 incentivised diseases. This provided 68,991 observations, representing a total of 15 million opportunities for exception reporting. Across all observations, the median overall exception reporting rate was 7.0% (7.04% in 2010-2011; 7.02% in 2011-2012 and 6.92% in 2012-2013). The median non-attendance rate due to ID was 0.9% (0.76% in 2010-2011; 0.88% in 2011-2012 and 0.96% in 2012-2013). Median population achievement was 83.5% (83.51% in 2010-2011; 83.41% in 2011-2012 and 83.63% in 2012-2013). The odds of ID reporting in 2012/2013 were 16.0% greater than in 2010/2011 (p < 0.001). Practices in Scotland's most deprived communities were twice as likely to report non-attendance due to ID (odds ratio 2.10, 95% confidence interval 1.83-2.40, p < 0.001) compared with those in the least deprived; rural practices reported lower levels of non-attendance due to ID. These predictors were also independently associated with overall exceptions. Rates of population achievement did not change over time, with higher levels (higher remuneration) associated with increased rates of overall and ID exception and more affluent practices. Non-attendance for CDM due to ID has risen over time, and higher rates are seen in patients from practices located in disadvantaged areas. This suggests that CDM incentivisation does not conform to the inverse equity hypothesis, because inequalities are widening over time with lower uptake of anticipatory care health checks and CDM reviews noted among those most in need. Incentivised CDM needs to include incentives for engaging with the 'hard to reach' if inequalities in healthcare delivery are to be tackled.

H0LiCOW - V. New COSMOGRAIL time delays of HE 0435-1223: H0 to 3.8 per cent precision from strong lensing in a flat ΛCDM model

NASA Astrophysics Data System (ADS)

Bonvin, V.; Courbin, F.; Suyu, S. H.; Marshall, P. J.; Rusu, C. E.; Sluse, D.; Tewes, M.; Wong, K. C.; Collett, T.; Fassnacht, C. D.; Treu, T.; Auger, M. W.; Hilbert, S.; Koopmans, L. V. E.; Meylan, G.; Rumbaugh, N.; Sonnenfeld, A.; Spiniello, C.

2017-03-01

We present a new measurement of the Hubble Constant H0 and other cosmological parameters based on the joint analysis of three multiply imaged quasar systems with measured gravitational time delays. First, we measure the time delay of HE 0435-1223 from 13-yr light curves obtained as part of the COSMOGRAIL project. Companion papers detail the modelling of the main deflectors and line-of-sight effects, and how these data are combined to determine the time-delay distance of HE 0435-1223. Crucially, the measurements are carried out blindly with respect to cosmological parameters in order to avoid confirmation bias. We then combine the time-delay distance of HE 0435-1223 with previous measurements from systems B1608+656 and RXJ1131-1231 to create a Time Delay Strong Lensing probe (TDSL). In flat Λ cold dark matter (ΛCDM) with free matter and energy density, we find H0 =71.9^{+2.4}_{-3.0} {km s^{-1} Mpc^{-1}} and Ω _{Λ }=0.62^{+0.24}_{-0.35}. This measurement is completely independent of, and in agreement with, the local distance ladder measurements of H0. We explore more general cosmological models combining TDSL with other probes, illustrating its power to break degeneracies inherent to other methods. The joint constraints from TDSL and Planck are H0 = 69.2_{-2.2}^{+1.4} {km s^{-1} Mpc^{-1}}, Ω _{Λ }=0.70_{-0.01}^{+0.01} and Ω _k=0.003_{-0.006}^{+0.004} in open ΛCDM and H0 =79.0_{-4.2}^{+4.4} {km s^{-1} Mpc^{-1}}, Ω _de=0.77_{-0.03}^{+0.02} and w=-1.38_{-0.16}^{+0.14} in flat wCDM. In combination with Planck and baryon acoustic oscillation data, when relaxing the constraints on the numbers of relativistic species we find Neff = 3.34_{-0.21}^{+0.21} in NeffΛCDM and when relaxing the total mass of neutrinos we find Σmν ≤ 0.182 eV in mνΛCDM. Finally, in an open wCDM in combination with Planck and cosmic microwave background lensing, we find H0 =77.9_{-4.2}^{+5.0} {km s^{-1} Mpc^{-1}}, Ω _de=0.77_{-0.03}^{+0.03}, Ω _k=-0.003_{-0.004}^{+0.004} and w=-1.37_{-0.23}^{+0.18}.

What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

PubMed Central

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

2016-01-01

Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.

PubMed

Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J; Homish, D Lynn

2016-08-01

We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. © The Author(s) 2016.

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

PubMed Central

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

2016-01-01

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

Distinction between Externally vs. Internally Guided Decision-Making: Operational Differences, Meta-Analytical Comparisons and Their Theoretical Implications

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

Most experimental studies of decision-making have specifically examined situations in which a single less-predictable correct answer exists (externally guided decision-making under uncertainty). Along with such externally guided decision-making, there are instances of decision-making in which no correct answer based on external circumstances is available for the subject (internally guided decision-making). Such decisions are usually made in the context of moral decision-making as well as in preference judgment, where the answer depends on the subject’s own, i.e., internal, preferences rather than on external, i.e., circumstantial, criteria. The neuronal and psychological mechanisms that allow guidance of decisions based on more internally oriented criteria in the absence of external ones remain unclear. This study was undertaken to compare decision-making of these two kinds empirically and theoretically. First, we reviewed studies of decision-making to clarify experimental–operational differences between externally guided and internally guided decision-making. Second, using multi-level kernel density analysis, a whole-brain-based quantitative meta-analysis of neuroimaging studies was performed. Our meta-analysis revealed that the neural network used predominantly for internally guided decision-making differs from that for externally guided decision-making under uncertainty. This result suggests that studying only externally guided decision-making under uncertainty is insufficient to account for decision-making processes in the brain. Finally, based on the review and results of the meta-analysis, we discuss the differences and relations between decision-making of these two types in terms of their operational, neuronal, and theoretical characteristics. PMID:22403525

Radio telescope search for the resonant conversion of cold dark matter axions from the magnetized astrophysical sources

NASA Astrophysics Data System (ADS)

Huang, Fa Peng; Kadota, Kenji; Sekiguchi, Toyokazu; Tashiro, Hiroyuki

2018-06-01

We study the conditions for the adiabatic resonant conversion of the cold dark matter (CDM) axions into photons in the astrophysically sourced strong magnetic fields such as those in the neutron star magnetosphere. We demonstrate the possibility that the forthcoming radio telescopes such as the SKA (Square Kilometre Array) can probe those photon signals from the CDM axions.

Operationalizing clean development mechanism baselines: A case study of China's electrical sector

NASA Astrophysics Data System (ADS)

Steenhof, Paul A.

The global carbon market is rapidly developing as the first commitment period of the Kyoto Protocol draws closer and Parties to the Protocol with greenhouse gas (GHG) emission reduction targets seek alternative ways to reduce their emissions. The Protocol includes the Clean Development Mechanism (CDM), a tool that encourages project-based investments to be made in developing nations that will lead to an additional reduction in emissions. Due to China's economic size and rate of growth, technological characteristics, and its reliance on coal, it contains a large proportion of the global CDM potential. As China's economy modernizes, more technologies and processes are requiring electricity and demand for this energy source is accelerating rapidly. Relatively inefficient technology to generate electricity in China thereby results in the electrical sector having substantial GHG emission reduction opportunities as related to the CDM. In order to ensure the credibility of the CDM in leading to a reduction in GHG emissions, it is important that the baseline method used in the CDM approval process is scientifically sound and accessible for both others to use and for evaluation purposes. Three different methods for assessing CDM baselines and environmental additionality are investigated in the context of China's electrical sector: a method based on a historical perspective of the electrical sector (factor decomposition), a method structured upon a current perspective (operating and build margins), and a simulation of the future (dispatch analysis). Assessing future emission levels for China's electrical sector is a very challenging task given the complexity of the system, its dynamics, and that it is heavily influenced by internal and external forces, but of the different baseline methods investigated, dispatch modelling is best suited for the Chinese context as it is able to consider the important regional and temporal dimensions of its economy and its future development. For China, the most promising options for promoting sustainable development, one of the goals of the Kyoto Protocol, appear to be tied to increasing electrical end-use and generation efficiency, particularly clean coal technology for electricity generation since coal will likely continue to be a dominant primary fuel.

Quantifying the biological impact of surface ocean light attenuation by colored detrital matter in an ESM using a new optical parameterization

NASA Astrophysics Data System (ADS)

Kim, G. E.; Pradal, M.-A.; Gnanadesikan, A.

2015-08-01

Light attenuation by colored detrital material (CDM) was included in a fully coupled Earth system model (ESM). This study presents a modified parameterization for shortwave attenuation, which is an empirical relationship between 244 concurrent measurements of the diffuse attenuation coefficient for downwelling irradiance, chlorophyll concentration and light absorption by CDM. Two ESM model runs using this parameterization were conducted, with and without light absorption by CDM. The light absorption coefficient for CDM was prescribed as the average of annual composite MODIS Aqua satellite data from 2002 to 2013. Comparing results from the two model runs shows that changes in light limitation associated with the inclusion of CDM decoupled trends between surface biomass and nutrients. Increases in surface biomass were expected to accompany greater nutrient uptake and therefore diminish surface nutrients. Instead, surface chlorophyll, biomass and nutrients increased together. These changes can be attributed to the different impact of light limitation on surface productivity versus total productivity. Chlorophyll and biomass increased near the surface but decreased at greater depths when CDM was included. The net effect over the euphotic zone was less total biomass leading to higher nutrient concentrations. Similar results were found in a regional analysis of the oceans by biome, investigating the spatial variability of response to changes in light limitation using a single parameterization for the surface ocean. In coastal regions, surface chlorophyll increased by 35 % while total integrated phytoplankton biomass diminished by 18 %. The largest relative increases in modeled surface chlorophyll and biomass in the open ocean were found in the equatorial biomes, while the largest decreases in depth-integrated biomass and chlorophyll were found in the subpolar and polar biomes. This mismatch of surface and subsurface trends and their regional dependence was analyzed by comparing the competing factors of diminished light availability and increased nutrient availability on phytoplankton growth in the upper 200 m. Understanding changes in biological productivity requires both surface and depth-resolved information. Surface trends may be minimal or of the opposite sign than depth-integrated amounts, depending on the vertical structure of phytoplankton abundance.

Strong gravitational lensing statistics as a test of cosmogonic scenarios

NASA Technical Reports Server (NTRS)

Cen, Renyue; Gott, J. Richard, III; Ostriker, Jeremiah P.; Turner, Edwin L.

1994-01-01

Gravitational lensing statistics can provide a direct and powerful test of cosmic structure formation theories. Since lensing tests, directly, the magnitude of the nonlinear mass density fluctuations on lines of sight to distant objects, no issues of 'bias' (of mass fluctuations with respect to galaxy density fluctuations) exist here, although lensing observations provide their own ambiguities of interpretation. We develop numerical techniques for generating model density distributions with the very large spatial dynamic range required by lensing considerations and for identifying regions of the simulations capable of multiple image lensing in a conservative and computationally efficient way that should be accurate for splittings significantly larger than 3 seconds. Applying these techniques to existing standard Cold dark matter (CDM) (Omega = 1) and Primeval Baryon Isocurvature (PBI) (Omega = 0.2) simulations (normalized to the Cosmic Background Explorer Satellite (COBE) amplitude), we find that the CDM model predicts large splitting (greater than 8 seconds) lensing events roughly an order-of-magnitude more frequently than the PBI model. Under the reasonable but idealized assumption that lensing structrues can be modeled as singular isothermal spheres (SIS), the predictions can be directly compared to observations of lensing events in quasar samples. Several large splitting (Delta Theta is greater than 8 seconds) cases are predicted in the standard CDM model (the exact number being dependent on the treatment of amplification bias), whereas none is observed. In a formal sense, the comparison excludes the CDM model at high confidence (essentially for the same reason that CDM predicts excessive small-scale cosmic velocity dispersions.) A very rough assessment of low-density but flat CDM model (Omega = 0.3, Lambda/3H(sup 2 sub 0) = 0.7) indicates a far lower and probably acceptable level of lensing. The PBI model is consistent with, but not strongly tested by, the available lensing data, and other open models would presumably do as well as PBI. These preliminary conclusions and the assumptions on which they are based can be tested and the analysis can be applied to other cosmogonic models by straightforward extension of the work presented here.

One Way of Thinking About Decision Making.

ERIC Educational Resources Information Center

Dalis, Gus T.; Strasser, Ben B.

The authors present the DALSTRA model of decision making, a descriptive statement of ways individuals or groups respond to different kinds of decision-making problems they encounter. Decision making is viewed in two phases: the decision-making antecedents (whether to decide, how to decide) and the modes of decision making (Chance/Impulse,…

Strategic Decision Making Paradigms: A Primer for Senior Leaders

DTIC Science & Technology

2009-07-01

decision making . STRATEGIC DECISION MAKING Strategic Change: There are several strategic...influenced by stakeholders outside of the organization. The Ontology of Strategic Decision Making . Strategic decisions are non-routine and involve...Coates USAWC, July 2009 5 The Complexity of Strategic Decision Making Strategic decisions entail “ill-structured,”6 “messy” or

Training in Decision-making Strategies: An approach to enhance students' competence to deal with socio-scientific issues

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2013-10-01

Dealing with socio-scientific issues in science classes enables students to participate productively in controversial discussions concerning ethical topics, such as sustainable development. In this respect, well-structured decision-making processes are essential for elaborate reasoning. To foster decision-making competence, a computer-based programme was developed that trains secondary school students (grades 11-13) in decision-making strategies. The main research question is: does training students to use these strategies foster decision-making competence? In addition, the influence of meta-decision aids was examined. Students conducted a task analysis to select an appropriate strategy prior to the decision-making process. Hence, the second research question is: does combining decision-making training with a task analysis enhance decision-making competence at a higher rate? To answer these questions, 386 students were tested in a pre-post-follow-up control-group design that included two training groups (decision-making strategies/decision-making strategies combined with a task analysis) and a control group (decision-making with additional ecological information instead of strategic training). An open-ended questionnaire was used to assess decision-making competence in situations related to sustainable development. The decision-making training led to a significant improvement in the post-test and the follow-up, which was administered three months after the training. Long-term effects on the quality of the students' decisions were evident for both training groups. Gains in competence when reflecting upon the decision-making processes of others were found, to a lesser extent, in the training group that received the additional meta-decision training. In conclusion, training in decision-making strategies is a promising approach to deal with socio-scientific issues related to sustainable development.

Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.

PubMed

Kon, Alexander A; Davidson, Judy E; Morrison, Wynne; Danis, Marion; White, Douglas B

2016-01-01

Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement. Six recommendations were endorsed: 1) DEFINITION: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their "default" approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

PubMed

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Acquisition of choice in concurrent chains: Assessing the cumulative decision model.

PubMed

Grace, Randolph C

2016-05-01

Concurrent chains is widely used to study pigeons' choice between terminal links that can vary in delay, magnitude, or probability of reinforcement. We review research on the acquisition of choice in this procedure. Acquisition has been studied with a variety of research designs, and some studies have incorporated no-food trials to allow for timing and choice to be observed concurrently. Results show that: Choice can be acquired rapidly within sessions when terminal links change unpredictably; under steady-state conditions, acquisition depends on both initial- and terminal-link schedules; and initial-link responding is mediated by learning about the terminal-link stimulus-reinforcer relations. The cumulative decision model (CDM) proposed by Christensen and Grace (2010) and Grace and McLean (2006, 2015) provides a good description of within-session acquisition, and correctly predicts the effects of initial and terminal-link schedules in steady-state designs (Grace, 2002a). Questions for future research include how abrupt shifts in preference within individual sessions and temporal control of terminal-link responding can be modeled. Copyright © 2016 Elsevier B.V. All rights reserved.

Patterns of Cognitive Strengths and Weaknesses: Identification Rates, Agreement, and Validity for Learning Disabilities Identification

PubMed Central

Miciak, Jeremy; Fletcher, Jack M.; Stuebing, Karla; Vaughn, Sharon; Tolar, Tammy D.

2014-01-01

Purpose Few empirical investigations have evaluated LD identification methods based on a pattern of cognitive strengths and weaknesses (PSW). This study investigated the reliability and validity of two proposed PSW methods: the concordance/discordance method (C/DM) and cross battery assessment (XBA) method. Methods Cognitive assessment data for 139 adolescents demonstrating inadequate response to intervention was utilized to empirically classify participants as meeting or not meeting PSW LD identification criteria using the two approaches, permitting an analysis of: (1) LD identification rates; (2) agreement between methods; and (3) external validity. Results LD identification rates varied between the two methods depending upon the cut point for low achievement, with low agreement for LD identification decisions. Comparisons of groups that met and did not meet LD identification criteria on external academic variables were largely null, raising questions of external validity. Conclusions This study found low agreement and little evidence of validity for LD identification decisions based on PSW methods. An alternative may be to use multiple measures of academic achievement to guide intervention. PMID:24274155

Decision-making in Swiss home-like childbirth: A grounded theory study.

PubMed

Meyer, Yvonne; Frank, Franziska; Schläppy Muntwyler, Franziska; Fleming, Valerie; Pehlke-Milde, Jessica

2017-12-01

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Influence of calcium depletion on iron-binding properties of milk.

PubMed

Mittal, V A; Ellis, A; Ye, A; Das, S; Singh, H

2015-04-01

We investigated the effects of calcium depletion on the binding of iron in milk. A weakly acidic cation-exchange resin was used to remove 3 different levels (18-22, 50-55, and 68-72%) of calcium from milk. Five levels of iron (5, 10, 15, 20, and 25 mM) were added to each of these calcium-depleted milks (CDM) and the resultant milks were analyzed for particle size, microstructure, and the distribution of protein and minerals between the colloidal and soluble phases. The depletion of calcium affected the distribution of protein and minerals in normal milk. Iron added to normal milk and low-CDM (~20% calcium depletion) bound mainly to the colloidal phase (material sedimented at 100,000 × g for 1 h at 20 °C), with little effect on the integrity of the casein micelles. Depletion of ~70% of the calcium from milk resulted in almost complete disintegration of the casein micelles, as indicated by all the protein remaining in the soluble phase upon ultracentrifugation. Addition of up to ~20 mM iron to high CDM resulted in the formation of small fibrous structures that remained in the soluble phase of milk. It appeared that the iron bound to soluble (nonsedimentable) caseins in high-CDM. We observed a decrease in the aqueous phosphorus content of all milks upon iron addition, irrespective of their calcium content. We considered the interaction between aqueous phosphorus and added iron to be responsible for the high iron-binding capacity of the proteins in milk. The soluble protein-iron complexes formed in high-CDM (~70% calcium depletion) could be used as an effective iron fortificant for a range of food products because of their good solubility characteristics. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Luminance level of a monitor: influence on detectability and detection rate of breast cancer in 2D mammography

NASA Astrophysics Data System (ADS)

Bemelmans, Frédéric; Rashidnasab, Alaleh; Chesterman, Frédérique; Kimpe, Tom; Bosmans, Hilde

2016-03-01

Purpose: To evaluate lesion detectability and reading time as a function of luminance level of the monitor. Material and Methods: 3D mass models and microcalcification clusters were simulated into ROIs of for processing mammograms. Randomly selected ROIs were subdivided in three groups according to their background glandularity: high (>30%), medium (15-30%) and low (<15%). 6 non-spiculated masses (9 - 11mm), 6 spiculated masses (5 - 7mm) and 6 microcalcification clusters (2 - 4mm) were scaled in 3D to create a range of sizes. The linear attenuation coefficient (AC) of the masses was adjusted from 100% glandular tissue to 90%, 80%, 70%, to create different contrasts. Six physicists read the full database on Barco's Coronis Uniti monitor for four different luminance levels (300, 800, 1000 and 1200 Cd/m2), using a 4-AFC tool. Percentage correct (PC) and time were computed for all different conditions. A paired t-test was performed to evaluate the effect of luminance on PC and time. A multi-factorial analysis was performed using MANOVA.. Results: Paired t-test indicated a statistically significant difference for the average time per session between 300 and 1200; 800 and 1200; 1000 and 1200 Cd/m2, for all participants combined. There was no effect on PC. MANOVA denoted significantly lower reading times for high glandularity images at 1200 Cd/m2. Both types of masses were significantly faster detected at 1200 Cd/m2, for the contrast study. In the size study, microcalcification clusters and spiculated masses had a significantly higher detection rate at 1200 Cd/m2. Conclusion: These results demonstrate a significant decrease in reading time, while detectability remained constant.

Development of a Highly Efficient Hybrid White Organic-Light-Emitting Diode with a Single Emission Layer by Solution Processing.

PubMed

Wu, Jun-Yi; Chen, Show-An

2018-02-07

We use a mixed host, 2,6-bis[3-(carbazol-9-yl)phenyl]pyridine blended with 20 wt % tris(4-carbazoyl-9-ylphenyl)amine, to lower the hole-injection barrier, along with the bipolar and high-photoluminescence-quantum-yield (Φ p = 84%), blue thermally activated delay fluorescence (TADF) material of 9,9-dimethyl-9,10-dihydroacridine-2,4,6-triphenyl-1,3,5-triazine (DMAC-TRZ) as a blue dopant to compose the emission layer for the fabrication of a TADF blue organic-light-emitting diode (BOLED). The device is highly efficient with the following performance parameters: maximum brightness (B max ) = 57586 cd/m 2 , maximum current efficiency (CE max ) = 35.3 cd/A, maximum power efficiency (PE max ) = 21.4 lm/W, maximum external quantum efficiency (EQE max ) = 14.1%, and CIE coordinates (0.18, 0.42). This device has the best performance recorded among the reported solution-processed TADF BOLEDs and has a low efficiency roll-off: at brightness values of 1000 and 5000 cd/m 2 , its CEs are close, being 35.1 and 30.1 cd/A, respectively. Upon further doping of the red phosphor Ir(dpm)PQ 2 (emission peak λ max = 595 nm) into the blue emission layer, we obtained a TADF-phosphor hybrid white organic-light-emitting diode (T-P hybrid WOLED) with high performance: B max = 43594 cd/m 2 , CE max = 28.8 cd/A, PE max = 18.1 lm/W, and CIE coordinates (0.38, 0.44). This B max = 43594 cd/m 2 is better than that of the vacuum-deposited WOLED with a blue TADF emitter, 10000 cd/m 2 . This is also the first report on a T-P hybrid WOLED with a solution-processed emitting layer.

Feasibility and utility of applications of the common data model to multiple, disparate observational health databases.

PubMed

Voss, Erica A; Makadia, Rupa; Matcho, Amy; Ma, Qianli; Knoll, Chris; Schuemie, Martijn; DeFalco, Frank J; Londhe, Ajit; Zhu, Vivienne; Ryan, Patrick B

2015-05-01

To evaluate the utility of applying the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) across multiple observational databases within an organization and to apply standardized analytics tools for conducting observational research. Six deidentified patient-level datasets were transformed to the OMOP CDM. We evaluated the extent of information loss that occurred through the standardization process. We developed a standardized analytic tool to replicate the cohort construction process from a published epidemiology protocol and applied the analysis to all 6 databases to assess time-to-execution and comparability of results. Transformation to the CDM resulted in minimal information loss across all 6 databases. Patients and observations excluded were due to identified data quality issues in the source system, 96% to 99% of condition records and 90% to 99% of drug records were successfully mapped into the CDM using the standard vocabulary. The full cohort replication and descriptive baseline summary was executed for 2 cohorts in 6 databases in less than 1 hour. The standardization process improved data quality, increased efficiency, and facilitated cross-database comparisons to support a more systematic approach to observational research. Comparisons across data sources showed consistency in the impact of inclusion criteria, using the protocol and identified differences in patient characteristics and coding practices across databases. Standardizing data structure (through a CDM), content (through a standard vocabulary with source code mappings), and analytics can enable an institution to apply a network-based approach to observational research across multiple, disparate observational health databases. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Propulsion Physics Using the Chameleon Density Model

NASA Technical Reports Server (NTRS)

Robertson, Glen A.

2011-01-01

To grow as a space faring race, future spaceflight systems will require a new theory of propulsion. Specifically one that does not require mass ejection without limiting the high thrust necessary to accelerate within or beyond our solar system and return within a normal work period or lifetime. The Chameleon Density Model (CDM) is one such model that could provide new paths in propulsion toward this end. The CDM is based on Chameleon Cosmology a dark matter theory; introduced by Khrouy and Weltman in 2004. Chameleon as it is hidden within known physics, where the Chameleon field represents a scalar field within and about an object; even in the vacuum. The CDM relates to density changes in the Chameleon field, where the density changes are related to matter accelerations within and about an object. These density changes in turn change how an object couples to its environment. Whereby, thrust is achieved by causing a differential in the environmental coupling about an object. As a demonstration to show that the CDM fits within known propulsion physics, this paper uses the model to estimate the thrust from a solid rocket motor. Under the CDM, a solid rocket constitutes a two body system, i.e., the changing density of the rocket and the changing density in the nozzle arising from the accelerated mass. Whereby, the interactions between these systems cause a differential coupling to the local gravity environment of the earth. It is shown that the resulting differential in coupling produces a calculated value for the thrust near equivalent to the conventional thrust model used in Sutton and Ross, Rocket Propulsion Elements. Even though imbedded in the equations are the Universe energy scale factor, the reduced Planck mass and the Planck length, which relates the large Universe scale to the subatomic scale.

Hidden from view: coupled dark sector physics and small scales

NASA Astrophysics Data System (ADS)

Elahi, Pascal J.; Lewis, Geraint F.; Power, Chris; Carlesi, Edoardo; Knebe, Alexander

2015-09-01

We study cluster mass dark matter (DM) haloes, their progenitors and surroundings in a coupled dark matter-dark energy (DE) model and compare it to quintessence and Λ cold dark matter (ΛCDM) models with adiabatic zoom simulations. When comparing cosmologies with different expansions histories, growth functions and power spectra, care must be taken to identify unambiguous signatures of alternative cosmologies. Shared cosmological parameters, such as σ8, need not be the same for optimal fits to observational data. We choose to set our parameters to ΛCDM z = 0 values. We find that in coupled models, where DM decays into DE, haloes appear remarkably similar to ΛCDM haloes despite DM experiencing an additional frictional force. Density profiles are not systematically different and the subhalo populations have similar mass, spin, and spatial distributions, although (sub)haloes are less concentrated on average in coupled cosmologies. However, given the scatter in related observables (V_max,R_{V_max}), this difference is unlikely to distinguish between coupled and uncoupled DM. Observations of satellites of Milky Way and M31 indicate a significant subpopulation reside in a plane. Coupled models do produce planar arrangements of satellites of higher statistical significance than ΛCDM models; however, in all models these planes are dynamically unstable. In general, the non-linear dynamics within and near large haloes masks the effects of a coupled dark sector. The sole environmental signature we find is that small haloes residing in the outskirts are more deficient in baryons than their ΛCDM counterparts. The lack of a pronounced signal for a coupled dark sector strongly suggests that such a phenomena would be effectively hidden from view.

Production of the short peptide surfactant DAMP4 from glucose or sucrose in high cell density cultures of Escherichia coli BL21(DE3).

PubMed

Bruschi, Michele; Krömer, Jens O; Steen, Jennifer A; Nielsen, Lars K

2014-08-19

Peptides are increasingly used in industry as highly functional materials. Bacterial production of recombinant peptides has the potential to provide large amounts of renewable and low cost peptides, however, achieving high product titers from Chemically Defined Media (CDM) supplemented with simple sugars remains challenging. In this work, the short peptide surfactant, DAMP4, was used as a model peptide to investigate production in Escherichia coli BL21(DE3), a classical strain used for protein production. Under the same fermentation conditions, switching production of DAMP4 from rich complex media to CDM resulted in a reduction in yield that could be attributed to the reduction in final cell density more so than a significant reduction in specific productivity. To maximize product titer, cell density at induction was maximized using a fed-batch approach. In fed-batch DAMP4 product titer increased 9-fold compared to batch, while maintaining 60% specific productivity. Under the fed-batch conditions, the final product titer of DAMP4 reached more than 7 g/L which is the highest titer of DAMP4 reported to date. To investigate production from sucrose, sucrose metabolism was engineered into BL21(DE3) using a simple plasmid approach. Using this strain, growth and DAMP4 production characteristics obtained from CDM supplemented with sucrose were similar to those obtained when culturing the parent strain on CDM supplemented with glucose. Production of a model peptide was increased to several grams per liter using a CDM medium with either glucose or sucrose feedstock. It is hoped that this work will contribute cost reduction for production of designer peptide surfactants to facilitate their commercial application.

THE CENTRAL SLOPE OF DARK MATTER CORES IN DWARF GALAXIES: SIMULATIONS VERSUS THINGS

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

Oh, Se-Heon; De Blok, W. J. G.; Brook, Chris

2011-07-15

We make a direct comparison of the derived dark matter (DM) distributions between hydrodynamical simulations of dwarf galaxies assuming a {Lambda}CDM cosmology and the observed dwarf galaxies sample from the THINGS survey in terms of (1) the rotation curve shape and (2) the logarithmic inner density slope {alpha} of mass density profiles. The simulations, which include the effect of baryonic feedback processes, such as gas cooling, star formation, cosmic UV background heating, and most importantly, physically motivated gas outflows driven by supernovae, form bulgeless galaxies with DM cores. We show that the stellar and baryonic mass is similar to thatmore » inferred from photometric and kinematic methods for galaxies of similar circular velocity. Analyzing the simulations in exactly the same way as the observational sample allows us to address directly the so-called cusp/core problem in the {Lambda}CDM model. We show that the rotation curves of the simulated dwarf galaxies rise less steeply than cold dark matter rotation curves and are consistent with those of the THINGS dwarf galaxies. The mean value of the logarithmic inner density slopes {alpha} of the simulated galaxies' DM density profiles is {approx}-0.4 {+-} 0.1, which shows good agreement with {alpha} = -0.29 {+-} 0.07 of the THINGS dwarf galaxies. The effect of non-circular motions is not significant enough to affect the results. This confirms that the baryonic feedback processes included in the simulations are efficiently able to make the initial cusps with {alpha} {approx}-1.0 to -1.5 predicted by DM-only simulations shallower and induce DM halos with a central mass distribution similar to that observed in nearby dwarf galaxies.« less

Shared decision-making - Rhetoric and reality: Women's experiences and perceptions of adjuvant treatment decision-making for breast cancer.

PubMed

Mahmoodi, Neda; Sargeant, Sally

2017-01-01

This interview-based study uses phenomenology as a theoretical framework and thematic analysis to challenge existing explanatory frameworks of shared decision-making, in an exploration of women's experiences and perceptions of shared decision-making for adjuvant treatment in breast cancer. Three themes emerged are as follows: (1) women's desire to participate in shared decision-making, (2) the degree to which shared decision-making is perceived to be shared and (3) to what extent are women empowered within shared decision-making. Studying breast cancer patients' subjective experiences of adjuvant treatment decision-making provides a broader perspective on patient participatory role preferences and doctor-patient power dynamics within shared decision-making for breast cancer.

Measuring Shared Decision Making in Psychiatric Care

PubMed Central

Salyers, Michelle P.; Matthias, Marianne S.; Fukui, Sadaaki; Holter, Mark C.; Collins, Linda; Rose, Nichole; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts. PMID:22854725

Λ CDM is Consistent with SPARC Radial Acceleration Relation

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

Keller, B. W.; Wadsley, J. W., E-mail: kellerbw@mcmaster.ca

2017-01-20

Recent analysis of the Spitzer Photometry and Accurate Rotation Curve (SPARC) galaxy sample found a surprisingly tight relation between the radial acceleration inferred from the rotation curves and the acceleration due to the baryonic components of the disk. It has been suggested that this relation may be evidence for new physics, beyond Λ CDM . In this Letter, we show that 32 galaxies from the MUGS2 match the SPARC acceleration relation. These cosmological simulations of star-forming, rotationally supported disks were simulated with a WMAP3 Λ CDM cosmology, and match the SPARC acceleration relation with less scatter than the observational data.more » These results show that this acceleration relation is a consequence of dissipative collapse of baryons, rather than being evidence for exotic dark-sector physics or new dynamical laws.« less

Indirectly Estimating International Net Migration Flows by Age and Gender: The Community Demographic Model International Migration (CDM-IM) Dataset

PubMed Central

Nawrotzki, Raphael J.; Jiang, Leiwen

2015-01-01

Although data for the total number of international migrant flows is now available, no global dataset concerning demographic characteristics, such as the age and gender composition of migrant flows exists. This paper reports on the methods used to generate the CDM-IM dataset of age and gender specific profiles of bilateral net (not gross) migrant flows. We employ raw data from the United Nations Global Migration Database and estimate net migrant flows by age and gender between two time points around the year 2000, accounting for various demographic processes (fertility, mortality). The dataset contains information on 3,713 net migrant flows. Validation analyses against existing data sets and the historical, geopolitical context demonstrate that the CDM-IM dataset is of reasonably high quality. PMID:26692590

Large- and small-scale constraints on power spectra in Omega = 1 universes

NASA Technical Reports Server (NTRS)

Gelb, James M.; Gradwohl, Ben-Ami; Frieman, Joshua A.

1993-01-01

The CDM model of structure formation, normalized on large scales, leads to excessive pairwise velocity dispersions on small scales. In an attempt to circumvent this problem, we study three scenarios (all with Omega = 1) with more large-scale and less small-scale power than the standard CDM model: (1) cold dark matter with significantly reduced small-scale power (inspired by models with an admixture of cold and hot dark matter); (2) cold dark matter with a non-scale-invariant power spectrum; and (3) cold dark matter with coupling of dark matter to a long-range vector field. When normalized to COBE on large scales, such models do lead to reduced velocities on small scales and they produce fewer halos compared with CDM. However, models with sufficiently low small-scale velocities apparently fail to produce an adequate number of halos.

Interpretation of the cosmic microwave background radiation anisotropy detected by the COBE Differential Microwave Radiometer

NASA Technical Reports Server (NTRS)

Wright, E. L.; Meyer, S. S.; Bennett, C. L.; Boggess, N. W.; Cheng, E. S.; Hauser, M. G.; Kogut, A.; Lineweaver, C.; Mather, J. C.; Smoot, G. F.

1992-01-01

The large-scale cosmic background anisotropy detected by the COBE Differential Microwave Radiometer (DMR) instrument is compared to the sensitive previous measurements on various angular scales, and to the predictions of a wide variety of models of structure formation driven by gravitational instability. The observed anisotropy is consistent with all previously measured upper limits and with a number of dynamical models of structure formation. For example, the data agree with an unbiased cold dark matter (CDM) model with H0 = 50 km/s Mpc and Delta-M/M = 1 in a 16 Mpc radius sphere. Other models, such as CDM plus massive neutrinos (hot dark matter (HDM)), or CDM with a nonzero cosmological constant are also consistent with the COBE detection and can provide the extra power seen on 5-10,000 km/s scales.

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.

Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

PubMed Central

Story, William T.; Burgard, Sarah A.

2012-01-01

This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556

Couples' reports of household decision-making and the utilization of maternal health services in Bangladesh.

PubMed

Story, William T; Burgard, Sarah A

2012-12-01

This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service utilization focus on women's reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands' involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. Copyright © 2012 Elsevier Ltd. All rights reserved.

Shared decision-making in epilepsy management.

PubMed

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

2015-06-01

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

[Shared decision-making in medical practice--patient-centred communication skills].

PubMed

van Staveren, Remke

2011-01-01

Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.

Advancing in the Career Decision-Making Process: The Role of Coping Strategies and Career Decision-Making Profiles

ERIC Educational Resources Information Center

Perez, Maya; Gati, Itamar

2017-01-01

We tested the associations among the career decision-making difficulties, the career decision status, and either (a) the career decision-making profiles of 575 young adults, or (b) the coping strategies of 379 young adults. As hypothesized, a more advanced decision status was negatively associated with both career decision-making difficulties…

Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision

PubMed Central

Edwards, Adrian; Elwyn, Glyn

2006-01-01

Abstract Background  Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. Aims  We undertook an empirical study to inform understanding of shared decision making and how it can be operationalized more widely. Method  The study involved patients visiting UK general practitioners already well experienced in shared decision making. After these consultations, semi‐structured telephone interviews were conducted and analysed using the constant comparative method of content analysis. Results  All patients described at least some components of shared decision making but half appeared to perceive the decision as shared and half as ‘patient‐led’. However, patients exhibited some uncertainty about who had made the decision, reflecting different meanings of decision making from those described in the literature. A distinction is indicated between the process of involvement (option portrayal, exchange of information and exploring preferences for who makes the decision) and the actual decisional responsibility (who makes the decision). The process of involvement appeared to deliver benefits for patients, not the action of making the decision. Preferences for decisional responsibility varied during some consultations, generating unsatisfactory interactions when actual decisional responsibility did not align with patient preferences at that stage of a consultation. However, when conducted well, shared decision making enhanced reported satisfaction, understanding and confidence in the decisions. Conclusions  Practitioners can focus more on the process of involving patients in decision making rather than attaching importance to who actually makes the decision. They also need to be aware of the potential for changing patient preferences for decisional responsibility during a consultation and address non‐alignment of patient preferences with the actual model of decision making if this occurs. PMID:17083558

Toward an Expanded Definition of Adaptive Decision Making.

ERIC Educational Resources Information Center

Phillips, Susan D.

1997-01-01

Uses the lifespan, life-space model to examine the definition of adaptive decision making. Reviews the existing definition of adaptive decision making as "rational" decision making and offers alternate perspectives on decision making with an emphasis on the implications of using the model. Makes suggestions for future theory, research,…

Clumpy cold dark matter

NASA Technical Reports Server (NTRS)

Silk, Joseph; Stebbins, Albert

1993-01-01

A study is conducted of cold dark matter (CDM) models in which clumpiness will inhere, using cosmic strings and textures suited to galaxy formation. CDM clumps of 10 million solar mass/cu pc density are generated at about z(eq) redshift, with a sizable fraction surviving. Observable implications encompass dark matter cores in globular clusters and in galactic nuclei. Results from terrestrial dark matter detection experiments may be affected by clumpiness in the Galactic halo.

Factors Affecting Exocellular Polysaccharide Production by Lactobacillus delbrueckii subsp. bulgaricus Grown in a Chemically Defined Medium†

PubMed Central

Petry, Sandrine; Furlan, Sylviane; Crepeau, Marie-Jeanne; Cerning, Jutta; Desmazeaud, Michel

2000-01-01

We developed a chemically defined medium (CDM) containing lactose or glucose as the carbon source that supports growth and exopolysaccharide (EPS) production of two strains of Lactobacillus delbrueckii subsp. bulgaricus. The factors found to affect EPS production in this medium were oxygen, pH, temperature, and medium constituents, such as orotic acid and the carbon source. EPS production was greatest during the stationary phase. Composition analysis of EPS isolated at different growth phases and produced under different fermentation conditions (varying carbon source or pH) revealed that the component sugars were the same. The EPS from strain L. delbrueckii subsp. bulgaricus CNRZ 1187 contained galactose and glucose, and that of strain L. delbrueckii subsp. bulgaricus CNRZ 416 contained galactose, glucose, and rhamnose. However, the relative proportions of the individual monosaccharides differed, suggesting that repeating unit structures can vary according to specific medium alterations. Under pH-controlled fermentation conditions, L. delbrueckii subsp. bulgaricus strains produced as much EPS in the CDM as in milk. Furthermore, the relative proportions of individual monosaccharides of EPS produced in pH-controlled CDM or in milk were very similar. The CDM we developed may be a useful model and an alternative to milk in studies of EPS production. PMID:10919802

Exploring the nature of power distance on general practitioner and community pharmacist relations in a chronic disease management context.

PubMed

Rieck, Allison Margaret

2014-09-01

To improve collaboration in Australian primary health care, there is a need to understand aspects of the general practitioner (GP)/community pharmacist relationship, its influence on collaborative chronic disease management (CDM) and if this influence can be explained by a pre-existing theory or concept. Adopting a grounded theory approach, 22 GP and 22 community pharmacist semi-structured interviews were undertaken. Analysis of the transcripts identified common themes regarding the GP/community pharmacist relationship. Trustworthiness of the themes identified was tested through negative case analysis and member checking. Hofstede's (in 1980) phenomenon of power distance was employed to illuminate the nature of GP/community pharmacist relations. The majority of GPs and community pharmacists described the characteristics of this phenomenon. The power distance was based on knowledge and expertise and was shown to be a barrier to collaboration between GPs and community pharmacists because GPs perceived that community pharmacists did not have the required expertise to improve CDM above what the GP could deliver alone. Power distance exists within the GP/community pharmacist relationship and has a negative influence on GP/community pharmacist collaborative CDM. Understanding and improving GP awareness of community pharmacist expertise has important implications for the future success of collaborative CDM.

Modified chemically defined medium for enhanced respiratory growth of Lactobacillus casei and Lactobacillus plantarum groups.

PubMed

Ricciardi, A; Ianniello, R G; Parente, E; Zotta, T

2015-09-01

Members of the Lactobacillus casei and Lactobacillus plantarum groups are capable of aerobic and respiratory growth. However, they grow poorly in aerobiosis in the currently available chemically defined media, suggesting that aerobic and respiratory growth require further supplementation. The effect of Tween 80, L-alanine, L-asparagine, L-aspartate, L-proline and L-serine on anaerobic and respiratory growth of Lact. casei N87 was investigated using a 2(5) factorial design. The effectiveness of modified CDM (mCDM) was validated on 21 strains of Lact. casei and Lact. plantarum groups. Tween 80 supplementation did not affect anaerobic growth, but improved respiratory growth. L-asparagine, L-proline and L-serine were stimulatory for respiring cells, while the presence of L-aspartate, generally, impaired biomass production. mCDM promoted the growth of Lact. casei and Lact. plantarum, with best results for strains showing a respiratory phenotype. The nutritional requirements of anaerobic and respiratory cultures of members of the Lact. casei and Lact. plantarum groups differ. Tween 80 and selected amino acids derived from pathways related to TCA cycle, pyruvate conversion and NADH recycling are required for respiration. The availability of mCDM will facilitate the study of aerobic metabolism of lactobacilli under controlled conditions. © 2015 The Society for Applied Microbiology.

Hierarchy of N-point functions in the ΛCDM and ReBEL cosmologies

NASA Astrophysics Data System (ADS)

Hellwing, Wojciech A.; Juszkiewicz, Roman; van de Weygaert, Rien

2010-11-01

In this work we investigate higher-order statistics for the ΛCDM and ReBEL scalar-interacting dark matter models by analyzing 180h-1Mpc dark matter N-body simulation ensembles. The N-point correlation functions and the related hierarchical amplitudes, such as skewness and kurtosis, are computed using the counts-in-cells method. Our studies demonstrate that the hierarchical amplitudes Sn of the scalar-interacting dark matter model significantly deviate from the values in the ΛCDM cosmology on scales comparable and smaller than the screening length rs of a given scalar-interacting model. The corresponding additional forces that enhance the total attractive force exerted on dark matter particles at galaxy scales lower the values of the hierarchical amplitudes Sn. We conclude that hypothetical additional exotic interactions in the dark matter sector should leave detectable markers in the higher-order correlation statistics of the density field. We focused in detail on the redshift evolution of the dark matter field’s skewness and kurtosis. From this investigation we find that the deviations from the canonical ΛCDM model introduced by the presence of the “fifth” force attain a maximum value at redshifts 0.5

Influence of monitor luminance and room illumination on soft-copy reading evaluation with electronically generated contrast-detail phantom: comparison of cathode-ray tube monitor with liquid crystal display.

PubMed

Muramoto, Hideyuki; Shimamoto, Kazuhiro; Ikeda, Mitsuru; Koyama, Kazuyuki; Fukushima, Hiromichi; Ishigaki, Takeo

2006-06-01

The influence of monitor brightness and room illumination on soft-copy diagnosis by both cathode-ray tube (CRT) monitor and liquid crystal display (LCD) was evaluated and compared using a contrast-detail phantom. Nine observers (7 radiologists and 2 radiological technicians) interpreted six types of electronically generated contrast-detail phantom images using a 21-inch CRT (2,048x2,560) and a 21-inch LCD (2,048x2,560) under 6 kinds of viewing conditions, i.e. monitor brightness of 330 cd/m2 or 450 cd/m2, and room illumination of 20, 100 or 420 lux at the center of the display. Observers were requested to determine the visible borderline of the objects. Between 330 cd/m2 and 450 cd/m2, no significant difference in the visible area was found under any of the three lighting conditions. However, in two low-contrast phantom images, the visible area on the LCD was significantly larger than that on the CRT, independent of both monitor brightness and room illumination. (p<0.05). The effect of room illumination was not significant, suggesting that the use of LCD at high room illumination is acceptable.

The Most Massive Galaxies and Black Holes Allowed by ΛCDM

NASA Astrophysics Data System (ADS)

Behroozi, Peter; Silk, Joseph

2018-04-01

Given a galaxy's stellar mass, its host halo mass has a lower limit from the cosmic baryon fraction and known baryonic physics. At z > 4, galaxy stellar mass functions place lower limits on halo number densities that approach expected ΛCDM halo mass functions. High-redshift galaxy stellar mass functions can thus place interesting limits on number densities of massive haloes, which are otherwise very difficult to measure. Although halo mass functions at z < 8 are consistent with observed galaxy stellar masses if galaxy baryonic conversion efficiencies increase with redshift, JWST and WFIRST will more than double the redshift range over which useful constraints are available. We calculate maximum galaxy stellar masses as a function of redshift given expected halo number densities from ΛCDM. We apply similar arguments to black holes. If their virial mass estimates are accurate, number density constraints alone suggest that the quasars SDSS J1044-0125 and SDSS J010013.02+280225.8 likely have black hole mass — stellar mass ratios higher than the median z = 0 relation, confirming the expectation from Lauer bias. Finally, we present a public code to evaluate the probability of an apparently ΛCDM-inconsistent high-mass halo being detected given the combined effects of multiple surveys and observational errors.

Fracture simulation of restored teeth using a continuum damage mechanics failure model.

PubMed

Li, Haiyan; Li, Jianying; Zou, Zhenmin; Fok, Alex Siu-Lun

2011-07-01

The aim of this paper is to validate the use of a finite-element (FE) based continuum damage mechanics (CDM) failure model to simulate the debonding and fracture of restored teeth. Fracture testing of plastic model teeth, with or without a standard Class-II MOD (mesial-occusal-distal) restoration, was carried out to investigate their fracture behavior. In parallel, 2D FE models of the teeth are constructed and analyzed using the commercial FE software ABAQUS. A CDM failure model, implemented into ABAQUS via the user element subroutine (UEL), is used to simulate the debonding and/or final fracture of the model teeth under a compressive load. The material parameters needed for the CDM model to simulate fracture are obtained through separate mechanical tests. The predicted results are then compared with the experimental data of the fracture tests to validate the failure model. The failure processes of the intact and restored model teeth are successfully reproduced by the simulation. However, the fracture parameters obtained from testing small specimens need to be adjusted to account for the size effect. The results indicate that the CDM model is a viable model for the prediction of debonding and fracture in dental restorations. Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada

PubMed Central

Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

2016-01-01

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change. PMID:27417591

A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada.

PubMed

Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

2016-01-04

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

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.

Registered nurses' decision-making regarding documentation in patients' progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive continuum theory as a decision-making framework, provides a powerful means of guiding nurses' decision-making. © 2012 Blackwell Publishing Ltd.

A timely account of the role of duration in decision making.

PubMed

Ariely, D; Zakay, D

2001-09-01

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

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

PubMed

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

2012-01-01

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

Composite collective decision-making

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-11-30

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

Analysis of the decision-making process of nurse managers: a collective reflection.

PubMed

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

2015-01-01

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

Shared Decision-Making for Nursing Practice: An Integrative Review.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T

2018-01-01

Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

Does future-oriented thinking predict adolescent decision making?

PubMed

Eskritt, Michelle; Doucette, Jesslyn; Robitaille, Lori

2014-01-01

A number of theorists, as well as plain common sense, suggest that future-oriented thinking (FOT) should be involved in decision making; therefore, the development of FOT should be related to better quality decision making. FOT and quality of the decision making were measured in adolescents as well as adults in 2 different experiments. Though the results of the first experiment revealed an increase in quality of decision making across adolescence into adulthood, there was no relationship between FOT and decision making. In the second experiment, FOT predicted performance on a more deliberative decision-making task independent of age, but not performance on the Iowa Gambling Task (IGT). Performance on the IGT was instead related to emotion regulation. The study's findings suggest that FOT can be related to reflective decision making but not necessarily decision making that is more intuitive.

Mothers' process of decision making for gastrostomy placement.

PubMed

Brotherton, Ailsa; Abbott, Janice

2012-05-01

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.

Path Analysis Examining Self-Efficacy and Decision-Making Performance on a Simulated Baseball Task

ERIC Educational Resources Information Center

Hepler, Teri J.; Feltz, Deborah L.

2012-01-01

The purpose of this study was to examine the relationship between decision-making self-efficacy and decision-making performance in sport. Undergraduate students (N = 78) performed 10 trials of a decision-making task in baseball. Self-efficacy was measured before performing each trial. Decision-making performance was assessed by decision speed and…

Decision Styles and Rationality: An Analysis of the Predictive Validity of the General Decision-Making Style Inventory

ERIC Educational Resources Information Center

Curseu, Petru Lucian; Schruijer, Sandra G. L.

2012-01-01

This study investigates the relationship between the five decision-making styles evaluated by the General Decision-Making Style Inventory, indecisiveness, and rationality in decision making. Using a sample of 102 middle-level managers, the results show that the rational style positively predicts rationality in decision making and negatively…

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

PubMed

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

2015-05-01

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

National evidence on the use of shared decision making in prostate-specific antigen screening.

PubMed

Han, Paul K J; Kobrin, Sarah; Breen, Nancy; Joseph, Djenaba A; Li, Jun; Frosch, Dominick L; Klabunde, Carrie N

2013-01-01

Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

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.

Autonomy and couples' joint decision-making in healthcare.

PubMed

Osamor, Pauline E; Grady, Christine

2018-01-11

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples (couples' joint decision-making) for health care and the circumstances under which such a practice should be respected as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples' joint decision-making, and the ethics of couples' joint decision-making. We believe that the extent to which couples' joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples' joint decision-making about a woman's own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman's autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples' joint decision-making should be viewed as consistent with the principle of respect for the woman's autonomy. At the other end of the spectrum are decisions made by the man without the woman's input, representing domination of one partner by the other. We recommend viewing the dynamics of couples' joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples' joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question.

Integrating Decision Making and Mental Health Interventions Research: Research Directions

PubMed Central

Wills, Celia E.; Holmes-Rovner, Margaret

2006-01-01

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/“micro” variables to services-level/“macro” variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs. PMID:16724158

An introduction to behavioural decision-making theories for paediatricians.

PubMed

Haward, Marlyse F; Janvier, Annie

2015-04-01

Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Shared decision-making, gender and new technologies.

PubMed

Zeiler, Kristin

2007-09-01

Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous decision-making process? Why make the distinction? Examples are drawn from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed.

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

PubMed Central

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

2013-01-01

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

Cosmic string with a light massive neutrino

NASA Technical Reports Server (NTRS)

Albrecht, Andreas; Stebbins, Albert

1992-01-01

We have estimated the power spectra of density fluctuations produced by cosmic strings with neutrino hot dark matter (HDM). Normalizing at 8/h Mpc, we find that the spectrum has more power on small scales than HDM + inflation, less than cold dark matter (CDM) + inflation, and significantly less the CDM + strings. With HDM, large wakes give significant contribution to the power on the galaxy scale and may give rise to large sheets of galaxies.

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

Wright, Bill S.; Winther, Hans A.; Koyama, Kazuya, E-mail: bill.wright@port.ac.uk, E-mail: hans.winther@port.ac.uk, E-mail: kazuya.koyama@port.ac.uk

The effect of massive neutrinos on the growth of cold dark matter perturbations acts as a scale-dependent Newton's constant and leads to scale-dependent growth factors just as we often find in models of gravity beyond General Relativity. We show how to compute growth factors for ΛCDM and general modified gravity cosmologies combined with massive neutrinos in Lagrangian perturbation theory for use in COLA and extensions thereof. We implement this together with the grid-based massive neutrino method of Brandbyge and Hannestad in MG-PICOLA and compare COLA simulations to full N -body simulations of ΛCDM and f ( R ) gravity withmore » massive neutrinos. Our implementation is computationally cheap if the underlying cosmology already has scale-dependent growth factors and it is shown to be able to produce results that match N -body to percent level accuracy for both the total and CDM matter power-spectra up to k ∼< 1 h /Mpc.« less

A ROBUST MEASURE OF DARK MATTER HALO ELLIPTICITIES

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

Evslin, Jarah

2016-08-01

In simulations of the standard cosmological model (ΛCDM), dark matter halos are aspherical. However, so far the asphericity of an individual galaxy’s halo has never been robustly established. We use the Jeans equations to define a quantity that robustly characterizes a deviation from rotational symmetry. This quantity is essentially the gravitational torque and it roughly provides the ellipticity projected along the line of sight. We show that the Thirty Meter Telescope (TMT), with a single epoch of observations combined with those of the Gaia Space Telescope , can distinguish the ΛCDM value of the torque from zero for each Sculptor-likemore » dwarf galaxy with a confidence between 0 and 5 σ , depending on the orientation of each halo. With two epochs of observations, TMT will achieve a 5 σ discovery of torque and thus asphericity for most such galaxies, thus providing a new and powerful test of the ΛCDM model.« less

Organic light-emitting diodes with direct contact-printed red, green, blue, and white light-emitting layers

NASA Astrophysics Data System (ADS)

Chen, Sun-Zen; Peng, Shiang-Hau; Ting, Tzu-Yu; Wu, Po-Shien; Lin, Chun-Hao; Chang, Chin-Yeh; Shyue, Jing-Jong; Jou, Jwo-Huei

2012-10-01

We demonstrate the feasibility of using direct contact-printing in the fabrication of monochromatic and polychromatic organic light-emitting diodes (OLEDs). Bright devices with red, green, blue, and white contact-printed light-emitting layers with a respective maximum luminance of 29 000, 29 000, 4000, and 18 000 cd/m2 were obtained with sound film integrity by blending a polymeric host into a molecular host. For the red OLED as example, the maximum luminance was decreased from 29 000 to 5000 cd/m2 as only the polymeric host was used, or decreased to 7000 cd/m2 as only the molecular host was used. The markedly improved device performance achieved in the devices with blended hosts may be attributed to the employed polymeric host that contributed a good film-forming character, and the molecular host that contributed a good electroluminescence character.

COLA with massive neutrinos

NASA Astrophysics Data System (ADS)

Wright, Bill S.; Winther, Hans A.; Koyama, Kazuya

2017-10-01

The effect of massive neutrinos on the growth of cold dark matter perturbations acts as a scale-dependent Newton's constant and leads to scale-dependent growth factors just as we often find in models of gravity beyond General Relativity. We show how to compute growth factors for ΛCDM and general modified gravity cosmologies combined with massive neutrinos in Lagrangian perturbation theory for use in COLA and extensions thereof. We implement this together with the grid-based massive neutrino method of Brandbyge and Hannestad in MG-PICOLA and compare COLA simulations to full N-body simulations of ΛCDM and f(R) gravity with massive neutrinos. Our implementation is computationally cheap if the underlying cosmology already has scale-dependent growth factors and it is shown to be able to produce results that match N-body to percent level accuracy for both the total and CDM matter power-spectra up to klesssim 1 h/Mpc.

Beyond Λ CDM: Problems, solutions, and the road ahead

NASA Astrophysics Data System (ADS)

Bull, Philip; Akrami, Yashar; Adamek, Julian; Baker, Tessa; Bellini, Emilio; Beltrán Jiménez, Jose; Bentivegna, Eloisa; Camera, Stefano; Clesse, Sébastien; Davis, Jonathan H.; Di Dio, Enea; Enander, Jonas; Heavens, Alan; Heisenberg, Lavinia; Hu, Bin; Llinares, Claudio; Maartens, Roy; Mörtsell, Edvard; Nadathur, Seshadri; Noller, Johannes; Pasechnik, Roman; Pawlowski, Marcel S.; Pereira, Thiago S.; Quartin, Miguel; Ricciardone, Angelo; Riemer-Sørensen, Signe; Rinaldi, Massimiliano; Sakstein, Jeremy; Saltas, Ippocratis D.; Salzano, Vincenzo; Sawicki, Ignacy; Solomon, Adam R.; Spolyar, Douglas; Starkman, Glenn D.; Steer, Danièle; Tereno, Ismael; Verde, Licia; Villaescusa-Navarro, Francisco; von Strauss, Mikael; Winther, Hans A.

2016-06-01

Despite its continued observational successes, there is a persistent (and growing) interest in extending cosmology beyond the standard model, Λ CDM. This is motivated by a range of apparently serious theoretical issues, involving such questions as the cosmological constant problem, the particle nature of dark matter, the validity of general relativity on large scales, the existence of anomalies in the CMB and on small scales, and the predictivity and testability of the inflationary paradigm. In this paper, we summarize the current status of Λ CDM as a physical theory, and review investigations into possible alternatives along a number of different lines, with a particular focus on highlighting the most promising directions. While the fundamental problems are proving reluctant to yield, the study of alternative cosmologies has led to considerable progress, with much more to come if hopes about forthcoming high-precision observations and new theoretical ideas are fulfilled.

Effects of electron transport material on blue organ light-emitting diode with fluorescent dopant of BCzVBi.

PubMed

Meng, Mei; Song, Wook; Kim, You-Hyun; Lee, Sang-Youn; Jhun, Chul-Gyu; Zhu, Fu Rong; Ryu, Dae Hyun; Kim, Woo-Young

2013-01-01

High efficiency blue organic light emitting diodes (OLEDs), based on 2-me-thyl-9,10-di(2-naphthyl) anthracene (MADN) doped with 4,4'-bis(9-ethyl-3-carbazovinylene)-1,1'-biphenyl (BCzVBi), were fabricated using two different electron transport layers (ETLs) of tris(8-hydroxyquinolino)-aluminum (Alq3) and 4,7-di-phenyl-1,10-phenanthroline (Bphen). Bphen ETL layers favored the efficient hole-electron recombination in the emissive layer of the BCzVBi-doped blue OLEDs, leading to high luminous efficiency and quantum efficiency of 8.34 cd/A at 100 mA/cm2 and 5.73% at 100 cd/m2, respectively. Maximum luminance of blue OLED with Bphen ETL and Alq3 ETL were 10670 cd/m2, and CIExy coordinates of blue OLEDs were (0.180, 0279) and (0.155, 0.212) at 100 cd/m2.

Redshift space clustering of galaxies and cold dark matter model

NASA Technical Reports Server (NTRS)

Bahcall, Neta A.; Cen, Renyue; Gramann, Mirt

1993-01-01

The distorting effect of peculiar velocities on the power speturm and correlation function of IRAS and optical galaxies is studied. The observed redshift space power spectra and correlation functions of IRAS and optical the galaxies over the entire range of scales are directly compared with the corresponding redshift space distributions using large-scale computer simulations of cold dark matter (CDM) models in order to study the distortion effect of peculiar velocities on the power spectrum and correlation function of the galaxies. It is found that the observed power spectrum of IRAS and optical galaxies is consistent with the spectrum of an Omega = 1 CDM model. The problems that such a model currently faces may be related more to the high value of Omega in the model than to the shape of the spectrum. A low-density CDM model is also investigated and found to be consistent with the data.

New observational constraints on f ( T ) gravity from cosmic chronometers

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

Nunes, Rafael C.; Pan, Supriya; Saridakis, Emmanuel N., E-mail: nunes@ecm.ub.edu, E-mail: span@iiserkol.ac.in, E-mail: Emmanuel_Saridakis@baylor.edu

2016-08-01

We use the local value of the Hubble constant recently measured with 2.4% precision, as well as the latest compilation of cosmic chronometers data, together with standard probes such as Supernovae Type Ia and Baryon Acoustic Oscillation distance measurements, in order to impose constraints on the viable and most used f ( T ) gravity models, where T is the torsion scalar in teleparallel gravity. In particular, we consider three f ( T ) models with two parameters, out of which one is independent, and we quantify their deviation from ΛCDM cosmology through a sole parameter. Our analysis reveals thatmore » for one of the models a small but non-zero deviation from ΛCDM cosmology is slightly favored, while for the other models the best fit is very close to ΛCDM scenario. Clearly, f ( T ) gravity is consistent with observations, and it can serve as a candidate for modified gravity.« less

A correction in the CDM methodological tool for estimating methane emissions from solid waste disposal sites.

PubMed

Santos, M M O; van Elk, A G P; Romanel, C

2015-12-01

Solid waste disposal sites (SWDS) - especially landfills - are a significant source of methane, a greenhouse gas. Although having the potential to be captured and used as a fuel, most of the methane formed in SWDS is emitted to the atmosphere, mainly in developing countries. Methane emissions have to be estimated in national inventories. To help this task the Intergovernmental Panel on Climate Change (IPCC) has published three sets of guidelines. In addition, the Kyoto Protocol established the Clean Development Mechanism (CDM) to assist the developed countries to offset their own greenhouse gas emissions by assisting other countries to achieve sustainable development while reducing emissions. Based on methodologies provided by the IPCC regarding SWDS, the CDM Executive Board has issued a tool to be used by project developers for estimating baseline methane emissions in their project activities - on burning biogas from landfills or on preventing biomass to be landfilled and so avoiding methane emissions. Some inconsistencies in the first two IPCC guidelines have already been pointed out in an Annex of IPCC latest edition, although with hidden details. The CDM tool uses a model for methane estimation that takes on board parameters, factors and assumptions provided in the latest IPCC guidelines, while using in its core equation the one of the second IPCC edition with its shortcoming as well as allowing a misunderstanding of the time variable. Consequences of wrong ex-ante estimation of baseline emissions regarding CDM project activities can be of economical or environmental type. Example of the first type is the overestimation of 18% in an actual project on biogas from landfill in Brazil that harms its developers; of the second type, the overestimation of 35% in a project preventing municipal solid waste from being landfilled in China, which harms the environment, not for the project per se but for the undue generated carbon credits. In a simulated landfill - the same amount of waste for 20 years -, the error would be an overestimation of 25% if the CDM project activity starts from the very first year or an underestimation of 15% if it starts just after the landfill closure. Therefore, a correction in the tool to calculate emissions from landfills as adopted by the CDM Executive Board is needed. Moreover, in countries not using the latest IPCC guidelines, which provides clear formulas to prevent misunderstandings, inventory compilers can also benefit from this paper by having more accurate results in national GHG inventories related to solid waste disposal, especially when increasing amounts of waste are landfilled, which is the case of the developing countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

Administrative decision making: a stepwise method.

PubMed

Oetjen, Reid M; Oetjen, Dawn M; Rotarius, Timothy

2008-01-01

Today's health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for today's larger, more complex health care organizations and the rapidly changing health care environment. As a result, today's health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.

This "Ethical Trap" Is for Roboticists, Not Robots: On the Issue of Artificial Agent Ethical Decision-Making.

PubMed

Miller, Keith W; Wolf, Marty J; Grodzinsky, Frances

2017-04-01

In this paper we address the question of when a researcher is justified in describing his or her artificial agent as demonstrating ethical decision-making. The paper is motivated by the amount of research being done that attempts to imbue artificial agents with expertise in ethical decision-making. It seems clear that computing systems make decisions, in that they make choices between different options; and there is scholarship in philosophy that addresses the distinction between ethical decision-making and general decision-making. Essentially, the qualitative difference between ethical decisions and general decisions is that ethical decisions must be part of the process of developing ethical expertise within an agent. We use this distinction in examining publicity surrounding a particular experiment in which a simulated robot attempted to safeguard simulated humans from falling into a hole. We conclude that any suggestions that this simulated robot was making ethical decisions were misleading.

Toward a Psychology of Surrogate Decision Making.

PubMed

Tunney, Richard J; Ziegler, Fenja V

2015-11-01

In everyday life, many of the decisions that we make are made on behalf of other people. A growing body of research suggests that we often, but not always, make different decisions on behalf of other people than the other person would choose. This is problematic in the practical case of legally designated surrogate decision makers, who may not meet the substituted judgment standard. Here, we review evidence from studies of surrogate decision making and examine the extent to which surrogate decision making accurately predicts the recipient's wishes, or if it is an incomplete or distorted application of the surrogate's own decision-making processes. We find no existing domain-general model of surrogate decision making. We propose a framework by which surrogate decision making can be assessed and a novel domain-general theory as a unifying explanatory concept for surrogate decisions. © The Author(s) 2015.

Group Dynamics and Decision Making: Backcountry Recreationists in Avalanche Terrain

ERIC Educational Resources Information Center

Bright, Leslie Shay

2010-01-01

The purpose of this study was to describe and determine the prevalence of decision-making characteristics of recreational backcountry groups when making a decision of where to travel and ride in avalanche terrain from the perspective of individuals. Decision-making characteristics encompassed communication, decision-making processes, leadership,…

24 CFR 55.20 - Decision making process.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Decision making process. 55.20... Decision making process. The decision making process for compliance with this part contains eight steps... decision making process are: (a) Step 1. Determine whether the proposed action is located in a 100-year...

Field and Experience Influences on Ethical Decision-Making in the Sciences

PubMed Central

Mumford, Michael D.; Connelly, Shane; Murphy, Stephen T.; Devenport, Lynn D.; Antes, Alison L.; Brown, Ryan P.; Hill, Jason H.; Waples, Ethan P.

2009-01-01

Differences across fields and experience levels are frequently considered in discussions of ethical decision-making and ethical behavior. In the present study, doctoral students in the health, biological, and social sciences completed measures of ethical decision-making. The effects of field and level of experience with respect to ethical decision-making, metacognitive reasoning strategies, social-behavioral responses, and exposure to unethical events were examined. Social and biological scientists performed better than health scientists with respect to ethical decision-making. Furthermore, the ethical decision-making of health science students decreased as experience increased. Moreover, these effects appeared to be linked to the specific strategies underlying participants' ethical decision-making. The implications of these findings for ethical decision-making are discussed. PMID:19750129

Research on Bidding Decision-making of International Public-Private Partnership Projects

NASA Astrophysics Data System (ADS)

Hu, Zhen Yu; Zhang, Shui Bo; Liu, Xin Yan

2018-06-01

In order to select the optimal quasi-bidding project for an investment enterprise, a bidding decision-making model for international PPP projects was established in this paper. Firstly, the literature frequency statistics method was adopted to screen out the bidding decision-making indexes, and accordingly the bidding decision-making index system for international PPP projects was constructed. Then, the group decision-making characteristic root method, the entropy weight method, and the optimization model based on least square method were used to set the decision-making index weights. The optimal quasi-bidding project was thus determined by calculating the consistent effect measure of each decision-making index value and the comprehensive effect measure of each quasi-bidding project. Finally, the bidding decision-making model for international PPP projects was further illustrated by a hypothetical case. This model can effectively serve as a theoretical foundation and technical support for the bidding decision-making of international PPP projects.

Categorization = Decision Making + Generalization

PubMed Central

Seger, Carol A; Peterson, Erik J.

2013-01-01

We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

Analyzing the effectiveness of teaching and factors in clinical decision-making.

PubMed

Hsieh, Ming-Chen; Lee, Ming-Shinn; Chen, Tsung-Ying; Tsai, Tsuen-Chiuan; Pai, Yi-Fong; Sheu, Min-Muh

2017-01-01

The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an "Analogy guide clinical decision-making" as a learning intervention for junior doctors. This study had a "quasi-experimental design" and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the "Analogy guide for teaching clinical decision-making" every day for 3 months. Program Evaluation: A "Clinical decision-making self-evaluation form" was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

PubMed Central

Perez-Brena, Norma; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.

2013-01-01

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully understand how family processes are embedded within culture. The goals of this study were to describe mothers’ and fathers’ decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including parent-unilateral, joint, and youth-unilateral decision-making, and to examine the socio-cultural and family characteristics associated with these different types of decision-making in 246 Mexican-origin families. Mothers reported more joint and youth-unilateral decision-making and less parent-unilateral decision-making than did fathers. Fathers reported more youth-unilateral decision-making with sons than with daughters. Further, for mothers, more traditional gender role attitudes and higher levels of mother-adolescent conflict were associated with more parent-unilateral and less joint decision-making. In contrast, for fathers, lower levels of respect values were associated with more youth-unilateral decision-making with sons, and higher levels of parent-adolescent warmth was associated with more youth-unilateral decision-making with daughters. The importance of understanding the different correlates of mothers’ and fathers’ decision-making with sons versus daughters is discussed. PMID:21484288

Shared Decision-Making for Nursing Practice: An Integrative Review

PubMed Central

Truglio-Londrigan, Marie; Slyer, Jason T.

2018-01-01

Background: Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. Objective: To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. Methods: An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Results: Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. Conclusion: A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions. PMID:29456779

Composite collective decision-making.

PubMed

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

2015-06-22

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

The Relations between Decision Making in Social Relationships and Decision Making Styles

ERIC Educational Resources Information Center

Sari, Enver

2008-01-01

The research reported in this paper aimed to examine the relationships between decisiveness in social relationships, and the decision-making styles of a group of university students and to investigate the contributions of decision-making styles in predicting decisiveness in social relationship (conflict resolution, social relationship selection…

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

Ernst, Kathleen M; Van Riemsdijk, Dr. Micheline

This article studies the participation of stakeholders in climate change decision-making in Alaska s National Parks. We place stakeholder participation within literatures on environmental and climate change decision-making. We conducted participant observation and interviews in two planning workshops to investigate the decision-making process, and our findings are three-fold. First, the inclusion of diverse stakeholders expanded climate change decision-making beyond National Park Service (NPS) institutional constraints. Second, workshops of the Climate Change Scenario Planning Project (CCSPP) enhanced institutional understandings of participants attitudes towards climate change and climate change decision-making. Third, the geographical context of climate change influences the decision-making process. Asmore » the first regional approach to climate change decision-making within the NPS, the CCSPP serves as a model for future climate change planning in public land agencies. This study shows how the participation of stakeholders can contribute to robust decisions, may move climate change decision-making beyond institutional barriers, and can provide information about attitudes towards climate change decision-making.« less

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders.

PubMed

Hamilton, Jada G; Lillie, Sarah E; Alden, Dana L; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Craddock Lee, Simon; Goldstein, Mary K; Jacobson, Robert M; Myers, Ronald E; Zikmund-Fisher, Brian J; Waters, Erika A

2017-02-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

Multi-disciplinary decision making in general practice.

PubMed

Kirby, Ann; Murphy, Aileen; Bradley, Colin

2018-04-09

Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making.

PubMed

Otto, Ashley S; Clarkson, Joshua J; Kardes, Frank R

2016-07-01

We all too often have to make decisions-from the mundane (e.g., what to eat for breakfast) to the complex (e.g., what to buy a loved one)-and yet there exists a multitude of strategies that allows us to make a decision. This work focuses on a subset of decision strategies that allows individuals to make decisions by bypassing the decision-making process-a phenomenon we term decision sidestepping. Critical to the present manuscript, however, we contend that decision sidestepping stems from the motivation to achieve closure. We link this proposition back to the fundamental nature of closure and how those seeking closure are highly bothered by decision making. As such, we argue that the motivation to achieve closure prompts a reliance on sidestepping strategies (e.g., default bias, choice delegation, status quo bias, inaction inertia, option fixation) to reduce the bothersome nature of decision making. In support of this framework, five experiments demonstrate that (a) those seeking closure are more likely to engage in decision sidestepping, (b) the effect of closure on sidestepping stems from the bothersome nature of decision making, and (c) the reliance on sidestepping results in downstream consequences for subsequent choice. Taken together, these findings offer unique insight into the cognitive motivations stimulating a reliance on decision sidestepping and thus a novel framework by which to understand how individuals make decisions while bypassing the decision-making process. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Everyday decision-making in dementia: findings from a longitudinal interview study of people with dementia and family carers.

PubMed

Samsi, Kritika; Manthorpe, Jill

2013-06-01

Exercising choice and control over decisions is central to quality of life. The Mental Capacity Act 2005 (England and Wales) provides a legal framework to safeguard the rights of people with dementia to make their own decisions for as long as possible. The impact of this on long-term planning has been investigated; everyday decision-making in people's own homes remains unexplored. Using a phenomenological approach, we interviewed 12 dyads (one person with dementia + one carer) four times over one year to ascertain experience of decision-making, how decisions were negotiated, and how dynamics changed. Qualitative interviews were conducted in people's own homes, and thematic analysis was applied to transcripts. Respecting autonomy, decision-specificity and best interests underlay most everyday decisions in this sample. Over time, dyads transitioned from supported decision-making, where person with dementia and carer made decisions together, to substituted decision-making, where carers took over much decision-making. Points along this continuum represented carers' active involvement in retaining their relative's engagement through providing cues, reducing options, using retrospective information, and using the best interests principle. Long-term spouse carers seemed most equipped to make substitute decisions for their spouses; adult children and friend carers struggled with this. Carers may gradually take on decision-making for people with dementia. This can bring with it added stresses, such as determining their relative's decision-making capacity and weighing up what is in their best interests. Practitioners and support services should provide timely advice to carers and people with dementia around everyday decision-making, and be mindful how abilities may change.

Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study.

PubMed

Watanabe, Yoshiko; Takahashi, Miyako; Kai, Ichiro

2008-02-27

Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process. We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland. The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was. In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.

The potential for shared decision-making and decision aids in rehabilitation medicine.

PubMed

van Til, Janine A; Drossaert, Constance H C; Punter, R Annemiek; Ijzerman, Maarten J

2010-06-01

Shared decision-making and the use of decision aids are increasingly promoted in various healthcare settings. The extent of their current use and potential in rehabilitation medicine is unknown. The aim of the present study was to explore the barriers to and facilitators of shared decision-making and use of decision aids in daily practice, and to explore the perceptions of physical and rehabilitation medicine (PRM) physicians toward them. A cross-sectional survey of 408 PRM physicians was performed (response rate 31%). PRM physicians expressed the highest levels of comfort with shared decision-making as opposed to paternalistic and informed decision-making. The majority reported that shared decision-making constituted their usual approach. The most important barriers to shared decision-making were cases in which the patient received conflicting recommendations and when the patient had difficulty accepting the disease. Key facilitators were the patient's trust in the PRM physician and the patient being knowledgeable about the disease and about treatment options. PRM physicians' attitudes towards the use of decision aids to inform patients were moderately positive. Shared decision-making appears to have great potential in the rehabilitation setting. Increasing the use of decision aids may contribute to the further implementation of shared decision-making.

Conflict and Group Decision-Making: A New Approach.

ERIC Educational Resources Information Center

Dace, Karen L.

In the opinion of decision-making scholars, conflict is a natural component of group decision-making. A new direction for conflict and group decision-making theory and research will help dispel the confusion as to the promotive or disruptive nature of disagreement in group decision-making. Conflict literature is replete with descriptions of the…

Dementia, Decision Making, and Capacity.

PubMed

Darby, R Ryan; Dickerson, Bradford C

After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia ABSTRACT: Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.

A meta-ethnography and theory of parental ethical decision making in the neonatal intensive care unit.

PubMed

Rosenthal, Sara A; Nolan, Marie T

2013-07-01

To synthesize the existing qualitative literature about parent ethical decision making in the neonatal intensive care unit (NICU) and to investigate the potential impact of culture on parents' decision making experiences. PubMed, CINAHL plus, and PsychInfo using the search terms parental decision making, culture, race, decision making, and parental decisions. Qualitative research studies investigating decision making for infants in the NICU from the parents' perspective were included. Studies involving older pediatric populations were excluded. Ten primary qualitative research articles were included. The primary author read all manuscripts and tabulated themes related to parents' ethical decision making. Study findings were synthesized using meta-ethnography involving translating concepts of separate studies into one another, exploring contradictions, and organizing these concepts into new theories. Key themes included parent involvement in decision making, parental role, necessity of good information, need for communication, desire for hope and compassion conveyed by providers, decision making satisfaction, and trust in caregiving team. A preliminary theoretical framework of ethical parent decision making was modeled based on the proposed relationships between the themes. Parent preferences for their involvement in decision making, their perceptions of communication with providers, and their relationships with providers are all important factors in the experience of making decisions for their infants. Needs of parents were the same regardless the ethnic or racial diversity of study participants. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Decision making about Pap test use among Korean immigrant women: A qualitative study.

PubMed

Kim, Kyounghae; Kim, Soohyun; Gallo, Joseph J; Nolan, Marie T; Han, Hae-Ra

2017-08-01

Understanding how individuals make decisions about Pap tests concerning their personal values helps health-care providers offer tailored approaches to guide patients' decision making. Yet research has largely ignored decision making about Pap tests among immigrant women who experience increased risk of cervical cancer. To explore decision making about Pap tests among Korean immigrant women. We conducted a qualitative descriptive study using 32 semi-structured, in-depth interviews with Korean immigrant women residing in a north-eastern metropolitan area. Data were audio-recorded, transcribed verbatim and analysed using inductive coding. Although most women with positive decisions made their own decisions, some women deferred to their providers, and others made decisions in collaboration with their providers and significant others. While women making positive decisions tended to consider both barriers to and facilitators of having Pap tests, women making negative decisions predominantly discussed the barriers to having Pap tests, such as modesty and differences between the South Korean and US health-care systems. The women's reflections on their decisions differed regarding their Pap test decisions. Women's desired roles in the decision-making process and reflection on their decision outcome appeared to vary, although most participants with positive decisions made their own decisions and were satisfied with their decisions. Future research should conduct longitudinal, quantitative studies to test our findings regarding decision-making processes and outcomes about Pap tests. The findings should be incorporated into cervical cancer screening practices to fulfil the unmet needs of immigrant women in patient-provider communication and to facilitate women's decision making about Pap tests. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Bright high z SnIa: A challenge for ΛCDM

NASA Astrophysics Data System (ADS)

Perivolaropoulos, L.; Shafieloo, A.

2009-06-01

It has recently been pointed out by Kowalski et. al. [Astrophys. J. 686, 749 (2008).ASJOAB0004-637X10.1086/589937] that there is “an unexpected brightness of the SnIa data at z>1.” We quantify this statement by constructing a new statistic which is applicable directly on the type Ia supernova (SnIa) distance moduli. This statistic is designed to pick up systematic brightness trends of SnIa data points with respect to a best fit cosmological model at high redshifts. It is based on binning the normalized differences between the SnIa distance moduli and the corresponding best fit values in the context of a specific cosmological model (e.g. ΛCDM). These differences are normalized by the standard errors of the observed distance moduli. We then focus on the highest redshift bin and extend its size toward lower redshifts until the binned normalized difference (BND) changes sign (crosses 0) at a redshift zc (bin size Nc). The bin size Nc of this crossing (the statistical variable) is then compared with the corresponding crossing bin size Nmc for Monte Carlo data realizations based on the best fit model. We find that the crossing bin size Nc obtained from the Union08 and Gold06 data with respect to the best fit ΛCDM model is anomalously large compared to Nmc of the corresponding Monte Carlo data sets obtained from the best fit ΛCDM in each case. In particular, only 2.2% of the Monte Carlo ΛCDM data sets are consistent with the Gold06 value of Nc while the corresponding probability for the Union08 value of Nc is 5.3%. Thus, according to this statistic, the probability that the high redshift brightness bias of the Union08 and Gold06 data sets is realized in the context of a (w0,w1)=(-1,0) model (ΛCDM cosmology) is less than 6%. The corresponding realization probability in the context of a (w0,w1)=(-1.4,2) model is more than 30% for both the Union08 and the Gold06 data sets indicating a much better consistency for this model with respect to the BND statistic.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

PubMed

Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle

2018-05-01

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

Microfinance participation and contraceptive decision-making: results from a national sample of women in Bangladesh.

PubMed

Murshid, N S; Ely, G E

2016-10-01

Our objective was to assess whether microfinance participation affords greater contraceptive decision-making power to women. Population based secondary data analysis. In this cross-sectional study using nationally representative data from the Bangladesh Demographic and Health Survey 2011 we conducted multinomial logistic regression to estimate the odds of contraceptive decision-making by respondents and their husbands based on microfinance participation. Microfinance participation was measured as a dichotomous variable and contraceptive decision-making was conceptualized based on who made decisions about contraceptive use: respondents only; their partners or husbands only; or both. The odds of decision-making by the respondent, with the reference case being joint decision-making, were higher for microfinance participants, but they were not significant. The odds of decision-making by the husband, with the reference case again being joint decision-making, were significantly lower among men who were partnered with women who participated in microfinance (RRR = 0.70, P < 0.01). Microfinance participation by women allowed men to share decision-making power with their wives that resulted in higher odds of joint decision-making. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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.

Considering Risk and Resilience in Decision-Making

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2015-01-01

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

Parent-Child Engagement in Decision Making and the Development of Adolescent Affective Decision Capacity and Binge Drinking

PubMed Central

Xiao, Lin; Bechara, Antoine; Palmer, Paula H.; Trinidad, Dennis R.; Wei, Yonglan; Jia, Yong; Johnson, C. Anderson

2010-01-01

The goal of this study was to investigate how parents’ engagement of their child in everyday decision-making influenced their adolescent’s development on two neuropsychological functions, namely, affective decision-making and working memory, and its effect on adolescent binge-drinking behavior. We conducted a longitudinal study of 192 Chinese adolescents. In 10th grade, the adolescents were tested for their affective decision-making ability using the Iowa Gambling Task (IGT) and working memory capacity using the Self-ordered Pointing Test (SOPT). Questionnaires were used to assess perceived parent-child engagement in decision-making, academic performance and drinking behavior. At one-year follow-up, the same neuropsychological tasks and questionnaires were repeated. Results indicate that working memory and academic performance were uninfluenced by parent-child engagement in decision-making. However, compared to adolescents whose parents made solitary decisions for them, adolescents engaged in everyday decision-making showed significant improvement on affective decision capacity and significantly less binge-drinking one year later. These findings suggest that parental engagement of children in everyday decision-making might foster the development of neurocognitive functioning relative to affective decision-making and reduce adolescent substance use behaviors. PMID:21804682

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

PubMed

Sepucha, Karen R; Simmons, Leigh H; Barry, Michael J; Edgman-Levitan, Susan; Licurse, Adam M; Chaguturu, Sreekanth K

2016-04-01

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program. Project HOPE—The People-to-People Health Foundation, Inc.

Why the dark matter of galaxies is clumps of micro­ brown­dwarfs and not Cold Dark Matter

NASA Astrophysics Data System (ADS)

Gibson, Carl H.

Observations of quasar microlensing by Schild 1996 show the baryonic dark matter BDM of galaxies is micro-brown-dwarfs, primordial hydrogen-helium planets formed at the plasma to gas transition 10^13 seconds, in trillion-planet clumps termed proto-globular-star-clusters PGCs. Large photon-viscosity {nu} of the plasma permits supercluster-mass gravitational fragmentation at 10^12 seconds when the horizon scale L_H = ct is matched by the Schwarz viscous scale L_SV of Gibson 1996. Voids begin expansion at sonic speeds c/ 3^1/2, where c is light speed and t is time, explaining 10^25 meter size regions observed to be devoid of all matter, either BDM or non-baryonic NBDM. Most of the NBDM is weakly-collisional, strongly-diffusive, neutrino-like particles. If cold NBDM (CDM) is assumed, it must soon become warm and diffuse because it is weakly-collisional. It cannot clump and its clumps cannot clump. CDM is ruled out with 99% confidence by local-group satellite observations of Kroupa et al. 2010. The satellites are clusters of PGCs. PGCs are recaptured by the Galaxy on an accretion disk as they freeze and diffuse from its core to form its BDM halo. Stars form by viscous mergers of primordial gas planets within PGCs. Stars die by overeating mBDs, making the first chemicals, oceans and life at 2-8 Myr.

Role of affect in decision making.

PubMed

Bandyopadhyay, Debarati; Pammi, V S Chandrasekhar; Srinivasan, Narayanan

2013-01-01

Emotion plays a major role in influencing our everyday cognitive and behavioral functions, including decision making. We introduce different ways in which emotions are characterized in terms of the way they influence or elicited by decision making. This chapter discusses different theories that have been proposed to explain the role of emotions in judgment and decision making. We also discuss incidental emotional influences, both long-duration influences like mood and short-duration influences by emotional context present prior to or during decision making. We present and discuss results from a study with emotional pictures presented prior to decision making and how that influences both decision processes and postdecision experience as a function of uncertainty. We conclude with a summary of the work on emotions and decision making in the context of decision-making theories and our work on incidental emotions. Copyright © 2013 Elsevier B.V. All rights reserved.

A decision-making model based on a spiking neural circuit and synaptic plasticity.

PubMed

Wei, Hui; Bu, Yijie; Dai, Dawei

2017-10-01

To adapt to the environment and survive, most animals can control their behaviors by making decisions. The process of decision-making and responding according to cues in the environment is stable, sustainable, and learnable. Understanding how behaviors are regulated by neural circuits and the encoding and decoding mechanisms from stimuli to responses are important goals in neuroscience. From results observed in Drosophila experiments, the underlying decision-making process is discussed, and a neural circuit that implements a two-choice decision-making model is proposed to explain and reproduce the observations. Compared with previous two-choice decision making models, our model uses synaptic plasticity to explain changes in decision output given the same environment. Moreover, biological meanings of parameters of our decision-making model are discussed. In this paper, we explain at the micro-level (i.e., neurons and synapses) how observable decision-making behavior at the macro-level is acquired and achieved.

Neuroanatomical basis for recognition primed decision making.

PubMed

Hudson, Darren

2013-01-01

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

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

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

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

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

PubMed

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

2013-01-01

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

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

PubMed

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

2015-10-12

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

Complexity science and participation in decision making among Taiwanese nurses.

PubMed

Liu, Yi

2008-04-01

The perspective of interconnection in complexity science is used to examine the concept of participation in decision making among Taiwanese nurses in the context of Chinese communication culture. Participation in decision making among nurses has been widely discussed and tested in the Western healthcare systems. Many studies have shown that participation in decision making relates to nurses' autonomy, job satisfaction and quality of care. However, participation in decision making has not been fully discussed in Taiwan's nursing community. In a different cultural environment, participation in decision making may have different effects. The concept of participation in decision making is analysed in three facets of Chinese communication culture: (1) hierarchical social relationship; (2) harmony maintenance; and (3) insider effects. Key issues Taiwanese nurses might establish different levels of participation and need to use different strategies to enhance participation in decision making for desired outcomes. While applying participation in decision making in a different context, it is very important to consider the social and cultural differences. Two implications are made. First, nursing leaders/managers who are working with a multicultural team should be aware of the cultural difference in the pattern of interaction in the process of participation in decision making. Second, leaders/managers should be creative and try to apply different strategies to encourage staff's participation in decision making.

A review of clinical decision making: models and current research.

PubMed

Banning, Maggi

2008-01-01

The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Literature review. Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. The characteristics of the three models of decision making were identified and the related research discussed. Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

Data-Based Decision Making in Education: Challenges and Opportunities

ERIC Educational Resources Information Center

Schildkamp, Kim, Ed.; Lai, Mei Kuin, Ed.; Earl, Lorna, Ed.

2013-01-01

In a context where schools are held more and more accountable for the education they provide, data-based decision making has become increasingly important. This book brings together scholars from several countries to examine data-based decision making. Data-based decision making in this book refers to making decisions based on a broad range of…

Efficient fluorescence/phosphorescence white organic light-emitting diodes with ultra high color stability and mild efficiency roll-off

NASA Astrophysics Data System (ADS)

Du, Xiaoyang; Tao, Silu; Huang, Yun; Yang, Xiaoxia; Ding, Xulin; Zhang, Xiaohong

2015-11-01

Efficient fluorescence/phosphorescence hybrid white organic light-emitting diodes (OLEDs) with single doped co-host structure have been fabricated. Device using 9-Naphthyl-10 -(4-triphenylamine)anthrancene as the fluorescent dopant and Ir(ppy)3 and Ir(2-phq)3 as the green and orange phosphorescent dopants show the luminous efficiency of 12.4% (17.6 lm/W, 27.5 cd/A) at 1000 cd/m2. Most important to note that the efficiency-brightness roll-off of the device was very mild. With the brightness rising up to 5000 and 10 000 cd/m2, the efficiency could be kept at 11.8% (14.0 lm/W, 26.5 cd/A) and 11.0% (11.8 lm/W, 25.0 cd/A). The Commission Internationale de L'Eclairage (CIE) coordinates and color rending index (CRI) were measured to be (0.45, 0.48) and 65, respectively, and remained the same in a large range of brightness (1000-10 000 cd/m2), which is scarce in the reported white OLEDs. The performance of the device at high luminance (5000 and 10 000 cd/m2) was among the best reported results including fluorescence/phosphorescence hybrid and all-phosphorescent white OLEDs. Moreover, the CRI of the white OLED can be improved to 83 by using a yellow-green emitter (Ir(ppy)2bop) in the device.

Did CDM particles of mass 2.47 x 10(-3) eV interact with precursor biopolymers and nucleic acids to initiate and boost lifeforms on Earth?

PubMed

Rosen, Gerald

2011-06-01

Recent observations and theoretical studies have shown that non-baryonic Cold Dark Matter (CDM), which constitutes about 84% of all matter in the Universe, may feature a complex-scalar-field that carries particles of mass ≅ 2.47 x 10(-3)eV with the associated Compton range m(-1) ≅8.02 x 10(-3) cm, a distance on the scale of extended bionucleic acids and living cells. Such a complex-scalar-field can enter a weak-isospin Lorentz-invariant interaction that generates the flow of right-handed electrons and induces a chirality-imbued quantum chemistry on the m (-1) scale. A phenomenological Volterra-type equation is proposed for the CDM-impacted time development of N, the number of base pairs in the most advanced organism at Earth-age t. The solution to this equation suggests that the boosts in N at t ≅ 1.1 Gyr (advent of the first living prokaryotic cells), at t ≅ 2.9 Gyr (advent of eukaryotic single-celled organisms) and finally at t ≅ 4.0 Gyr (the Cambrian explosion) may be associated with three multi-Myr-duration cosmic showers of the complex-scalar-field CDM particles. If so, the signature of the particles may be detectible in Cambrian rocks.

The Rh = ct universe in alternative theories of gravity

NASA Astrophysics Data System (ADS)

Sultana, Joseph; Kazanas, Demosthenes

2017-12-01

The Λ cold dark matter (ΛCDM) model (one comprising of a cosmological constant Λ and cold dark matter) is generally considered the standard model in cosmology. One of the alternatives that has received attention in the last few years is the Rh = ct universe, which provides an age for the Universe similar to that of ΛCDM and whose (vanishing) deceleration parameter is apparently not inconsistent with observations. Like the ΛCDM, the Rh = ct universe is based on a Friedmann-Robertson-Walker cosmology with the total energy density ρ and pressure p of the cosmic fluid satisfying the simple equation of state ρ + 3p = 0, i.e. a vanishing total active gravitational mass. In an earlier paper, we examined the possible sources for the Rh = ct universe within general relativity, and we have shown that it still contains a dark energy component, albeit not in the form of a cosmological constant. The growing interest in gravitational theories, alternative to Einstein's general relativity, in cosmology, is mainly driven by the need for cosmological models that attain a late-time accelerated expansion without the presence of a cosmological constant as in the ΛCDM, and thereby avoiding the problems associated with it. In this paper, we discuss some of these common alternative theories and show that the Rh = ct is also a solution to some of them.

Can f(T) gravity theories mimic ΛCDM cosmic history

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

Setare, M.R.; Mohammadipour, N., E-mail: rezakord@ipm.ir, E-mail: N.Mohammadipour@uok.ac.ir

2013-01-01

Recently the teleparallel Lagrangian density described by the torsion scalar T has been extended to a function of T. The f(T) modified teleparallel gravity has been proposed as the natural gravitational alternative for dark energy to explain the late time acceleration of the universe. In order to reconstruct the function f(T) by demanding a background ΛCDM cosmology we assume that, (i) the background cosmic history provided by the flat ΛCDM (the radiation ere with ω{sub eff} = (1/3), matter and de Sitter eras with ω{sub eff} = 0 and ω{sub eff} = −1, respectively) (ii) the radiation dominate in themore » radiation era with Ω{sub 0r} = 1 and the matter dominate during the matter phases when Ω{sub 0m} = 1. We find the cosmological dynamical system which can obey the ΛCDM cosmic history. In each era, we find a critical lines that, the radiation dominated and the matter dominated are one points of them in the radiation and matter phases, respectively. Also, we drive the cosmologically viability condition for these models. We investigate the stability condition with respect to the homogeneous scalar perturbations in each era and we obtain the stability conditions for the fixed points in each eras. Finally, we reconstruct the function f(T) which mimics cosmic expansion history.« less

Model Selection with Strong-lensing Systems

NASA Astrophysics Data System (ADS)

Leaf, Kyle; Melia, Fulvio

2018-05-01

In this paper, we use an unprecedentedly large sample (158) of confirmed strong lens systems for model selection, comparing five well studied Friedmann-Robertson-Walker cosmologies: ΛCDM, wCDM (the standard model with a variable dark-energy equation of state), the Rh = ct universe, the (empty) Milne cosmology, and the classical Einstein-de Sitter (matter dominated) universe. We first use these sources to optimize the parameters in the standard model and show that they are consistent with Planck, though the quality of the best fit is not satisfactory. We demonstrate that this is likely due to under-reported errors, or to errors yet to be included in this kind of analysis. We suggest that the missing dispersion may be due to scatter about a pure single isothermal sphere (SIS) model that is often assumed for the mass distribution in these lenses. We then use the Bayes information criterion, with the inclusion of a suggested SIS dispersion, to calculate the relative likelihoods and ranking of these models, showing that Milne and Einstein-de Sitter are completely ruled out, while Rh = ct is preferred over ΛCDM/wCDM with a relative probability of ˜73% versus ˜24%. The recently reported sample of new strong lens candidates by the Dark Energy Survey, if confirmed, may be able to demonstrate which of these two models is favoured over the other at a level exceeding 3σ.

Cold dark matter. 2: Spatial and velocity statistics

NASA Technical Reports Server (NTRS)

Gelb, James M.; Bertschinger, Edmund

1994-01-01

We examine high-resolution gravitational N-body simulations of the omega = 1 cold dark matter (CDM) model in order to determine whether there is any normalization of the initial density fluctuation spectrum that yields acceptable results for galaxy clustering and velocities. Dense dark matter halos in the evolved mass distribution are identified with luminous galaxies; the most massive halos are also considered as sites for galaxy groups, with a range of possibilities explored for the group mass-to-light ratios. We verify the earlier conclusions of White et al. (1987) for the low-amplitude (high-bias) CDM model-the galaxy correlation function is marginally acceptable but that there are too many galaxies. We also show that the peak biasing method does not accurately reproduce the results obtained using dense halos identified in the simulations themselves. The Cosmic Background Explorer (COBE) anisotropy implies a higher normalization, resulting in problems with excessive pairwise galaxy velocity dispersion unless a strong velocity bias is present. Although we confirm the strong velocity bias of halos reported by Couchman & Carlberg (1992), we show that the galaxy motions are still too large on small scales. We find no amplitude for which the CDM model can reconcile simultaneously and galaxy correlation function, the low pairwise velocity dispersion, and the richness distribution of groups and clusters. With the normalization implied by COBE, the CDM spectrum has too much power on small scales if omega = 1.

Reconstruction, thermodynamics and stability of the ΛCDM model in f(T,{ T }) gravity

NASA Astrophysics Data System (ADS)

Junior, Ednaldo L. B.; Rodrigues, Manuel E.; Salako, Ines G.; Houndjo, Mahouton J. S.

2016-06-01

We reconstruct the ΛCDM model for f(T,{ T }) theory, where T is the torsion scalar and { T } the trace of the energy-momentum tensor. The result shows that the action of ΛCDM is a combination of a linear term, a constant (-2{{Λ }}) and a nonlinear term given by the product \\sqrt{-T}{F}g[({T}1/3/16π G) (16π G{ T }+T+8{{Λ }})], with F g being a generic function. We show that to maintain conservation of the energy-momentum tensor, we should impose that {F}g[y] must be linear on the trace { T }. This reconstruction decays in f (T) theory for {F}g\\equiv Q, with Q a constant. Our reconstruction describes the cosmological eras to the present time. The model present stability within the geometric and matter perturbations for the choice {F}g=y, where y=({T}1/3/16π G)(16π G{ T }+T+8{{Λ }}), except for the geometric part in the de Sitter model. We impose the first and second laws of thermodynamics to ΛCDM and find the condition where they are satisfied, that is, {T}A,{G}{{eff}}\\gt 0, however where this is not possible in the cases that we choose, this leads to a breakdown of positive entropy and Misner-Sharp energy.

Angular Baryon Acoustic Oscillation measure at z=2.225 from the SDSS quasar survey

NASA Astrophysics Data System (ADS)

de Carvalho, E.; Bernui, A.; Carvalho, G. C.; Novaes, C. P.; Xavier, H. S.

2018-04-01

Following a quasi model-independent approach we measure the transversal BAO mode at high redshift using the two-point angular correlation function (2PACF). The analyses done here are only possible now with the quasar catalogue from the twelfth data release (DR12Q) from the Sloan Digital Sky Survey, because it is spatially dense enough to allow the measurement of the angular BAO signature with moderate statistical significance and acceptable precision. Our analyses with quasars in the redshift interval z in [2.20,2.25] produce the angular BAO scale θBAO = 1.77° ± 0.31° with a statistical significance of 2.12 σ (i.e., 97% confidence level), calculated through a likelihood analysis performed using the theoretical covariance matrix sourced by the analytical power spectra expected in the ΛCDM concordance model. Additionally, we show that the BAO signal is robust—although with less statistical significance—under diverse bin-size choices and under small displacements of the quasars' angular coordinates. Finally, we also performed cosmological parameter analyses comparing the θBAO predictions for wCDM and w(a)CDM models with angular BAO data available in the literature, including the measurement obtained here, jointly with CMB data. The constraints on the parameters ΩM, w0 and wa are in excellent agreement with the ΛCDM concordance model.

Decision Support Systems and the Conflict Model of Decision Making: A Stimulus for New Computer-Assisted Careers Guidance Systems.

ERIC Educational Resources Information Center

Ballantine, R. Malcolm

Decision Support Systems (DSSs) are computer-based decision aids to use when making decisions which are partially amenable to rational decision-making procedures but contain elements where intuitive judgment is an essential component. In such situations, DSSs are used to improve the quality of decision-making. The DSS approach is based on Simon's…

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

PubMed

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

2013-05-01

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

Graphic Representations as Tools for Decision Making.

ERIC Educational Resources Information Center

Howard, Judith

2001-01-01

Focuses on the use of graphic representations to enable students to improve their decision making skills in the social studies. Explores three visual aids used in assisting students with decision making: (1) the force field; (2) the decision tree; and (3) the decision making grid. (CMK)

Fertility Preservation in Pediatric and Adolescent Oncology Patients: The Decision-Making Process of Parents.

PubMed

Li, Nancy; Jayasinghe, Yasmin; Kemertzis, Matthew A; Moore, Paddy; Peate, Michelle

2017-06-01

Decisions surrounding fertility preservation (FP) in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data. This review examines the decision-making process of oncology patients and their parents (if patients are in the pediatric or adolescent population) to better understand experiences of decisional conflict and regret. Two electronic databases, Embase and Pubmed, were searched using the terms (Decision-making OR Conflict (Psychology) OR Decision regret) AND (Freezing OR Oocyte OR Ovarian tissue OR Semen preservation OR Fertility preservation OR Cryopreservation) AND (Neoplasms OR Cancer OR Chemotherapy OR Drug therapy OR Radiotherapy). Medical Subject Heading terms were utilized where possible. Included articles discussed FP decision-making from the patient's perspective. Thirty-five articles discussing FP decision-making were included (24 in the adult population, 11 in the pediatric and adolescent population). Key themes from these articles included the following: factors considered in FP decision-making, decision-making in established procedures and experimental procedures, decisional conflict and regret, the perceived importance of information, adolescent involvement in decision-making, and ethical considerations in the pediatric population. Unique ethical issues arise in the pediatric and adolescent population. Considering that the decision to pursue FP is known to be difficult in the adult population, decisional conflict and regret may be greater for parents who are making the decision for their child.

Development of an instrument to understand the child protective services decision-making process, with a focus on placement decisions.

PubMed

Dettlaff, Alan J; Christopher Graham, J; Holzman, Jesse; Baumann, Donald J; Fluke, John D

2015-11-01

When children come to the attention of the child welfare system, they become involved in a decision-making process in which decisions are made that have a significant effect on their future and well-being. The decision to remove children from their families is particularly complex; yet surprisingly little is understood about this decision-making process. This paper presents the results of a study to develop an instrument to explore, at the caseworker level, the context of the removal decision, with the objective of understanding the influence of the individual and organizational factors on this decision, drawing from the Decision Making Ecology as the underlying rationale for obtaining the measures. The instrument was based on the development of decision-making scales used in prior decision-making studies and administered to child protection caseworkers in several states. Analyses included reliability analyses, principal components analyses, and inter-correlations among the resulting scales. For one scale regarding removal decisions, a principal components analysis resulted in the extraction of two components, jointly identified as caseworkers' decision-making orientation, described as (1) an internal reference to decision-making and (2) an external reference to decision-making. Reliability analyses demonstrated acceptable to high internal consistency for 9 of the 11 scales. Full details of the reliability analyses, principal components analyses, and inter-correlations among the seven scales are discussed, along with implications for practice and the utility of this instrument to support the understanding of decision-making in child welfare. Copyright © 2015 Elsevier Ltd. All rights reserved.

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

PubMed Central

Han, Paul K. J.; Kobrin, Sarah; Breen, Nancy; Joseph, Djenaba A.; Li, Jun; Frosch, Dominick L.; Klabunde, Carrie N.

2013-01-01

PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making—a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%–90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%–43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening. PMID:23835816

Shared decision making in chronic care in the context of evidence based practice in nursing.

PubMed

Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M

2015-01-01

In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence-based practice to deliver patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Risk-taking and decision-making in youth: relationships to addiction vulnerability.

PubMed

Balogh, Kornelia N; Mayes, Linda C; Potenza, Marc N

2013-03-01

Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors.

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

PubMed Central

López, Mónica E.; Kaplan, Celia P.; Nápoles, Anna M.; Hwang, E. Shelly; Livaudais, Jennifer C.; Karliner, Leah S.

2013-01-01

Objective To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Methods Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women’s preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Results Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Conclusion Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Practice Implications Use of professional interpreters may address communication-related disparities for these women. PMID:24207116

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS.

PubMed

López, Mónica E; Kaplan, Celia P; Nápoles, Anna M; Hwang, E Shelley; Livaudais, Jennifer C; Karliner, Leah S

2014-01-01

To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Use of professional interpreters may address communication-related disparities for these women. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

The involvement of the striatum in decision making

PubMed Central

Goulet-Kennedy, Julie; Labbe, Sara; Fecteau, Shirley

2016-01-01

Decision making has been extensively studied in the context of economics and from a group perspective, but still little is known on individual decision making. Here we discuss the different cognitive processes involved in decision making and its associated neural substrates. The putative conductors in decision making appear to be the prefrontal cortex and the striatum. Impaired decision-making skills in various clinical populations have been associated with activity in the prefrontal cortex and in the striatum. We highlight the importance of strengthening the degree of integration of both cognitive and neural substrates in order to further our understanding of decision-making skills. In terms of cognitive paradigms, there is a need to improve the ecological value of experimental tasks that assess decision making in various contexts and with rewards; this would help translate laboratory learnings into real-life benefits. In terms of neural substrates, the use of neuroimaging techniques helps characterize the neural networks associated with decision making; more recently, ways to modulate brain activity, such as in the prefrontal cortex and connected regions (eg, striatum), with noninvasive brain stimulation have also shed light on the neural and cognitive substrates of decision making. Together, these cognitive and neural approaches might be useful for patients with impaired decision-making skills. The drive behind this line of work is that decision-making abilities underlie important aspects of wellness, health, security, and financial and social choices in our daily lives. PMID:27069380

Mild cognitive impairment is associated with poorer decision-making in community-based older persons.

PubMed

Han, S Duke; Boyle, Patricia A; James, Bryan D; Yu, Lei; Bennett, David A

2015-04-01

To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. Community-based epidemiological cohort study. Communities throughout northeastern Illinois. Older persons without dementia from the Rush Memory and Aging Project (N = 730). All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI. MCI was associated with lower total, financial, and healthcare decision-making scores after accounting for the effects of age, education, and sex. The effect of MCI on total decision-making was equivalent to the effect of more than 10 additional years of age. Additional models showed that, when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision-making in participants with MCI. Persons with MCI may have poorer financial and healthcare decision-making in real-world situations, and perceptual speed may be an important contributor to poorer decision-making in persons with MCI. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Understanding shared decision making in pediatric otolaryngology.

PubMed

Chorney, Jill; Haworth, Rebecca; Graham, M Elise; Ritchie, Krista; Curran, Janet A; Hong, Paul

2015-05-01

The aim of this study was to describe the level of decisional conflict experienced by parents considering surgery for their children and to determine if decisional conflict and perceptions of shared decision making are related. Prospective cohort study. Academic pediatric otolaryngology clinic. Sixty-five consecutive parents of children who underwent surgical consultation for elective otolaryngological procedures were prospectively enrolled. Participants completed the Shared Decision Making Questionnaire and the Decisional Conflict Scale. Surgeons completed the Shared Decision Making Questionnaire-Physician version. Eleven participants (16.9%) scored over 25 on the Decisional Conflict Scale, a previously defined clinical cutoff indicating significant decisional conflict. Parent years of education and parent ratings of shared decision making were significantly correlated with decisional conflict (positively and negatively correlated, respectively). A logistic regression indicated that shared decision making but not education predicted the presence of significant decisional conflict. Parent and physician ratings of shared decision making were not related, and there was no correlation between physician ratings of shared decision making and parental decisional conflict. Many parents experienced considerable decisional conflict when making decisions about their child's surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict. Parents and physicians had different perceptions of shared decision making. Future research should develop and assess interventions to increase parents' involvement in decision making and explore the impact of significant decisional conflict on health outcomes. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

PubMed

Lippa, Katherine D; Feufel, Markus A; Robinson, F Eric; Shalin, Valerie L

2017-06-01

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

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

PubMed

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

2017-08-01

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

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

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

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

Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

PubMed

Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

2015-05-01

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

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

Frequencies of decision making and monitoring in adaptive resource management

PubMed Central

Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions. PMID:28800591

Frequencies of decision making and monitoring in adaptive resource management

USGS Publications Warehouse

Williams, Byron K.; Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions.

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 making from economic and signal detection perspectives: development of an integrated framework

PubMed Central

Lynn, Spencer K.; Wormwood, Jolie B.; Barrett, Lisa F.; Quigley, Karen S.

2015-01-01

Behavior is comprised of decisions made from moment to moment (i.e., to respond one way or another). Often, the decision maker cannot be certain of the value to be accrued from the decision (i.e., the outcome value). Decisions made under outcome value uncertainty form the basis of the economic framework of decision making. Behavior is also based on perception—perception of the external physical world and of the internal bodily milieu, which both provide cues that guide decision making. These perceptual signals are also often uncertain: another person's scowling facial expression may indicate threat or intense concentration, alternatives that require different responses from the perceiver. Decisions made under perceptual uncertainty form the basis of the signals framework of decision making. Traditional behavioral economic approaches to decision making focus on the uncertainty that comes from variability in possible outcome values, and typically ignore the influence of perceptual uncertainty. Conversely, traditional signal detection approaches to decision making focus on the uncertainty that arises from variability in perceptual signals and typically ignore the influence of outcome value uncertainty. Here, we compare and contrast the economic and signals frameworks that guide research in decision making, with the aim of promoting their integration. We show that an integrated framework can expand our ability to understand a wider variety of decision-making behaviors, in particular the complexly determined real-world decisions we all make every day. PMID:26217275

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.

Real-life decision making in college students. II: Do individual differences show reliable effects?

PubMed

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

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for upcoming terms (on 3 different occasions), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. They also completed a survey of self-reported decision-making styles and the Need for Cognition survey (Cacioppo & Petty, 1982) to assess their focus on rationality and enjoyment of analytic thinking. Results showed few statistically significant correlations between stylistic measures and behavioral measures of decision making, in either the amount of information considered or the way in which the information integration tracked predictions of linear models of decision making applied to each participant's data. However, there were consistent correlations, across the 7 decisions, between stylistic measures and affective reactions to, or retrospective descriptions of, episodes of decision making. We suggest that decision-making styles instruments may better reflect the construction of narratives of self as a decision maker more than they do actual behavior during decision making.

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2015-10-01

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

PubMed Central

Hamilton, Jada G.; Lillie, Sarah E.; Alden, Dana L.; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Lee, Simon Craddock; Goldstein, Mary K.; Jacobson, Robert M.; Myers, Ronald E.; Zikmund-Fisher, Brian J.; Waters, Erika A.

2016-01-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process. PMID:27566316

The Effect of Decision-Making Skill Training Programs on Self-Esteem and Decision-Making Styles

ERIC Educational Resources Information Center

Colakkadioglu, Oguzhan; Celik, D. Billur

2016-01-01

Problem Statement: Decision making is a critical cognitive process in every area of human life. In this process, the individuals play an active role and obtain outputs with their functional use of decision-making skills. Therefore, the decision-making process can affect the course of life, life satisfaction, and the social relations of an…

Adolescent Sexual Decision-Making: An Integrative Review.

PubMed

Hulton, Linda J.

2001-10-03

PURPOSE: The purpose of this integrative review was to summarize the present literature to identify factors associated with adolescent sexual decision-making. Thirty-eight salient research studies were selected as a basis of this review from the databases of Medline, CINAHL, and Psychinfo using the Cooper methodology. CONCLUSIONS: Two categories of decision-making were identified: 1) The research on factors related to the decisions that adolescents make to become sexually active or to abstain from sexual activity; 2) The research on factors related to contraceptive decision-making. The most consistent findings were that the factors of gender differences, cognitive development, perception of benefits, parental influences, social influences, and sexual knowledge were important variables in the decision-making processes of adolescents. IMPLICATIONS: Practice implications for nursing suggest that clinicians should assess adolescent sexual decision-making in greater detail and address the social and psychological context in which sexual experiences occur. Nurses must be aware of the differences between adolescent and adult decision-making processes and incorporate knowledge of growth and development into intervention strategies. Moreover, to the degree that adolescent sexual decision-making proves to be less than rational, interventions designed to improve competent sexual decision-making are needed.

The relationships among three factors affecting the financial decision-making abilities of adults with mild intellectual disabilities.

PubMed

Suto, W M I; Clare, I C H; Holland, A J; Watson, P C

2005-03-01

Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals' decision-making abilities are sufficient, and many factors may affect the development of such abilities. As part of a wider project on financial decision-making, we analysed previous data from a group of 30 adults with mild IDs, identifying correlations among four variables: (i) financial decision-making abilities; (ii) intellectual ability; (iii) understanding of some basic concepts relevant to finance; and (iv) decision-making opportunities in everyday life. The analysis indicated a direct relationship between ID and basic financial understanding. Strong relationships of a potentially reciprocal nature were identified between basic financial understanding and everyday decision-making opportunities, and between such opportunities and financial decision-making abilities. The findings suggest that the role of intellectual ability in determining financial decision-making abilities is only indirect, and that access to both basic skills education and everyday decision-making opportunities is crucial for maximizing capacity. The implications of this are discussed.

Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style.

PubMed

Giannunzio, Valeria; Degortes, Daniela; Tenconi, Elena; Collantoni, Enrico; Solmi, Marco; Santonastaso, Paolo; Favaro, Angela

2018-07-01

Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style. Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Twelve myths about shared decision making.

PubMed

Légaré, France; Thompson-Leduc, Philippe

2014-09-01

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

Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

PubMed

Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

2017-05-08

Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors. This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make competently make decisions.

Mild Cognitive Impairment is Associated with PoorerDecision Making in Community-Based Older Persons

PubMed Central

Duke Han, S.; Boyle, Patricia A.; James, Bryan D.; Yu, Lei; Bennett, David A.

2015-01-01

Background/Objectives Financial and healthcare decision making are important for maintaining wellbeing and independence in old age. We tested the hypothesis that Mild Cognitive Impairment (MCI) is associated with poorer decision making in financial and healthcare matters. Design Community-based epidemiologic cohort study. Setting Communities throughout Northeastern Illinois. Participants Participants were 730 older nondemented persons from the Rush Memory and Aging Project. Measurements All participants underwent a detailed clinical evaluation and decision making assessment using a measure that closely approximates materials utilized in real world financial and healthcare settings. This allowed for measurement of total decision making, as well as financial and healthcare decision making. Regression models were used to examine whether the presence of MCI was associated with a lower level of decision making. In subsequent analyses, we explored the relation of specific cognitive systems (i.e., episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability) with decision making in those with MCI. Results Results showed that MCI was associated with lower decision making total scores as well as financial and healthcare scores, respectively, after accounting for the effects of age, education, and sex. The effect of MCI on total decision making was equivalent to the effect of more than 10 additional years of age. Additional models showed that when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision making among participants with MCI. Conclusion Results suggest that persons with MCI may exhibit poorer financial and healthcare decision making in real world situations, and that perceptual speed may be an important contributor to poorer decision making among persons with MCI. PMID:25850350

Family health care decision making and self-efficacy with patients with ALS at the end of life

PubMed Central

NOLAN, MARIE T.; KUB, JOAN; HUGHES, MARK T.; TERRY, PETER B.; ASTROW, ALAN B.; CARBO, CYNTHIA A.; THOMPSON, RICHARD E.; CLAWSON, LORA; TEXEIRA, KENNETH; SULMASY, DANIEL P.

2008-01-01

Objective: Persons with ALS differ from those with other terminal illnesses in that they commonly retain capacity for decision making close to death. The role patients would opt to have their families play in decision making at the end of life may therefore be unique. This study compared the preferences of patients with ALS for involving family in health care decisions at the end of life with the actual involvement reported by the family after death. Methods: A descriptive correlational design with 16 patient–family member dyads was used. Quantitative findings were enriched with in-depth interviews of a subset of five family members following the patient's death. Results: Eighty-seven percent of patients had issued an advance directive. Patients who would opt to make health care decisions independently (i.e., according to the patient's preferences alone) were most likely to have their families report that decisions were made in the style that the patient preferred. Those who preferred shared decision making with family or decision making that relied upon the family were more likely to have their families report that decisions were made in a style that was more independent than preferred. When interviewed in depth, some family members described shared decision making although they had reported on the survey that the patient made independent decisions. Significance of results: The structure of advance directives may suggest to families that independent decision making is the ideal, causing them to avoid or underreport shared decision making. Fear of family recriminations may also cause family members to avoid or underreport shared decision making. Findings from this study might be used to guide clinicians in their discussions of treatments and health care decision making with persons with ALS and their families. PMID:18662421

The emergency patient's participation in medical decision-making.

PubMed

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

2016-09-01

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

Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

2016-07-01

Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Individual differences in decision making competence revealed by multivariate fMRI.

PubMed

Talukdar, Tanveer; Román, Francisco J; Operskalski, Joachim T; Zwilling, Christopher E; Barbey, Aron K

2018-06-01

While an extensive literature in decision neuroscience has elucidated the neurobiological foundations of decision making, prior research has focused primarily on group-level effects in a sample population. Due to the presence of inherent differences between individuals' cognitive abilities, it is also important to examine the neural correlates of decision making that explain interindividual variability in cognitive performance. This study therefore investigated how individual differences in decision making competence, as measured by the Adult Decision Making Competence (A-DMC) battery, are related to functional brain connectivity patterns derived from resting-state fMRI data in a sample of 304 healthy participants. We examined connectome-wide associations, identifying regions within frontal, parietal, temporal, and occipital cortex that demonstrated significant associations with decision making competence. We then assessed whether the functional interactions between brain regions sensitive to decision making competence and seven intrinsic connectivity networks (ICNs) were predictive of specific facets of decision making assessed by subtests of the A-DMC battery. Our findings suggest that individual differences in specific facets of decision making competence are mediated by ICNs that support executive, social, and perceptual processes, and motivate an integrative framework for understanding the neural basis of individual differences in decision making competence. © 2018 Wiley Periodicals, Inc.

Career Decision-Making Characteristics of Primary Education Students in Greece

ERIC Educational Resources Information Center

Sidiropoulou-Dimakakou, Despina; Mylonas, Kostas; Argyropoulou, Katerina; Drosos, Nikos

2013-01-01

The present study aims at investigating career decision-making process of 6th grade students with the use of the Childhood Career Decision-Making Questionnaire (CCDMQ). CCDMQ offers scores for the following three decision-making dimensions: (a) "Concerns/fears regarding career future", (b) "Investment ?n decision-making…

Decision Making in Adults with ADHD

ERIC Educational Resources Information Center

Montyla, Timo; Still, Johanna; Gullberg, Stina; Del Missier, Fabio

2012-01-01

Objectives: This study examined decision-making competence in ADHD by using multiple decision tasks with varying demands on analytic versus affective processes. Methods: Adults with ADHD and healthy controls completed two tasks of analytic decision making, as measured by the Adult Decision-Making Competence (A-DMC) battery, and two affective…

Evaluation of Electronic Healthcare Databases for Post-Marketing Drug Safety Surveillance and Pharmacoepidemiology in China.

PubMed

Yang, Yu; Zhou, Xiaofeng; Gao, Shuangqing; Lin, Hongbo; Xie, Yanming; Feng, Yuji; Huang, Kui; Zhan, Siyan

2018-01-01

Electronic healthcare databases (EHDs) are used increasingly for post-marketing drug safety surveillance and pharmacoepidemiology in Europe and North America. However, few studies have examined the potential of these data sources in China. Three major types of EHDs in China (i.e., a regional community-based database, a national claims database, and an electronic medical records [EMR] database) were selected for evaluation. Forty core variables were derived based on the US Mini-Sentinel (MS) Common Data Model (CDM) as well as the data features in China that would be desirable to support drug safety surveillance. An email survey of these core variables and eight general questions as well as follow-up inquiries on additional variables was conducted. These 40 core variables across the three EHDs and all variables in each EHD along with those in the US MS CDM and Observational Medical Outcomes Partnership (OMOP) CDM were compared for availability and labeled based on specific standards. All of the EHDs' custodians confirmed their willingness to share their databases with academic institutions after appropriate approval was obtained. The regional community-based database contained 1.19 million people in 2015 with 85% of core variables. Resampled annually nationwide, the national claims database included 5.4 million people in 2014 with 55% of core variables, and the EMR database included 3 million inpatients from 60 hospitals in 2015 with 80% of core variables. Compared with MS CDM or OMOP CDM, the proportion of variables across the three EHDs available or able to be transformed/derived from the original sources are 24-83% or 45-73%, respectively. These EHDs provide potential value to post-marketing drug safety surveillance and pharmacoepidemiology in China. Future research is warranted to assess the quality and completeness of these EHDs or additional data sources in China.

Reading performance of monofocal pseudophakic patients with and without glasses under normal and dim light conditions.

PubMed

Radner, Wolfgang; Radner, Stephan; Raunig, Valerian; Diendorfer, Gabriela

2014-03-01

To evaluate reading performance of patients with monofocal intraocular lenses (IOLs) (Acrysof SN60WF) with or without reading glasses under bright and dim light conditions. Austrian Academy of Ophthalmology, Vienna, Austria. Evaluation of a diagnostic test or technology. In pseudophakic patients, the spherical refractive error was limited to between +0.50 diopter (D) and -0.75 D with astigmatism of 0.75 D (mean spherical equivalent: right eye, -0.08 ± 0.43 [SD]; left eye, -0.15 ± 0.35). Near addition was +2.75 D. Reading performance was assessed binocularly with or without reading glasses at an illumination of 100 candelas (cd)/m(2) and 4 cd/m(2) using the Radner Reading Charts. In the 25 patients evaluated, binocularly, the mean corrected distance visual acuity was -0.07 ± 0.06 logMAR and the mean uncorrected distance visual acuity was 0.01 ± 0.11 logMAR. The mean reading acuity with reading glasses was 0.02 ± 0.10 logRAD at 100 cd/m(2) and 0.12 ± 0.14 logRAD at 4 cd/m(2). Without reading glasses, it was 0.44 ± 0.13 logRAD and 0.56 ± 0.16 logRAD, respectively (P < .05). Without reading glasses and at 100 cd/m(2), 40% of patients read 0.4 logRAD at more than 80 words per minute (wpm), 68% exceeded this limit at 0.5 logRAD, and 92% exceeded it at 0.6 logRAD. The mean reading speed at 0.5 logRAD was 134.76 ± 48.22 wpm; with reading glasses it was 167.65 ± 32.77 wpm (P < .05). A considerable percentage of patients with monofocal IOLs read newspaper print size without glasses under good light conditions. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A COMPARATIVE ANALYSIS OF THE SUPERNOVA LEGACY SURVEY SAMPLE WITH ΛCDM AND THE R{sub h}=ct UNIVERSE

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

Wei, Jun-Jie; Wu, Xue-Feng; Melia, Fulvio

The use of Type Ia supernovae (SNe Ia) has thus far produced the most reliable measurement of the expansion history of the universe, suggesting that ΛCDM offers the best explanation for the redshift–luminosity distribution observed in these events. However, analysis of other kinds of sources, such as cosmic chronometers, gamma-ray bursts, and high-z quasars, conflicts with this conclusion, indicating instead that the constant expansion rate implied by the R{sub h} = ct universe is a better fit to the data. The central difficulty with the use of SNe Ia as standard candles is that one must optimize three or fourmore » nuisance parameters characterizing supernova (SN) luminosities simultaneously with the parameters of an expansion model. Hence, in comparing competing models, one must reduce the data independently for each. We carry out such a comparison of ΛCDM and the R{sub h} = ct universe using the SN Legacy Survey sample of 252 SN events, and show that each model fits its individually reduced data very well. However, since R{sub h} = ct has only one free parameter (the Hubble constant), it follows from a standard model selection technique that it is to be preferred over ΛCDM, the minimalist version of which has three (the Hubble constant, the scaled matter density, and either the spatial curvature constant or the dark energy equation-of-state parameter). We estimate using the Bayes Information Criterion that in a pairwise comparison, the likelihood of R{sub h} = ct is ∼90%, compared with only ∼10% for a minimalist form of ΛCDM, in which dark energy is simply a cosmological constant. Compared to R{sub h} = ct, versions of the standard model with more elaborate parametrizations of dark energy are judged to be even less likely.« less

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

PubMed

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

2018-02-01

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

Take the First Heuristic, Self-Efficacy, and Decision-Making in Sport

ERIC Educational Resources Information Center

Hepler, Teri J.; Feltz, Deborah L.

2012-01-01

Can taking the first (TTF) option in decision-making lead to the best decisions in sports contexts? And, is one's decision-making self-efficacy in that context linked to TTF decisions? The purpose of this study was to examine the role of the TTF heuristic and self-efficacy in decision-making on a simulated sports task. Undergraduate and graduate…

Decision Making Under Uncertainty

DTIC Science & Technology

2010-11-01

A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

The enactment stage of end-of-life decision-making for children.

PubMed

Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

2018-01-11

Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.

Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.

PubMed

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte; Verhoef, Marja

2014-01-01

Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.

[Cancer screening in clinical practice: the value of shared decision-making].

PubMed

Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

2010-07-14

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

"Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making": Correction to Otto et al. (2016).

PubMed

2016-09-01

Reports an error in "Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making" by Ashley S. Otto, Joshua J. Clarkson and Frank R. Kardes ( Journal of Personality and Social Psychology , 2016[Jul], Vol 111[1], 1-16). In the article, the main heading for Experiment 3 was missing due to a production error, and the first sentence of the first paragraph of Experiment 3 should begin as follows: Experiment 2 offered support for the hypothesis that those seeking closure engage in decision sidestepping to reduce the bothersome nature of decision making. (The following abstract of the original article appeared in record 2016-30159-001.) We all too often have to make decisions—from the mundane (e.g., what to eat for breakfast) to the complex (e.g., what to buy a loved one)—and yet there exists a multitude of strategies that allows us to make a decision. This work focuses on a subset of decision strategies that allows individuals to make decisions by bypassing the decision-making process—a phenomenon we term decision sidestepping. Critical to the present manuscript, however, we contend that decision sidestepping stems from the motivation to achieve closure. We link this proposition back to the fundamental nature of closure and how those seeking closure are highly bothered by decision making. As such, we argue that the motivation to achieve closure prompts a reliance on sidestepping strategies (e.g., default bias, choice delegation, status quo bias, inaction inertia, option fixation) to reduce the bothersome nature of decision making. In support of this framework, five experiments demonstrate that (a) those seeking closure are more likely to engage in decision sidestepping, (b) the effect of closure on sidestepping stems from the bothersome nature of decision making, and (c) the reliance on sidestepping results in downstream consequences for subsequent choice. Taken together, these findings offer unique insight into the cognitive motivations stimulating a reliance on decision sidestepping and thus a novel framework by which to understand how individuals make decisions while bypassing the decision-making process. PsycINFO Database Record (c) 2016 APA, all rights reserved

Decision-Making under Criteria Uncertainty

NASA Astrophysics Data System (ADS)

Kureychik, V. M.; Safronenkova, I. B.

2018-05-01

Uncertainty is an essential part of a decision-making procedure. The paper deals with the problem of decision-making under criteria uncertainty. In this context, decision-making under uncertainty, types and conditions of uncertainty were examined. The decision-making problem under uncertainty was formalized. A modification of the mathematical decision support method under uncertainty via ontologies was proposed. A critical distinction of the developed method is ontology usage as its base elements. The goal of this work is a development of a decision-making method under criteria uncertainty with the use of ontologies in the area of multilayer board designing. This method is oriented to improvement of technical-economic values of the examined domain.

Risk-taking and decision-making in youth: relationships to addiction vulnerability

PubMed Central

Balogh, Kornelia N.; Mayes, Linda C.; Potenza, Marc N.

2013-01-01

Background Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Methods Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Results Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Conclusions Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors. PMID:24294500

Do patients want to participate in medical decision making?

PubMed

Strull, W M; Lo, B; Charles, G

1984-12-07

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.

Shared Problem Models and Crew Decision Making

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Statler, Irving C. (Technical Monitor)

1994-01-01

The importance of crew decision making to aviation safety has been well established through NTSB accident analyses: Crew judgment and decision making have been cited as causes or contributing factors in over half of all accidents in commercial air transport, general aviation, and military aviation. Yet the bulk of research on decision making has not proven helpful in improving the quality of decisions in the cockpit. One reason is that traditional analytic decision models are inappropriate to the dynamic complex nature of cockpit decision making and do not accurately describe what expert human decision makers do when they make decisions. A new model of dynamic naturalistic decision making is offered that may prove more useful for training or aiding cockpit decision making. Based on analyses of crew performance in full-mission simulation and National Transportation Safety Board accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation and reflect the crew's metacognitive skill. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relation between communication that serves to build performance. Implications of these findings for crew training will be discussed.

Decision Making and Cancer

PubMed Central

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

2014-01-01

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

Relationship of external influence to parental distress in decision making regarding children with a life-threatening illness.

PubMed

Miller, Victoria A; Luce, Mary Frances; Nelson, Robert M

2011-01-01

To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making.

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

Ernst, Kathleen M; Van Riemsdijk, Dr. Micheline

This article studies the participation of stakeholders in climate change decision-making in Alaska s National Parks. We place stakeholder participation within literatures on environmental and climate change decision-making. We conducted participant observation and interviews in two planning workshops to investigate the decision-making process, and our findings are three-fold. First, the inclusion of diverse stakeholders expanded climate change decision-making beyond National Park Service (NPS) institutional constraints. Second, workshops of the Climate Change Scenario Planning Project (CCSPP) enhanced institutional understandings of participants attitudes towards climate change and climate change decision-making. Third, the geographical context of climate change influences the decisionmaking process. Asmore » the first regional approach to climate change decision-making within the NPS, the CCSPP serves as a model for future climate change planning in public land agencies. This study shows how the participation of stakeholders can contribute to robust decisions, may move climate change decision-making beyond institutional barriers, and can provide information about attitudes towards climate change decision-making.« less

Risk perception & strategic decision making :general insights, a framework, and specific application to electricity generation using nuclear energy.

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

Brewer, Jeffrey D.

The objective of this report is to promote increased understanding of decision making processes and hopefully to enable improved decision making regarding high-consequence, highly sophisticated technological systems. This report brings together insights regarding risk perception and decision making across domains ranging from nuclear power technology safety, cognitive psychology, economics, science education, public policy, and neural science (to name a few). It forms them into a unique, coherent, concise framework, and list of strategies to aid in decision making. It is suggested that all decision makers, whether ordinary citizens, academics, or political leaders, ought to cultivate their abilities to separate themore » wheat from the chaff in these types of decision making instances. The wheat includes proper data sources and helpful human decision making heuristics; these should be sought. The chaff includes ''unhelpful biases'' that hinder proper interpretation of available data and lead people unwittingly toward inappropriate decision making ''strategies''; obviously, these should be avoided. It is further proposed that successfully accomplishing the wheat vs. chaff separation is very difficult, yet tenable. This report hopes to expose and facilitate navigation away from decision-making traps which often ensnare the unwary. Furthermore, it is emphasized that one's personal decision making biases can be examined, and tools can be provided allowing better means to generate, evaluate, and select among decision options. Many examples in this report are tailored to the energy domain (esp. nuclear power for electricity generation). The decision making framework and approach presented here are applicable to any high-consequence, highly sophisticated technological system.« less

Black Sea spectral bio-optical models based on satellite data and their applications for assessment of spatial and temporal variability in waters transparency, chlorophyll a content and primary production

NASA Astrophysics Data System (ADS)

Churilova, T.; Suslin, V.

2012-04-01

Satellite observations of ocean color provide a unique opportunity in oceanography to assess productivity of the sea on different spatial and temporal scales. However it has been shown that the standard SeaWiFS algorithm generally overestimates summer chlorophyll concentration and underestimates pigment content during spring phytoplankton bloom in comparison with in situ measurements. It is required to develop regional algorithms which are based on biooptical characteristics typical for the Sea and consequently could be used for correct transformation of spectral features of water-leaving radiance to chlorophyll a concentrations (Chl), light absorption features of suspended and dissolved organic matter (CDM), downwelling light attenuation coefficient/euphotic zone depth (PAR1%) and rate of primary synthesis of organic substances (PP). The numerous measurements of light absorption spectra of phytoplankton, non-algal particles and coloured dissolved organic matter carried out since 1996 in different seasons and regions of the Black Sea allowed to make a parameterization of the light absorption by all optically active components. Taking into account regional peculiarities of the biooptical parameters, their difference between seasons, shallow and deep-waters, their depth-dependent variability within photosynthetic zone regional spectral models for estimation of chlorophyll a concentration (Chl Model), colored dissolved and suspended organic matter absorption (CDM Model), downwelling irradiance (PAR Model) and primary production (PP Model) have been developed based on satellite data. Test of validation of models showed appropriate accuracy of the models. The developed models have been applied for estimation of spatial/temporal variability of chlorophyll a, dissolved organic matter concentrations, waters transparency, euphotic zone depth and primary production based on SeaWiFS data. Two weeks averaged maps of spatial distribution of these parameters have been composed for period from 1998 to 2009 (most of them presented on site http://blackseacolor.com/browser3.html). Comparative analysis of long-term series (since 1998) of these parameters with subsurface water temperature (SST) and solar radiance of the sea surface (PAR-0m) revealed the key factors determining the seasonal and inter-annual variations of Chl, PAR1%, CDM, PP. The seasonal dynamics of these parameters were more pronounced compared with inter-annual variability. The later was related to climate effect. In deep-waters region relatively lower SST during cold winters were forcing more intensive winter-spring phytoplankton bloom. In north-western shelf inter-annual variability in river (Danube) run off, which was related to climate change as well, determined year-to-year changing in Chl, CDM, PAR1%, and PP.

Factors and outcomes of decision making for cancer clinical trial participation.

PubMed

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

Decision Making in the Airplane

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

The Importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful In improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking In response to a problem, This presentation will examine the relations between leadership, communication, decision making and overall crew performance. Implications of these findings for training will be discussed.

Correlates of healthcare and financial decision making among older adults without dementia.

PubMed

Stewart, Christopher C; Yu, Lei; Wilson, Robert S; Bennett, David A; Boyle, Patricia A

2018-03-22

Healthcare and financial decision making among older persons has been previously associated with cognition, health and financial literacy, and risk aversion; however, the manner by which these resources support decision making remains unclear, as past studies have not systematically investigated the pathways linking these resources with decision making. In the current study, we use path analysis to examine the direct and indirect pathways linking age, education, cognition, literacy, and risk aversion with decision making. We also decomposed literacy into its subcomponents, conceptual knowledge and numeracy, in order to examine their associations with decision making. Participants were 937 community-based older adults without dementia from the Rush Memory and Aging Project who completed a battery of cognitive tests and assessments of healthcare and financial decision making, health and financial literacy, and risk aversion. Age and education exerted effects on decision making, but nearly two thirds of their effects were indirect, working mostly through cognition and literacy. Cognition exerted a strong direct effect on decision making and a robust indirect effect working primarily through literacy. Literacy also exerted a powerful direct effect on decision making, as did its subcomponents, conceptual knowledge and numeracy. The direct effect of risk aversion was comparatively weak. In addition to cognition, health and financial literacy emerged as independent and primary correlates of healthcare and financial decision making. These findings suggest specific actions that might be taken to optimize healthcare and financial decision making and, by extension, improve health and well-being in advanced age. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Shared decision-making in home-care from the nurse's perspective: sitting at the kitchen table--a qualitative descriptive study.

PubMed

Truglio-Londrigan, Marie

2013-10-01

To come to know, understand and describe the experience of shared decision-making in home-care from the nurse's perspective. The literature presents the concept of shared decision-making as a complex process characterised by a partnership between the healthcare provider and the patient, which is participatory and action oriented with education and negotiation leading to agreement. Few studies have been carried out to explore and describe the events that make up the experiences of shared decision-making in home-care from the nurse's perspective. A qualitative descriptive study was implemented. Semi structured interviews were performed with 10 home-care nurses who were asked to reflect on a time in their practice when they were involved in a shared decision-making process with their patient. All data were analysed using Colaizzi's method. The following Themes were uncovered: Begin where the patient is; Education for shared decision-making; The village and shared decision-making; and Whose decision is it? Each of the four Themes contained Subthemes. The findings of this study present shared decision-making as a complex, multidimensional and fluid process. A thorough understanding of shared decision-making is essential within the multiple contexts in which care is delivered. Nurses in clinical practice need to know and understand the events of the experience of shared decision-making. A more comprehensive understanding of these facts can assist home-care nurses in their practice with regard to the application of shared decision-making. © 2013 Blackwell Publishing Ltd.

Development of the Supported Decision Making Inventory System.

PubMed

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

2017-12-01

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

Competence and Quality in Real-Life Decision Making.

PubMed

Geisler, Martin; Allwood, Carl Martin

2015-01-01

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria.

Goal Setting and Decision Making by At-Risk Youth

ERIC Educational Resources Information Center

Galotti, Kathleen M.; Kozberg, Steven F.; Gustafon, Mary

2009-01-01

Typically, adolescence is a time when individuals begin to make consequential, life-framing decisions. However, much of the decision-making literature focuses on high-risk decisions, such as the use of drugs and alcohol, while much less is known about how adolescents make positive decisions, for example, regarding their educational or career…

The Career Decision-Making Competence: A New Construct for the Career Realm

ERIC Educational Resources Information Center

Ceschi, Andrea; Costantini, Arianna; Phillips, Susan D.; Sartori, Riccardo

2017-01-01

Purpose: This paper aims to link findings from laboratory-based decision-making research and decision-making competence (DMC) aspects that may be central for career-related decision-making processes. Past research has identified individual differences in rational responses in decision situations, which the authors refer to as DMC. Although there…

From Career Decision-Making Styles to Career Decision-Making Profiles: A Multidimensional Approach

ERIC Educational Resources Information Center

Gati, Itamar; Landman, Shiri; Davidovitch, Shlomit; Asulin-Peretz, Lisa; Gadassi, Reuma

2010-01-01

Previous research on individual differences in career decision-making processes has often focused on classifying individuals into a few types of decision-making "styles" based on the most dominant trait or characteristic of their approach to the decision process (e.g., rational, intuitive, dependent; Harren, 1979). In this research, an…

Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others

PubMed Central

Starks, Helene; Taylor, Janelle S.; Hopley, Elizabeth K.; Fryer-Edwards, Kelly

2007-01-01

BACKGROUND A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES To better understand the challenges of decision-making from the surrogate’s perspective. DESIGN Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS Fifty designated surrogates with previous decision-making experience. APPROACH We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates’ social networks (such as intrafamily discord about the “right” decision), (3) surrogate–patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate–clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient’s condition, prognosis, and treatment options. PMID:17619223

Shared decision-making during surgical consultation for gallstones at a safety-net hospital.

PubMed

Mueck, Krislynn M; Leal, Isabel M; Wan, Charlie C; Goldberg, Braden F; Saunders, Tamara E; Millas, Stefanos G; Liang, Mike K; Ko, Tien C; Kao, Lillian S

2018-04-01

Understanding patient perspectives regarding shared decision-making is crucial to providing informed, patient-centered care. Little is known about perceptions of vulnerable patients regarding shared decision-making during surgical consultation. The purpose of this study was to evaluate whether a validated tool reflects perceptions of shared decision-making accurately among patients seeking surgical consultation for gallstones at a safety-net hospital. A mixed methods study was conducted in a sample of adult patients with gallstones evaluated at a safety-net surgery clinic between May to July 2016. Semi-structured interviews were conducted after their initial surgical consultation and analyzed for emerging themes. Patients were administered the Shared Decision-Making Questionnaire and Autonomy Preference Scale. Univariate analyses were performed to identify factors associated with shared decision-making and to compare the results of the surveys to those of the interviews. The majority of patients (N = 30) were female (90%), Hispanic (80%), Spanish-speaking (70%), and middle-aged (45.7 ± 16 years). The proportion of patients who perceived shared decision-making was greater in the Shared Decision-Making Questionnaire versus the interviews (83% vs 27%, P < .01). Age, sex, race/ethnicity, primary language, diagnosis, Autonomy Preference Scale score, and decision for operation was not associated with shared decision-making. Contributory factors to this discordance include patient unfamiliarity with shared decision-making, deference to surgeon authority, lack of discussion about different treatments, and confusion between aligned versus shared decisions. Available questionnaires may overestimate shared decision-making in vulnerable patients suggesting the need for alternative or modifications to existing methods. Furthermore, such metrics should be assessed for correlation with patient-reported outcomes, such as satisfaction with decisions and health status. Copyright © 2017 Elsevier Inc. All rights reserved.

Shared Decision Making Interventions: Theoretical and Empirical Evidence with Implications for Health Literacy.

PubMed

Stacey, Dawn; Hill, Sophie; McCaffery, Kirsten; Boland, Laura; Lewis, Krystina B; Horvat, Lidia

2017-01-01

Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals. When patients are involved in shared decision making, they have better health outcomes, better healthcare experiences, and likely lower costs. Yet, their degree of involvement is influenced by their level of health literacy. Interventions to facilitate shared decision making are patient decision aids, decision coaching, and question prompt lists. Patient decision aids have been shown to improve knowledge, accurate risk perceptions, and chosen options congruent with patients' values. Decision coaching improves knowledge and patient satisfaction. Question prompts also improve satisfaction. When shared decision making interventions have been evaluated with patients presumed to have lower health literacy, they appeared to be more beneficial to disadvantaged groups compared to those with higher literacy or better socioeconomic status. However, special attention needs to be applied when designing these interventions for populations with lower literacy. Two case exemplars are provided to illustrate the design and choice of interventions to better support patients with varying levels of health literacy. Despite evidence indicating these interventions are effective for involving patients in shared decision making, few are used in routine clinical practice. To increase their uptake, implementation strategies need to overcome barriers interfering with their use. Implementation strategies include training health care professionals, adopting SDM interventions that target patients, such as patient decision aids, and monitor patients' decisional comfort using the SURE test. Integrating health literacy principles is important when developing interventions that facilitate shared decision making and essential to avoid inadvertently producing higher inequalities between patients with varying levels of health literacy.

Decision-Making Under Risk: Integrating Perspectives From Biology, Economics, and Psychology.

PubMed

Mishra, Sandeep

2014-08-01

Decision-making under risk has been variably characterized and examined in many different disciplines. However, interdisciplinary integration has not been forthcoming. Classic theories of decision-making have not been amply revised in light of greater empirical data on actual patterns of decision-making behavior. Furthermore, the meta-theoretical framework of evolution by natural selection has been largely ignored in theories of decision-making under risk in the human behavioral sciences. In this review, I critically examine four of the most influential theories of decision-making from economics, psychology, and biology: expected utility theory, prospect theory, risk-sensitivity theory, and heuristic approaches. I focus especially on risk-sensitivity theory, which offers a framework for understanding decision-making under risk that explicitly involves evolutionary considerations. I also review robust empirical evidence for individual differences and environmental/situational factors that predict actual risky decision-making that any general theory must account for. Finally, I offer steps toward integrating various theoretical perspectives and empirical findings on risky decision-making. © 2014 by the Society for Personality and Social Psychology, Inc.

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

PubMed

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

2015-06-01

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

A Common Mechanism Underlying Food Choice and Social Decisions.

PubMed

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-10-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others' benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making.

A Common Mechanism Underlying Food Choice and Social Decisions

PubMed Central

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-01-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others’ benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812

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

PubMed

Hughes, K K; Dvorak, E M

1997-01-01

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

The Impact of Multifaceted Osteoporosis Group Education on Patients' Decision-Making regarding Treatment Options and Lifestyle Changes.

PubMed

Jensen, Annesofie L; Wind, Gitte; Langdahl, Bente Lomholt; Lomborg, Kirsten

2018-01-01

Patients with chronic diseases like osteoporosis constantly have to make decisions related to their disease. Multifaceted osteoporosis group education (GE) may support patients' decision-making. This study investigated multifaceted osteoporosis GE focusing on the impact of GE on patients' decision-making related to treatment options and lifestyle. An interpretive description design using ethnographic methods was utilized with 14 women and three men diagnosed with osteoporosis who attended multifaceted GE. Data consisted of participant observation during GE and individual interviews. Attending GE had an impact on the patients' decision-making in all educational themes. Patients decided on new ways to manage osteoporosis and made decisions regarding bone health and how to implement a lifestyle ensuring bone health. During GE, teachers and patients shared evidence-based knowledge and personal experiences and preferences, respectively, leading to a two-way exchange of information and deliberation about recommendations. Though teachers and patients explored the implications of the decisions and shared their preferences, teachers stressed that the patients ultimately had to make the decision. Teachers therefore refrained from participating in the final step of the decision-making process. Attending GE has an impact on the patients' decision-making as it can initiate patient reflection and support decision-making.

Perspectives of adolescents on decision making about participation in a biobank study: a pilot study.

PubMed

Grootens-Wiegers, Petronella; Visser, Eline G; van Rossum, Annemarie M C; van Waardhuizen, Claudia N; de Wildt, Saskia N; Sweep, Boudewijn; van den Broek, Jos M; de Vries, Martine C

2017-01-01

To be able to truly involve adolescents in decision making about clinical research participation, we need more insight in the perspective of adolescents themselves. To this end, adolescents in an ongoing biobank study were consulted to test a tentative decision assessment tool. The perspectives of adolescents (n=8) concerning participation in decision making for research participation were explored in interviews with a tentative tool, which covered six topics: information material usage, understanding, disease perceptions, anxiety, decision-making process and role sharing. All adolescents unequivocally expressed the desire to be involved in decision making, but also wanted advice from their parents. The extent of the preferred role of adolescent versus parents varied between individuals. In decision making, adolescents relied on parents for information. More than half hardly used the information material. Adolescents in our study preferred a shared decision-making process. The extent of sharing varied between individuals. The decision assessment tool was a fruitful starting point to discuss adolescents' perspectives and may aid in tailoring the situation to the individual to achieve optimal participation practices. Consulting adolescents about their preferences concerning decision making using the tool will facilitate tailoring of the shared decision-making process and optimising the developing autonomy of minors.

[A study on participation in clinical decision making by home healthcare nurses].

PubMed

Kim, Se Young

2010-12-01

This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.

Prospective Analysis of Decision Making During Joint Cardiology Cardiothoracic Conference in Treatment of 107 Consecutive Children with Congenital Heart Disease.

PubMed

Duignan, Sophie; Ryan, Aedin; O'Keeffe, Dara; Kenny, Damien; McMahon, Colin J

2018-05-12

The complexity and potential biases involved in decision making have long been recognised and examined in both the aviation and business industries. More recently, the medical community have started to explore this concept and its particular importance in our field. Paediatric cardiology is a rapidly expanding field and for many of the conditions we treat, there is limited evidence available to support our decision-making. Variability exists within decision-making in paediatric cardiology and this may influence outcomes. There are no validated tools available to support and examine consistent decision-making for various treatment strategies in children with congenital heart disease in a multidisciplinary cardiology and cardiothoracic institution. Our primary objective was to analyse the complexity of decision-making for children with cardiac conditions in the context of our joint cardiology and cardiothoracic conference (JCC). Two paediatric cardiologists acted as investigators by observing the weekly joint cardiology-cardiothoracic surgery conference and prospectively evaluating the degree of complexity of decision-making in the management of 107 sequential children with congenital heart disease discussed. Additionally, the group consensus on the same patients was prospectively assessed to compare this to the independent observers. Of 107 consecutive children discussed at our JCC conference 32 (27%) went on to receive surgical intervention, 20 (17%) underwent catheterisation and 65 (56%) received medical treatment. There were 53 (50%) cases rated as simple by one senior observer, while 54 (50%) were rated as complex to some degree. There was high inter-observer agreement with a Krippendorff's alpha of ≥ 0.8 between 2 observers and between 2 observers and the group consensus as a whole for grading of the complexity of decision-making. Different decisions were occasionally made on patients with the same data set. Discussions revisiting the same patient, in complex cases, resulted in different management decisions being reached in this series. Anchoring of decision-making was witnessed in certain cases. Potential application of decision making algorithms is discussed in making decisions in paediatric cardiology patients. Decision-making in our institution's joint cardiology-cardiothoracic conference proved to be complex in approximately half of our patients. Inconsistency in decision-making for patients with the same diagnosis, and different decisions made for the same complex patient at different time points confounds the reliability of the decision-making process. These novel data highlight the absence of evidence-based medicine for many decisions, occasional lack of consistency and the impact of anchoring, heuristics and other biases in complex cases. Validated decision-making algorithms may assist in providing consistency to decision-making in this setting.

The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study.

PubMed

Zeng-Treitler, Qing; Gibson, Bryan; Hill, Brent; Butler, Jorie; Christensen, Carrie; Redd, Douglas; Shao, Yijun; Bray, Bruce

2016-07-22

Shared decision-making can improve patient satisfaction and outcomes. To participate in shared decision-making, patients need information about the potential risks and benefits of treatment options. Our team has developed a novel prototype tool for shared decision-making called hearts like mine (HLM) that leverages EHR data to provide personalized information to patients regarding potential outcomes of different treatments. These potential outcomes are presented through an Icon array and/or simulated narratives for each "person" in the display. In this pilot project we sought to determine whether the inclusion of simulated narratives in the display affects individuals' decision-making. Thirty subjects participated in this block-randomized study in which they used a version of HLM with simulated narratives and a version without (or in the opposite order) to make a hypothetical therapeutic decision. After each decision, participants completed a questionnaire that measured decisional confidence. We used Chi square tests to compare decisions across conditions and Mann-Whitney U tests to examine the effects of narratives on decisional confidence. Finally, we calculated the mean of subjects' post-experiment rating of whether narratives were helpful in their decision-making. In this study, there was no effect of simulated narratives on treatment decisions (decision 1: Chi squared = 0, p = 1.0; decision 2: Chi squared = 0.574, p = 0.44) or Decisional confidence (decision 1, w = 105.5, p = 0.78; decision 2, w = 86.5, p = 0.28). Post-experiment, participants reported that narratives helped them to make decisions (mean = 3.3/4). We found that simulated narratives had no measurable effect on decisional confidence or decisions and most participants felt that the narratives were helpful to them in making therapeutic decisions. The use of simulated stories holds promise for promoting shared decision-making while minimizing their potential biasing effect.

An Evaluation of Factors Affecting Decision Making among 4th Grade Elementary School Students with Low Socio-Economic Status

ERIC Educational Resources Information Center

Kaskaya, Alper; Calp, Sükran; Kuru, Oguzhan

2017-01-01

Decision making is one of the most important life skills. While making correct, timely, accurate and appropriate decisions lead to positive changes in one's life, making incorrect decisions may have a negative impact. It is an important issue to examine what the 4th grade students in primary school have about the decision-making ability to be…

Impaired decision-making and brain shrinkage in alcoholism.

PubMed

Le Berre, A-P; Rauchs, G; La Joie, R; Mézenge, F; Boudehent, C; Vabret, F; Segobin, S; Viader, F; Allain, P; Eustache, F; Pitel, A-L; Beaunieux, H

2014-03-01

Alcohol-dependent individuals usually favor instant gratification of alcohol use and ignore its long-term negative consequences, reflecting impaired decision-making. According to the somatic marker hypothesis, decision-making abilities are subtended by an extended brain network. As chronic alcohol consumption is known to be associated with brain shrinkage in this network, the present study investigated relationships between brain shrinkage and decision-making impairments in alcohol-dependent individuals early in abstinence using voxel-based morphometry. Thirty patients performed the Iowa Gambling Task and underwent a magnetic resonance imaging investigation (1.5T). Decision-making performances and brain data were compared with those of age-matched healthy controls. In the alcoholic group, a multiple regression analysis was conducted with two predictors (gray matter [GM] volume and decision-making measure) and two covariates (number of withdrawals and duration of alcoholism). Compared with controls, alcoholics had impaired decision-making and widespread reduced gray matter volume, especially in regions involved in decision-making. The regression analysis revealed links between high GM volume in the ventromedial prefrontal cortex, dorsal anterior cingulate cortex and right hippocampal formation, and high decision-making scores (P<0.001, uncorrected). Decision-making deficits in alcoholism may result from impairment of both emotional and cognitive networks. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

PubMed Central

Légaré, France; Moumjid-Ferdjaoui, Nora; Drolet, Renée; Stacey, Dawn; Härter, Martin; Bastian, Hilda; Beaulieu, Marie-Dominique; Borduas, Francine; Charles, Cathy; Coulter, Angela; Desroches, Sophie; Friedrich, Gwendolyn; Gafni, Amiram; Graham, Ian D.; Labrecque, Michel; LeBlanc, Annie; Légaré, Jean; Politi, Mary; Sargeant, Joan; Thomson, Richard

2014-01-01

Shared decision making is now making inroads in health care professionals’ continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training. PMID:24347105

Doing what's right: A grounded theory of ethical decision-making in occupational therapy.

PubMed

VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

2018-04-20

Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated. The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice. A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making. An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core. Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.

Mental fatigue impairs soccer-specific decision-making skill.

PubMed

Smith, Mitchell R; Zeuwts, Linus; Lenoir, Matthieu; Hens, Nathalie; De Jong, Laura M S; Coutts, Aaron J

2016-07-01

This study aimed to investigate the impact of mental fatigue on soccer-specific decision-making. Twelve well-trained male soccer players performed a soccer-specific decision-making task on two occasions, separated by at least 72 h. The decision-making task was preceded in a randomised order by 30 min of the Stroop task (mental fatigue) or 30 min of reading from magazines (control). Subjective ratings of mental fatigue were measured before and after treatment, and mental effort (referring to treatment) and motivation (referring to the decision-making task) were measured after treatment. Performance on the soccer-specific decision-making task was assessed using response accuracy and time. Visual search behaviour was also assessed throughout the decision-making task. Subjective ratings of mental fatigue and effort were almost certainly higher following the Stroop task compared to the magazines. Motivation for the upcoming decision-making task was possibly higher following the Stroop task. Decision-making accuracy was very likely lower and response time likely higher in the mental fatigue condition. Mental fatigue had unclear effects on most visual search behaviour variables. The results suggest that mental fatigue impairs accuracy and speed of soccer-specific decision-making. These impairments are not likely related to changes in visual search behaviour.

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

PubMed

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

2012-08-01

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

A review of the literature: midwifery decision-making and birth.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2010-12-01

Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the 'rational reasoning' as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman-midwife partnership where the woman is the ultimate decision-maker. CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review. Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision. We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention. Copyright © 2010 Australian College of Midwives. All rights reserved.

A communication model of shared decision making: accounting for cancer treatment decisions.

PubMed

Siminoff, Laura A; Step, Mary M

2005-07-01

The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient.

Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

PubMed

Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

2015-12-01

Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

Decision Making in Action: Applying Research to Practice

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Hart, Sandra G. (Technical Monitor)

1994-01-01

The importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment: Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relations between leadership, communication, decision making and overall crew performance. Implications of these findings for training will be discussed.

Incompetent Patients, Substitute Decision Making, and Quality of Life: Some Ethical Considerations

PubMed Central

Kluge, Eike-Henner W.

2008-01-01

One of the most difficult situations facing physicians involves decision making by substitute decision makers for patients who have never been competent. This paper begins with a brief examination of the ethics of substitute decision making for previously competent patients. It then applies the results to substitute decision making for patients who have never been competent, and critically analyzes 5 models of substitute decision making for such patients, showing why each either contravenes basic ethical principles or fails to guarantee the use of ethically appropriate values. It concludes by sketching a modified objective reasonable person standard for substitute decision making that avoids valuational difficulties and allows for a protocol that satisfies ethical principles. PMID:19099031

A MDMP for All Seasons: Modifying the MDMP for Success

DTIC Science & Technology

2004-05-26

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

How Critical Thinking Shapes the Military Decision Making Process

DTIC Science & Technology

2004-05-17

emotional rebuttal. Conversely, people cannot make good rational decisions without at least a twinge of emotion attached to the decision . 2) Our minds... decision they make . If emotions overwhelm reason, then decisions should be postponed.27 Service biases are one of the strongest emotional bias. Any...FINAL 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE How Critical Thinking Shapes the Military Decision Making Process 5a. CONTRACT

Decision Making under Ambiguity and Objective Risk in Higher Age - A Review on Cognitive and Emotional Contributions.

PubMed

Liebherr, Magnus; Schiebener, Johannes; Averbeck, Heike; Brand, Matthias

2017-01-01

The ability of decision making plays a highly relevant role in our survival, but is adversely affected during the process of aging. The present review aims to provide a better understanding of age-related differences in decision making and the role of cognitive and emotional factors in this context. We reviewed the literature about age-effects on decision-making performance, focusing on decision making under ambiguous and objective risk. In decisions under ambiguous risks, as measured by the Iowa Gambling Task, decisions are based on the experiences with consequences. In this case, many articles have attributed age-related impairments in decision making to changes in emotional and somatic reward- and punishment processing. In decisions under objective risks, as measured for example by the Game of Dice Task, decisions can be based on explicit information about risks and consequences. In this case, age-related changes have been attributed mainly to a cognitive decline, particularly impaired executive functions. However, recent findings challenge these conclusions. The present review summarizes neuropsychological and neurophysiological findings of age-related differences in decision making under ambiguous and objective risk. In this context, the relevance of learning, but also of cognitive and emotional contributors - responsible for age-related differences in decision making - are additionally pointed out.

Decision Making under Ambiguity and Objective Risk in Higher Age – A Review on Cognitive and Emotional Contributions

PubMed Central

Liebherr, Magnus; Schiebener, Johannes; Averbeck, Heike; Brand, Matthias

2017-01-01

The ability of decision making plays a highly relevant role in our survival, but is adversely affected during the process of aging. The present review aims to provide a better understanding of age-related differences in decision making and the role of cognitive and emotional factors in this context. We reviewed the literature about age-effects on decision-making performance, focusing on decision making under ambiguous and objective risk. In decisions under ambiguous risks, as measured by the Iowa Gambling Task, decisions are based on the experiences with consequences. In this case, many articles have attributed age-related impairments in decision making to changes in emotional and somatic reward- and punishment processing. In decisions under objective risks, as measured for example by the Game of Dice Task, decisions can be based on explicit information about risks and consequences. In this case, age-related changes have been attributed mainly to a cognitive decline, particularly impaired executive functions. However, recent findings challenge these conclusions. The present review summarizes neuropsychological and neurophysiological findings of age-related differences in decision making under ambiguous and objective risk. In this context, the relevance of learning, but also of cognitive and emotional contributors – responsible for age-related differences in decision making – are additionally pointed out. PMID:29270145

Galaxy clusters and cold dark matter - A low-density unbiased universe?

NASA Technical Reports Server (NTRS)

Bahcall, Neta A.; Cen, Renyue

1992-01-01

Large-scale simulations of a universe dominated by cold dark matter (CDM) are tested against two fundamental properties of clusters of galaxies: the cluster mass function and the cluster correlation function. We find that standard biased CDM models are inconsistent with these observations for any bias parameter b. A low-density, low-bias CDM-type model, with or without a cosmological constant, appears to be consistent with both the cluster mass function and the cluster correlations. The low-density model agrees well with the observed correlation function of the Abell, Automatic Plate Measuring Facility (APM), and Edinburgh-Durham cluster catalogs. The model is in excellent agreement with the observed dependence of the correlation strength on cluster mean separation, reproducing the measured universal dimensionless cluster correlation. The low-density model is also consistent with other large-scale structure observations, including the APM angular galaxy-correlations, and for lambda = 1-Omega with the COBE results of the microwave background radiation fluctuations.

Curvaton as dark matter with secondary inflation

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

Gong, Jinn-Ouk; Kitajima, Naoya; Terada, Takahiro, E-mail: jinn-ouk.gong@apctp.org, E-mail: naoya.kitajima@apctp.org, E-mail: terada@kias.re.kr

2017-03-01

We consider a novel cosmological scenario in which a curvaton is long-lived and plays the role of cold dark matter (CDM) in the presence of a short, secondary inflation. Non-trivial evolution of the large scale cosmological perturbation in the curvaton scenario can affect the duration of the short term inflation, resulting in the inhomogeneous end of inflation. Non-linear parameters of the curvature perturbation are predicted to be f {sub NL} ≈ 5/4 and g {sub NL} ≈ 0. The curvaton abundance can be well diluted by the short-term inflation and accordingly, it does not have to decay into the Standardmore » Model particles. Then the curvaton can account for the present CDM with the isocurvature perturbation being sufficiently suppressed because both the adiabatic and CDM isocurvature perturbations have the same origin. As an explicit example, we consider the thermal inflation scenario and a string axion as a candidate for this curvaton-dark matter. We further discuss possibilities to identify the curvaton-dark matter with the QCD axion.« less

Topology in two dimensions. IV - CDM models with non-Gaussian initial conditions

NASA Astrophysics Data System (ADS)

Coles, Peter; Moscardini, Lauro; Plionis, Manolis; Lucchin, Francesco; Matarrese, Sabino; Messina, Antonio

1993-02-01

The results of N-body simulations with both Gaussian and non-Gaussian initial conditions are used here to generate projected galaxy catalogs with the same selection criteria as the Shane-Wirtanen counts of galaxies. The Euler-Poincare characteristic is used to compare the statistical nature of the projected galaxy clustering in these simulated data sets with that of the observed galaxy catalog. All the models produce a topology dominated by a meatball shift when normalized to the known small-scale clustering properties of galaxies. Models characterized by a positive skewness of the distribution of primordial density perturbations are inconsistent with the Lick data, suggesting problems in reconciling models based on cosmic textures with observations. Gaussian CDM models fit the distribution of cell counts only if they have a rather high normalization but possess too low a coherence length compared with the Lick counts. This suggests that a CDM model with extra large scale power would probably fit the available data.

DNA bases thymine and adenine in bio-organic light emitting diodes.

PubMed

Gomez, Eliot F; Venkatraman, Vishak; Grote, James G; Steckl, Andrew J

2014-11-24

We report on the use of nucleic acid bases (NBs) in organic light emitting diodes (OLEDs). NBs are small molecules that are the basic building blocks of the larger DNA polymer. NBs readily thermally evaporate and integrate well into the vacuum deposited OLED fabrication. Adenine (A) and thymine (T) were deposited as electron-blocking/hole-transport layers (EBL/HTL) that resulted in increases in performance over the reference OLED containing the standard EBL material NPB. A-based OLEDs reached a peak current efficiency and luminance performance of 48 cd/A and 93,000 cd/m(2), respectively, while T-based OLEDs had a maximum of 76 cd/A and 132,000 cd/m(2). By comparison, the reference OLED yielded 37 cd/A and 113,000 cd/m(2). The enhanced performance of T-based devices is attributed to a combination of energy levels and structured surface morphology that causes more efficient and controlled hole current transport to the emitting layer.

The tangential velocity of M31: CLUES from constrained simulations

NASA Astrophysics Data System (ADS)

Carlesi, Edoardo; Hoffman, Yehuda; Sorce, Jenny G.; Gottlöber, Stefan; Yepes, Gustavo; Courtois, Hélène; Tully, R. Brent

2016-07-01

Determining the precise value of the tangential component of the velocity of M31 is a non-trivial astrophysical issue that relies on complicated modelling. This has recently lead to conflicting estimates, obtained by several groups that used different methodologies and assumptions. This Letter addresses the issue by computing a Bayesian posterior distribution function of this quantity, in order to measure the compatibility of those estimates with Λ cold dark matter (ΛCDM). This is achieved using an ensemble of Local Group (LG) look-alikes collected from a set of constrained simulations (CSs) of the local Universe, and a standard unconstrained ΛCDM. The latter allows us to build a control sample of LG-like pairs and to single out the influence of the environment in our results. We find that neither estimate is at odds with ΛCDM; however, whereas CSs favour higher values of vtan, the reverse is true for estimates based on LG samples gathered from unconstrained simulations, overlooking the environmental element.

Entropy corrected holographic dark energy models in modified gravity

NASA Astrophysics Data System (ADS)

Jawad, Abdul; Azhar, Nadeem; Rani, Shamaila

We consider the power law and the entropy corrected holographic dark energy (HDE) models with Hubble horizon in the dynamical Chern-Simons modified gravity. We explore various cosmological parameters and planes in this framework. The Hubble parameter lies within the consistent range at the present and later epoch for both entropy corrected models. The deceleration parameter explains the accelerated expansion of the universe. The equation of state (EoS) parameter corresponds to quintessence and cold dark matter (ΛCDM) limit. The ωΛ-ωΛ‧ approaches to ΛCDM limit and freezing region in both entropy corrected models. The statefinder parameters are consistent with ΛCDM limit and dark energy (DE) models. The generalized second law of thermodynamics remain valid in all cases of interacting parameter. It is interesting to mention here that our results of Hubble, EoS parameter and ωΛ-ωΛ‧ plane show consistency with the present observations like Planck, WP, BAO, H0, SNLS and nine-year WMAP.

Can chronic disease management plans including occupational therapy and physiotherapy services contribute to reducing falls risk in older people?

PubMed

Mackenzie, Lynette; Clemson, Lindy

2014-04-01

Exercise and home modifications are effective interventions for preventing falls. Chronic disease management (CDM) items are one way for general practitioners (GPs) to access these interventions. This study aimed to evaluate the outcomes and feasibility of using CDM items for occupational therapy (OT) and physiotherapy (PT) sessions to address falls risk. A pre-post pilot study design was used to evaluate five collaborative sessions shared by a private OT and PT using CDM items and a GP management plan. Pre and post intervention measures were used to evaluate outcomes for eight patients aged ≥75 years from two GP practices. At 2 months post-intervention there were significant improvements in everyday functioning (P = 0.04), physical capacity (P = 0.01) and falls efficacy (P =0.01). Adherence to the intervention was excellent. Falls prevention interventions can be effective in primary care settings and sustainable pathways need to be developed to ensure access for older people at risk.

The Adaptability of Career Decision-Making Profiles: Associations with Self-Efficacy, Emotional Difficulties, and Decision Status

ERIC Educational Resources Information Center

Gadassi, Reuma; Gati, Itamar; Wagman-Rolnick, Halleli

2013-01-01

The present study investigated a new model for characterizing the way individuals make career decisions (career decision-making profiles [CDMP]). Using data from 285 students in a preacademic program, the present study assessed the association of the CDMP's dimensions with the Emotional and Personality-related Career decision-making Difficulties…

Couple decision making and use of cultural scripts in Malawi.

PubMed

Mbweza, Ellen; Norr, Kathleen F; McElmurry, Beverly

2008-01-01

To examine the decision-making processes of husband and wife dyads in matrilineal and patrilineal marriage traditions of Malawi in the areas of money, food, pregnancy, contraception, and sexual relations. Qualitative grounded theory using simultaneous interviews of 60 husbands and wives (30 couples). Data were analyzed according to the guidelines of simultaneous data collection and analysis. The analysis resulted in development of core categories and categories of decision-making process. Data matrixes were used to identify similarities and differences within couples and across cases. Most couples reported using a mix of final decision-making approaches: husband-dominated, wife-dominated, and shared. Gender based and nongender based cultural scripts provided rationales for their approaches to decision making. Gender based cultural scripts (husband-dominant and wife-dominant) were used to justify decision-making approaches. Non-gender based cultural scripts (communicating openly, maintaining harmony, and children's welfare) supported shared decision making. Gender based cultural scripts were used in decision making more often among couples from the district with a patrilineal marriage tradition and where the husband had less than secondary school education and was not formally employed. Nongender based cultural scripts to encourage shared decision making can be used in designing culturally tailored reproductive health interventions for couples. Nurses who work with women and families should be aware of the variations that occur in actual couple decision-making approaches. Shared decision making can be used to encourage the involvement of men in reproductive health programs.

Grey situation group decision-making method based on prospect theory.

PubMed

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example.

Grey Situation Group Decision-Making Method Based on Prospect Theory

PubMed Central

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example. PMID:25197706

38 CFR 26.7 - VA environmental decision making and documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental decision making and documents. (a) Relevant environmental documents shall accompany other decision documents as they proceed through the decision-making process. (b) The major decision points for VA actions... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision...

Factors that impact on emergency nurses' ethical decision-making ability.

PubMed

Alba, Barbara

2016-11-10

Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson's r was the statistical method used to analyze three primary and two secondary research questions. A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. A relationship between intuition and perceived ethical decision-making ability (r = .252, p = .001) was a significant finding in this study. This study is one of the first of this nature to make a connection between intuition and nurses' ethical decision-making ability. This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions. © The Author(s) 2016.

Promoting informed choice: evaluating a decision-making tool for family planning clients and providers in Mexico.

PubMed

Kim, Young Mi; Kols, Adrienne; Martin, Antonieta; Silva, David; Rinehart, Ward; Prammawat, Sarah; Johnson, Sarah; Church, Kathryn

2005-12-01

The World Health Organization (WHO) has developed a decision-making tool to be used by providers and clients during family planning visits to improve the quality of services. It is important to examine the tool's usability and its impact on counseling and decision-making processes during family planning consultations. Thirteen providers in Mexico City were videotaped with family planning clients three months before and one month after attending a training session on the WHO decision-making tool. The videotapes were coded for client-provider communication and eye contact, and decision-making behaviors were rated. In-depth interviews and focus group discussions explored clients' and providers' opinions of the tool. After providers began using the decision-making tool, they gave clients more information on family planning, tailored that information more closely to clients' situations and more often discussed HIV/AIDS prevention, dual protection and condom use. Client involvement in the decision-making process and client active communication increased, contributing to a shift from provider-dominated to shared decision making. Clients reported that the tool helped them understand the provider's explanations and made them feel more comfortable talking and asking questions during consultations. After one month of practice with the decision-making tool, most providers felt comfortable with it and found it useful; however, they recommended some changes to the tool to help engage clients in the decision-making process. The decision-making tool was useful both as a job aid for providers and as a decision aid for clients.

Teachers' Grading Decision Making

ERIC Educational Resources Information Center

Isnawati, Ida; Saukah, Ali

2017-01-01

This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

Reimbursement decisions in health policy--extending our understanding of the elements of decision-making.

PubMed

Wirtz, Veronika; Cribb, Alan; Barber, Nick

2005-09-08

Previous theoretical and empirical work on health policy decisions about reimbursement focuses on specific rationales such as effectiveness, economic considerations and equal access for equal needs. As reimbursement decisions take place in a social and political context we propose that the analysis of decision-making should incorporate factors, which go beyond those commonly discussed. As an example we chose three health technologies (sildenafil, rivastigmine and statins) to investigate how decisions about reimbursement of medicines are made in the United Kingdom National Health Service and what factors influence these decisions. From face-to-face, in-depth interviews with a purposive sample of 20 regional and national policy makers and stakeholders we identified two dimensions of decision-making, which extend beyond the rationales conventionally cited. The first dimension relates to the role of 'subjectivity' or 'the personal' in the decisions, including personal experiences of the condition and excitement about the novelty or potential benefit of the technology-these factors affect what counts as evidence, or how evidence is interpreted, in practice. The second dimension relates to the social and political function of decision-making and broadens what counts as the relevant ends of decision-making to include such things as maintaining relationships, avoiding organisational burden, generating politically and legally defensible decisions and demonstrating the willingness to care. More importantly, we will argue that these factors should not be treated as contaminants of an otherwise rational decision-making. On the contrary we suggest that they seem relevant, reasonable and also of substantial importance in considering in decision-making. Complementing the analysis of decision-making about reimbursement by incorporating these factors could increase our understanding and potentially improve decision-making.

Understanding medical decision making in hand surgery.

PubMed

Myers, John; McCabe, Steven J

2005-10-01

The practice of medicine takes place in an environment of uncertainty. Expected value decision making, prospect theory, and regret theory are three theories of decision making under uncertainty that may be used to help us learn how patients and physicians make decisions. These theories form the underpinnings of decision analysis and provide the opportunity to introduce the broad discipline of decision science. Because decision analysis and economic analysis are underrepresented in upper extremity surgery, the authors believe these are important areas for future research.

Enhancing Decision-Making in STSE Education by Inducing Reflection and Self-Regulated Learning

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2017-02-01

Thoughtful decision-making to resolve socioscientific issues is central to science, technology, society, and environment (STSE) education. One approach for attaining this goal involves fostering students' decision-making processes. Thus, the present study explores whether the application of decision-making strategies, combined with reflections on the decision-making processes of others, enhances decision-making competence. In addition, this study examines whether this process is supported by elements of self-regulated learning, i.e., self-reflection regarding one's own performance and the setting of goals for subsequent tasks. A computer-based training program which involves the resolution of socioscientific issues related to sustainable development was developed in two versions: with and without elements of self-regulated learning. Its effects on decision-making competence were analyzed using a pre test-post test follow-up control-group design ( N = 242 high school students). Decision-making competence was assessed using an open-ended questionnaire that focused on three facets: consideration of advantages and disadvantages, metadecision aspects, and reflection on the decision-making processes of others. The findings suggest that students in both training groups incorporated aspects of metadecision into their statements more often than students in the control group. Furthermore, both training groups were more successful in reflecting on the decision-making processes of others. The students who received additional training in self-regulated learning showed greater benefits in terms of metadecision aspects and reflection, and these effects remained significant two months later. Overall, our findings demonstrate that the application of decision-making strategies, combined with reflections on the decision-making process and elements of self-regulated learning, is a fruitful approach in STSE education.

Parental decision-making after ultrasound diagnosis of a serious foetal abnormality.

PubMed

Bijma, Hilmar H; Wildschut, Hajo I J; van der Heide, Agnes; Passchier, Jan; Wladimiroff, Juriy W; van der Maas, Paul J

2005-01-01

The purpose of this article is to provide clinicians who are involved in the field of foetal medicine with a comprehensive overview of theories that are relevant for the parental decision-making process after ultrasound diagnosis of a serious foetal abnormality. Since little data are available of parental decision-making after ultrasound diagnosis of foetal abnormality, we reviewed the literature on parental decision-making in genetic counselling of couples at increased genetic risk together with the literature on general decision-making theories. The findings were linked to the specific situation of parental decision-making after an ultrasound diagnosis of foetal abnormality. Based on genetic counselling studies, several cognitive mechanisms play a role in parental decision-making regarding future pregnancies. Parents often have a binary perception of risk. Probabilistic information is translated into two options: the child will or will not be affected. The graduality of chance seems to be of little importance in this process. Instead, the focus shifts to the possible consequences for future family life. General decision-making theories often focus on rationality and coherence of the decision-making process. However, studies of both the influence of framing and the influence of stress indicate that emotional mechanisms can have an important and beneficial function in the decision-making process. Cognitive mechanisms that are elicited by emotions and that are not necessarily rational can have an important and beneficial function in parental decision-making after ultrasound diagnosis of a foetal abnormality. Consequently, the process of parental decision-making should not solely be assessed on the basis of its rationality, but also on the basis of the parental emotional outcome. Copyright (c) 2005 S. Karger AG, Basel.

How social cognition can inform social decision making.

PubMed

Lee, Victoria K; Harris, Lasana T

2013-12-25

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

How social cognition can inform social decision making

PubMed Central

Lee, Victoria K.; Harris, Lasana T.

2013-01-01

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

Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

PubMed

Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

2013-09-05

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing. The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

PubMed Central

2013-01-01

Background Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals’ perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. Methods The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign (‘Ask 3 Questions’); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. Results A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: ‘coherence,’ ‘cognitive participation,’ ‘collective action,’ and ‘reflexive monitoring.’ Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose (‘coherence’). Shared decision making was facilitated when teams engaged in developing and delivering interventions (‘cognitive participation’), and when those interventions fit with existing skill sets and organizational priorities (‘collective action’) resulting in demonstrable improvements to practice (‘reflexive monitoring’). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; ‘coherence’ was often missing. Conclusions The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation. PMID:24006959

Consumer and relationship factors associated with shared decision making in mental health consultations.

PubMed

Matthias, Marianne S; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A; Firmin, Ruth L; Oles, Sylwia K; Adams, Erin L; Collins, Linda A; Salyers, Michelle P

2014-12-01

This study explored the association between shared decision making and consumers' illness management skills and consumer-provider relationships. Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.

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.

32 CFR 322.7 - Exempt systems of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... information permits more informed decision-making by the Department when making required suitability... becomes clear. Such information permits more informed decision-making by the Department when making... becomes clear. Such information permits more informed decision-making by the Department when making...

Altered moral decision-making in patients with idiopathic Parkinson's disease.

PubMed

Rosen, Jan B; Rott, Elisa; Ebersbach, Georg; Kalbe, Elke

2015-10-01

Moral decision-making essentially contributes to social conduct. Although patients with Parkinson's disease (PD) show deficits in (non-moral) decision making and related neuropsychological functions, i.e. executive functions, theory of mind (ToM), and empathy, moral decision-making has rarely been examined in PD patients. We examined possible alterations of moral decision-making and associated functions in PD. Twenty non-demented PD patients and 23 age- and education-matched healthy control participants were examined with tests that assess reasoning, executive functions (set-shifting and planning), ToM and empathy, decision-making under risk, and moral intuitions. Moral decision-making was assessed with a close-to-everyday moral dilemma paradigm that opposes socially oriented "altruistic" choices to self-beneficial "egoistic" choices in 20 moral dilemma short stories (10 high and 10 low emotional). Concurrently, electrodermal activity was recorded. PD patients made more egoistic moral decisions than healthy controls. Remarkably, while reasoning, planning and empathy correlated with moral decision-making in the control group, in the PD group neuropsychological functions and dopaminergic medication did not correlate with moral decisions. No evidence for reduced skin conductance responses in PD patients and no relationships between skin conductance responses and moral decisions were observed. This study provides evidence for moral decision-making dysfunctions in PD patients who made more egoistic moral decisions. As a possible underlying mechanism, reduced exercise of attentional control due to a dysfunctional interplay between the prefrontal cortex and the basal ganglia is discussed. Future research will have to determine the impact of PD patients' moral decision-making dysfunctions on everyday life and further determine correlates of the deficits. Copyright © 2015 Elsevier Ltd. All rights reserved.

Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

PubMed Central

Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

2015-01-01

Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate. PMID:26509317