36 CFR 220.4 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency decisionmaking by: (1) Completing the environmental document review before making a decision on...(s) before rendering a decision on the proposal; and (5) Making a decision encompassed within the... preparing to make a decision on one or more alternative means of accomplishing that goal and the effects can...

Hemispheric Activation Differences in Novice and Expert Clinicians during Clinical Decision Making

ERIC Educational Resources Information Center

Hruska, Pam; Hecker, Kent G.; Coderre, Sylvain; McLaughlin, Kevin; Cortese, Filomeno; Doig, Christopher; Beran, Tanya; Wright, Bruce; Krigolson, Olav

2016-01-01

Clinical decision making requires knowledge, experience and analytical/non-analytical types of decision processes. As clinicians progress from novice to expert, research indicates decision-making becomes less reliant on foundational biomedical knowledge and more on previous experience. In this study, we investigated how knowledge and experience…

Insights into the concept and measurement of health literacy from a study of shared decision-making in a low literacy population.

PubMed

Smith, Sian K; Nutbeam, Don; McCaffery, Kirsten J

2013-08-01

This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.

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

Marine Steam Condenser Design Optimization.

DTIC Science & Technology

1983-12-01

to make design decisions to obtain a feasible design. CONNIN, as do most optimizers, requires complete control in determining all iterative design...neutralize all the places where such design decisions are made. By removing the ability for CONDIP to make any design decisions it became totally passive...dependent on CONNIN for design decisions , does not have that capability. Pemeabering that CONHIN requires a complete once-through analysis in order to

Challenging the Academically Adrift: A New Decision-Making Tool to Help Improve Student Commitment to Academic Preparation

ERIC Educational Resources Information Center

Davis, Carolyn D.

2013-01-01

This paper describes research in progress concerning the development and use of a newly created tool, the Decision-Making Grid, which was designed to teach undergraduate management students to develop and use metacognitive regulation skills to improve decision-making by requiring students to construct improved decision-making models in a boundedly…

Goal-Directed Decision Making with Spiking Neurons.

PubMed

Friedrich, Johannes; Lengyel, Máté

2016-02-03

Behavioral and neuroscientific data on reward-based decision making point to a fundamental distinction between habitual and goal-directed action selection. The formation of habits, which requires simple updating of cached values, has been studied in great detail, and the reward prediction error theory of dopamine function has enjoyed prominent success in accounting for its neural bases. In contrast, the neural circuit mechanisms of goal-directed decision making, requiring extended iterative computations to estimate values online, are still unknown. Here we present a spiking neural network that provably solves the difficult online value estimation problem underlying goal-directed decision making in a near-optimal way and reproduces behavioral as well as neurophysiological experimental data on tasks ranging from simple binary choice to sequential decision making. Our model uses local plasticity rules to learn the synaptic weights of a simple neural network to achieve optimal performance and solves one-step decision-making tasks, commonly considered in neuroeconomics, as well as more challenging sequential decision-making tasks within 1 s. These decision times, and their parametric dependence on task parameters, as well as the final choice probabilities match behavioral data, whereas the evolution of neural activities in the network closely mimics neural responses recorded in frontal cortices during the execution of such tasks. Our theory provides a principled framework to understand the neural underpinning of goal-directed decision making and makes novel predictions for sequential decision-making tasks with multiple rewards. Goal-directed actions requiring prospective planning pervade decision making, but their circuit-level mechanisms remain elusive. We show how a model circuit of biologically realistic spiking neurons can solve this computationally challenging problem in a novel way. The synaptic weights of our network can be learned using local plasticity rules such that its dynamics devise a near-optimal plan of action. By systematically comparing our model results to experimental data, we show that it reproduces behavioral decision times and choice probabilities as well as neural responses in a rich set of tasks. Our results thus offer the first biologically realistic account for complex goal-directed decision making at a computational, algorithmic, and implementational level. Copyright © 2016 the authors 0270-6474/16/361529-18$15.00/0.

Goal-Directed Decision Making with Spiking Neurons

PubMed Central

Lengyel, Máté

2016-01-01

Behavioral and neuroscientific data on reward-based decision making point to a fundamental distinction between habitual and goal-directed action selection. The formation of habits, which requires simple updating of cached values, has been studied in great detail, and the reward prediction error theory of dopamine function has enjoyed prominent success in accounting for its neural bases. In contrast, the neural circuit mechanisms of goal-directed decision making, requiring extended iterative computations to estimate values online, are still unknown. Here we present a spiking neural network that provably solves the difficult online value estimation problem underlying goal-directed decision making in a near-optimal way and reproduces behavioral as well as neurophysiological experimental data on tasks ranging from simple binary choice to sequential decision making. Our model uses local plasticity rules to learn the synaptic weights of a simple neural network to achieve optimal performance and solves one-step decision-making tasks, commonly considered in neuroeconomics, as well as more challenging sequential decision-making tasks within 1 s. These decision times, and their parametric dependence on task parameters, as well as the final choice probabilities match behavioral data, whereas the evolution of neural activities in the network closely mimics neural responses recorded in frontal cortices during the execution of such tasks. Our theory provides a principled framework to understand the neural underpinning of goal-directed decision making and makes novel predictions for sequential decision-making tasks with multiple rewards. SIGNIFICANCE STATEMENT Goal-directed actions requiring prospective planning pervade decision making, but their circuit-level mechanisms remain elusive. We show how a model circuit of biologically realistic spiking neurons can solve this computationally challenging problem in a novel way. The synaptic weights of our network can be learned using local plasticity rules such that its dynamics devise a near-optimal plan of action. By systematically comparing our model results to experimental data, we show that it reproduces behavioral decision times and choice probabilities as well as neural responses in a rich set of tasks. Our results thus offer the first biologically realistic account for complex goal-directed decision making at a computational, algorithmic, and implementational level. PMID:26843636

Assessment of Healthcare Decision-making Capacity

PubMed Central

Palmer, Barton W.; Harmell, Alexandrea L.

2016-01-01

It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity. PMID:27551024

Conceptual Problems.

ERIC Educational Resources Information Center

Foley, Walter J.

A systems theory approach to information requirements in education and in evaluation strategies is applied to decision making. Educational decision making itself involves long range planning, system structuring to implement goals, system allocation (cost), and system monitoring which provides the feedback. Each level requires differential…

Integrated Risk-Informed Decision-Making for an ALMR PRISM

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

Muhlheim, Michael David; Belles, Randy; Denning, Richard S.

Decision-making is the process of identifying decision alternatives, assessing those alternatives based on predefined metrics, selecting an alternative (i.e., making a decision), and then implementing that alternative. The generation of decisions requires a structured, coherent process, or a decision-making process. The overall objective for this work is that the generalized framework is adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or no human intervention. The overriding goal of automation is to replace ormore » supplement human decision makers with reconfigurable decision-making modules that can perform a given set of tasks rationally, consistently, and reliably. Risk-informed decision-making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The probabilistic portion of the decision-making engine of the supervisory control system is based on the control actions associated with an ALMR PRISM. Newly incorporated into the probabilistic models are the prognostic/diagnostic models developed by Pacific Northwest National Laboratory. These allow decisions to incorporate the health of components into the decision–making process. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic portion of the decision-making engine uses thermal-hydraulic modeling and components for an advanced liquid-metal reactor Power Reactor Inherently Safe Module. The deterministic multi-attribute decision-making framework uses various sensor data (e.g., reactor outlet temperature, steam generator drum level) and calculates its position within the challenge state, its trajectory, and its margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. The metrics that are evaluated are based on reactor trip set points. The integration of the deterministic calculations using multi-physics analyses and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermalhydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies, and developing a user interface to mimic display panels at a modern nuclear power plant.« less

Does Evidence Matter? How Middle School Students Make Decisions about Socioscientific Issues

ERIC Educational Resources Information Center

Emery, Katherine Beth

2013-01-01

People worldwide are faced with making decisions daily. While many decisions are quick (e.g., what clothes to wear), others, such as those about environmental issues (e.g., overfishing), require more thought and have less immediate outcomes. How one makes such decisions depends on how one interprets, evaluates, and uses evidence. The central…

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

PubMed

Dolan, James G

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare

PubMed Central

Dolan, James G.

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers. Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine “hard data” with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings. The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP) PMID:21394218

Perception, Action, and Cognition of Football Referees in Extreme Temperatures: Impact on Decision Performance.

PubMed

Gaoua, Nadia; de Oliveira, Rita F; Hunter, Steve

2017-01-01

Different professional domains require high levels of physical performance alongside fast and accurate decision-making. Construction workers, police officers, firefighters, elite sports men and women, the military and emergency medical professionals are often exposed to hostile environments with limited options for behavioral coping strategies. In this (mini) review we use football refereeing as an example to discuss the combined effect of intense physical activity and extreme temperatures on decision-making and suggest an explicative model. In professional football competitions can be played in temperatures ranging from -5°C in Norway to 30°C in Spain for example. Despite these conditions, the referee's responsibility is to consistently apply the laws fairly and uniformly, and to ensure the rules are followed without waning or adversely influencing the competitiveness of the play. However, strenuous exercise in extreme environments imposes increased physiological and psychological stress that can affect decision-making. Therefore, the physical exertion required to follow the game and the thermal strain from the extreme temperatures may hinder the ability of referees to make fast and accurate decisions. Here, we review literature on the physical and cognitive requirements of football refereeing and how extreme temperatures may affect referees' decisions. Research suggests that both hot and cold environments have a negative impact on decision-making but data specific to decision-making is still lacking. A theoretical model of decision-making under the constraint of intense physical activity and thermal stress is suggested. Future naturalistic studies are needed to validate this model and provide clear recommendations for mitigating strategies.

Perception, Action, and Cognition of Football Referees in Extreme Temperatures: Impact on Decision Performance

PubMed Central

Gaoua, Nadia; de Oliveira, Rita F.; Hunter, Steve

2017-01-01

Different professional domains require high levels of physical performance alongside fast and accurate decision-making. Construction workers, police officers, firefighters, elite sports men and women, the military and emergency medical professionals are often exposed to hostile environments with limited options for behavioral coping strategies. In this (mini) review we use football refereeing as an example to discuss the combined effect of intense physical activity and extreme temperatures on decision-making and suggest an explicative model. In professional football competitions can be played in temperatures ranging from -5°C in Norway to 30°C in Spain for example. Despite these conditions, the referee’s responsibility is to consistently apply the laws fairly and uniformly, and to ensure the rules are followed without waning or adversely influencing the competitiveness of the play. However, strenuous exercise in extreme environments imposes increased physiological and psychological stress that can affect decision-making. Therefore, the physical exertion required to follow the game and the thermal strain from the extreme temperatures may hinder the ability of referees to make fast and accurate decisions. Here, we review literature on the physical and cognitive requirements of football refereeing and how extreme temperatures may affect referees’ decisions. Research suggests that both hot and cold environments have a negative impact on decision-making but data specific to decision-making is still lacking. A theoretical model of decision-making under the constraint of intense physical activity and thermal stress is suggested. Future naturalistic studies are needed to validate this model and provide clear recommendations for mitigating strategies. PMID:28912742

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.

Long range healthcare capacity planning in the Netherlands. The case of radiotherapy.

PubMed

Postma, T J B M; Terpstra, S

2002-01-01

This contribution discusses centralization vs. decentralization in healthcare strategic decision making, focusing on long-range planning of facilities for radiotherapy. The radiotherapy case illustrates that more centralized, comprehensive, and systematic planning and strategic decisions making may be necessary to account for inputs of various parties and decision-making levels in this area. The expertise required cannot generally be found at a local or even regional level. It requires initiatives from coordinating healthcare institutions such as the Health Council and other professional organizations.

Examining Moral Reasoning and Ethical Decision Making among Mississippi's Community College Administrators

ERIC Educational Resources Information Center

Wilson, Vernesia Bracey

2010-01-01

As ethical dilemmas arise in community colleges, administrators make decisions that require sensitivity to the organizational, political, and environmental factors surrounding their particular institutional climates and locales. The moral reasoning and ethical decision-making of community college administrators were examined in this study. In…

18 CFR 401.93 - The record for decision-making.

Code of Federal Regulations, 2010 CFR

2010-04-01

... record for decision-making. (a) Written submission. In addition to the information required by the... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false The record for decision-making. 401.93 Section 401.93 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION...

Patients' decision making in total knee arthroplasty: a systematic review of qualitative research.

PubMed

Barlow, T; Griffin, D; Barlow, D; Realpe, A

2015-10-01

A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review's objective is to systematically examine the qualitative literature surrounding patients' decision making in knee arthroplasty. A systematic literature review using Medline and Embase was conducted to identify qualitative studies that examined patients' decision making around knee arthroplasty. An aggregated account of what is known about patients' decision making in knee arthroplasties is provided. Seven studies with 234 participants in interviews or focus groups are included. Ten themes are replicated across studies, namely: expectations of surgery; coping mechanisms; relationship with clinician; fear; pain; function; psychological implications; social network; previous experience of surgery; and conflict in opinions. This review is helpful in not only directing future research to areas that are not understood, or require confirmation, but also in highlighting areas that future interventions could address. These include those aimed at delivering information, which are likely to affect the satisfaction rate, demand, and use of knee arthroplasties. Cite this article: Bone Joint Res 2015;4;163-169. ©2015 Griffin.

ENABLING SMART MANUFACTURING TECHNOLOGIES FOR DECISION-MAKING SUPPORT

PubMed Central

Helu, Moneer; Libes, Don; Lubell, Joshua; Lyons, Kevin; Morris, KC

2017-01-01

Smart manufacturing combines advanced manufacturing capabilities and digital technologies throughout the product lifecycle. These technologies can provide decision-making support to manufacturers through improved monitoring, analysis, modeling, and simulation that generate more and better intelligence about manufacturing systems. However, challenges and barriers have impeded the adoption of smart manufacturing technologies. To begin to address this need, this paper defines requirements for data-driven decision making in manufacturing based on a generalized description of decision making. Using these requirements, we then focus on identifying key barriers that prevent the development and use of data-driven decision making in industry as well as examples of technologies and standards that have the potential to overcome these barriers. The goal of this research is to promote a common understanding among the manufacturing community that can enable standardization efforts and innovation needed to continue adoption and use of smart manufacturing technologies. PMID:28649678

Faulty judgment, expert opinion, and decision-making capacity.

PubMed

Silberfeld, M; Checkland, D

1999-08-01

An assessment of decision-making capacity is the accepted procedure for determining when a person is not competent. An inferential gap exists between the criteria for capacity specific abilities and the legal requirements to understand relevant information and appreciate the consequences of a decision. This gap extends to causal influences on a person's capacity to decide. Using a published case of depression, we illustrate that assessors' uses of diagnostic information is frequently not up to the task of bridging this inferential gap in a justifiable way. We then describe cases of faulty judgement which challenge the understanding of diagnostic causal influences. These cases help to clarify the nature of the expertise required for capacity assessments. In practice, the requirements of decision-making capacity are often abandoned to other considerations due to a lack of requisite expertise. The legal policy supporting decision-making capacity as a means to protective intervention is justified only if the requisite expertise is developed. We propose the requisite expertise to be developed in the long term as a distinct multidisciplinary endeavour.

Decisions, Decisions, Decisions: Using Data to Make Instructional Decisions for Struggling Readers

ERIC Educational Resources Information Center

Filderman, Marissa J.; Toste, Jessica R.

2018-01-01

Reading proficiency is fundamental to school success. However, up to 50% of students with reading disabilities are not making adequate progress. Students who demonstrate persistent and severe reading difficulties require increasingly intensive instruction individualized to meet their instructional needs Individualizing instruction with…

A taxonomy of decision problems on the flight deck

NASA Technical Reports Server (NTRS)

Orasanu, Judith M.; Fischer, Ute; Tarrel, Richard J.

1993-01-01

Examining cases of real crews making decisions in full-mission simulators or through Aviation Safety Reporting System (ASRS) reports shows that there are many different types of decisions that crews must make. Features of the situation determine the type of decision that must be made. The paper identifies six types of decisions that require different types of cognitive work and are also subject to different types of error or failure. These different requirements, along with descriptions of effective crew strategies, can serve as a basis for developing training practices and for evaluating crews.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

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

PubMed

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

2007-09-01

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

Reconciliation of Decision-Making Heuristics Based on Decision Trees Topologies and Incomplete Fuzzy Probabilities Sets

PubMed Central

Doubravsky, Karel; Dohnal, Mirko

2015-01-01

Complex decision making tasks of different natures, e.g. economics, safety engineering, ecology and biology, are based on vague, sparse, partially inconsistent and subjective knowledge. Moreover, decision making economists / engineers are usually not willing to invest too much time into study of complex formal theories. They require such decisions which can be (re)checked by human like common sense reasoning. One important problem related to realistic decision making tasks are incomplete data sets required by the chosen decision making algorithm. This paper presents a relatively simple algorithm how some missing III (input information items) can be generated using mainly decision tree topologies and integrated into incomplete data sets. The algorithm is based on an easy to understand heuristics, e.g. a longer decision tree sub-path is less probable. This heuristic can solve decision problems under total ignorance, i.e. the decision tree topology is the only information available. But in a practice, isolated information items e.g. some vaguely known probabilities (e.g. fuzzy probabilities) are usually available. It means that a realistic problem is analysed under partial ignorance. The proposed algorithm reconciles topology related heuristics and additional fuzzy sets using fuzzy linear programming. The case study, represented by a tree with six lotteries and one fuzzy probability, is presented in details. PMID:26158662

Reconciliation of Decision-Making Heuristics Based on Decision Trees Topologies and Incomplete Fuzzy Probabilities Sets.

PubMed

Doubravsky, Karel; Dohnal, Mirko

2015-01-01

Complex decision making tasks of different natures, e.g. economics, safety engineering, ecology and biology, are based on vague, sparse, partially inconsistent and subjective knowledge. Moreover, decision making economists / engineers are usually not willing to invest too much time into study of complex formal theories. They require such decisions which can be (re)checked by human like common sense reasoning. One important problem related to realistic decision making tasks are incomplete data sets required by the chosen decision making algorithm. This paper presents a relatively simple algorithm how some missing III (input information items) can be generated using mainly decision tree topologies and integrated into incomplete data sets. The algorithm is based on an easy to understand heuristics, e.g. a longer decision tree sub-path is less probable. This heuristic can solve decision problems under total ignorance, i.e. the decision tree topology is the only information available. But in a practice, isolated information items e.g. some vaguely known probabilities (e.g. fuzzy probabilities) are usually available. It means that a realistic problem is analysed under partial ignorance. The proposed algorithm reconciles topology related heuristics and additional fuzzy sets using fuzzy linear programming. The case study, represented by a tree with six lotteries and one fuzzy probability, is presented in details.

Applications of the International Space Station Probabilistic Risk Assessment Model

NASA Technical Reports Server (NTRS)

Grant, Warren; Lutomski, Michael G.

2011-01-01

Recently the International Space Station (ISS) has incorporated more Probabilistic Risk Assessments (PRAs) in the decision making process for significant issues. Future PRAs will have major impact to ISS and future spacecraft development and operations. These PRAs will have their foundation in the current complete ISS PRA model and the current PRA trade studies that are being analyzed as requested by ISS Program stakeholders. ISS PRAs have recently helped in the decision making process for determining reliability requirements for future NASA spacecraft and commercial spacecraft, making crew rescue decisions, as well as making operational requirements for ISS orbital orientation, planning Extravehicular activities (EVAs) and robotic operations. This paper will describe some applications of the ISS PRA model and how they impacted the final decision. This paper will discuss future analysis topics such as life extension, requirements of new commercial vehicles visiting ISS.

Evidence and Obesity Prevention: Developing Evidence Summaries to Support Decision Making

ERIC Educational Resources Information Center

Clark, Rachel; Waters, Elizabeth; Armstrong, Rebecca; Conning, Rebecca; Allender, Steven; Swinburn, Boyd

2013-01-01

Public health practitioners make decisions based on research evidence in combination with a variety of other influences. Evidence summaries are one of a range of knowledge translation options used to support evidence-informed decision making. The literature relevant to obesity prevention requires synthesis for it to be accessible and relevant to…

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.

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

Efficient group decision making in workshop settings

Treesearch

Daniel L. Schmoldt; David L. Peterson

2001-01-01

Public land managers must treat multiple values coincidentally in time and space, which requires the participation of multiple resource specialists and consideration of diverse clientele interests in the decision process. This implies decision making that includes multiple participants, both internally and externally. Decades of social science research on decision...

Leadership of risk decision making in a complex, technology organization: The deliberative decision making model

NASA Astrophysics Data System (ADS)

Flaming, Susan C.

2007-12-01

The continuing saga of satellite technology development is as much a story of successful risk management as of innovative engineering. How do program leaders on complex, technology projects manage high stakes risks that threaten business success and satellite performance? This grounded theory study of risk decision making portrays decision leadership practices at one communication satellite company. Integrated product team (IPT) leaders of multi-million dollar programs were interviewed and observed to develop an extensive description of the leadership skills required to navigate organizational influences and drive challenging risk decisions to closure. Based on the study's findings the researcher proposes a new decision making model, Deliberative Decision Making, to describe the program leaders' cognitive and organizational leadership practices. This Deliberative Model extends the insights of prominent decision making models including the rational (or classical) and the naturalistic and qualifies claims made by bounded rationality theory. The Deliberative Model describes how leaders proactively engage resources to play a variety of decision leadership roles. The Model incorporates six distinct types of leadership decision activities, undertaken in varying sequence based on the challenges posed by specific risks. Novel features of the Deliberative Decision Model include: an inventory of leadership methods for managing task challenges, potential stakeholder bias and debates; four types of leadership meta-decisions that guide decision processes, and aligned organizational culture. Both supporting and constraining organizational influences were observed as leaders managed major risks, requiring active leadership on the most difficult decisions. Although the company's engineering culture emphasized the importance of data-based decisions, the uncertainties intrinsic to satellite risks required expert engineering judgment to be exercised throughout. An investigation into the co-variation of decision methods with uncertainty suggests that perceived risk severity may serve as a robust indicator for choices about decision practices. The Deliberative Decision processes incorporate multiple organizational and cultural controls as cross-checks to mitigate potential parochial bias of individuals, stakeholder groups, or leaders. Overall the Deliberative Decision framework describes how expert leadership practices, supportive organizational systems along with aligned cultural values and behavioral norms help leaders drive high stakes risk decisions to closure in this complex, advanced-technology setting.

Decision making in the ageing brain: changes in affective and motivational circuits.

PubMed

Samanez-Larkin, Gregory R; Knutson, Brian

2015-05-01

As the global population ages, older decision makers will be required to take greater responsibility for their own physical, psychological and financial well-being. With this in mind, researchers have begun to examine the effects of ageing on decision making and associated neural circuits. A new 'affect-integration-motivation' (AIM) framework may help to clarify how affective and motivational circuits support decision making. Recent research has shed light on whether and how ageing influences these circuits, providing an interdisciplinary account of how ageing can alter decision making.

Decision making in the ageing brain: Changes in affective and motivational circuits

PubMed Central

Samanez-Larkin, Gregory R.; Knutson, Brian

2017-01-01

As the global population ages, older decision makers will be required to take greater responsibility for their own physical, psychological and financial well-being. With this in mind, researchers have begun to examine the effects of ageing on decision making and associated neural circuits. A new “affect, integration, motivation” (or AIM) framework may help clarify how affective and motivational circuits support decision making. Recent research has shed light on whether and how ageing influences these circuits, providing an interdisciplinary account of how ageing can alter decision making. PMID:25873038

Applying predictive analytics to develop an intelligent risk detection application for healthcare contexts.

PubMed

Moghimi, Fatemeh Hoda; Cheung, Michael; Wickramasinghe, Nilmini

2013-01-01

Healthcare is an information rich industry where successful outcomes require the processing of multi-spectral data and sound decision making. The exponential growth of data and big data issues coupled with a rapid increase of service demands in healthcare contexts today, requires a robust framework enabled by IT (information technology) solutions as well as real-time service handling in order to ensure superior decision making and successful healthcare outcomes. Such a context is appropriate for the application of real time intelligent risk detection decision support systems using predictive analytic techniques such as data mining. To illustrate the power and potential of data science technologies in healthcare decision making scenarios, the use of an intelligent risk detection (IRD) model is proffered for the context of Congenital Heart Disease (CHD) in children, an area which requires complex high risk decisions that need to be made expeditiously and accurately in order to ensure successful healthcare outcomes.

Development of a First-of-a-Kind Deterministic Decision-Making Tool for Supervisory Control System

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

Cetiner, Sacit M; Kisner, Roger A; Muhlheim, Michael David

2015-07-01

Decision-making is the process of identifying and choosing alternatives where each alternative offers a different approach or path to move from a given state or condition to a desired state or condition. The generation of consistent decisions requires that a structured, coherent process be defined, immediately leading to a decision-making framework. The overall objective of the generalized framework is for it to be adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or nomore » human intervention. The overriding goal of automation is to replace or supplement human decision makers with reconfigurable decision- making modules that can perform a given set of tasks reliably. Risk-informed decision making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The implementation of the probabilistic portion of the decision-making engine of the proposed supervisory control system was detailed in previous milestone reports. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic multi-attribute decision-making framework uses variable sensor data (e.g., outlet temperature) and calculates where it is within the challenge state, its trajectory, and margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. Metrics to be evaluated include stability, cost, time to complete (action), power level, etc. The integration of deterministic calculations using multi-physics analyses (i.e., neutronics, thermal, and thermal-hydraulics) and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermal-hydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies.« less

The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

PubMed

Kelly, B D

2017-05-01

Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

Decision making in prioritization of required operational capabilities

NASA Astrophysics Data System (ADS)

Andreeva, P.; Karev, M.; Kovacheva, Ts.

2015-10-01

The paper describes an expert heuristic approach to prioritization of required operational capabilities in the field of defense. Based on expert assessment and by application of the method of Analytical Hierarchical Process, a methodology for their prioritization has been developed. It has been applied to practical simulation decision making games.

Psychological Peculiarities of Judge Professional Activity and Decision-Making

ERIC Educational Resources Information Center

Uspanov, Zholdybai T.; Turabayeva, Dana S.

2016-01-01

The article considers the psychological peculiarities of judge professional activity and decision-making, judge's mental set and requirements to ethical and moral requirements and quality. Moreover, this work offers original job analysis and competency model of judge professional activity. The authors have studied the problems concerning the…

Game theory and neural basis of social decision making

PubMed Central

Lee, Daeyeol

2008-01-01

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

Decision making in midwifery: rationality and intuition.

PubMed

Steinhauer, Suyai

2015-04-01

Decision making in midwifery is a complex process that shapes and underpins clinical practice and determines, to a large extent, the quality of care. Effective decision making and professional accountability are central to clinical governance, and being able.to justify all decisions is a professional and legal requirement. At the same time, there is an emphasis in midwifery on shared decision making, and keeping women at the centre of their care, and research reveals that feelings of choice, control and autonomy are central to a positive birth experience. However the extent to which decisions are really shared and care truly woman-centred is debatable and affected by environment and culture. Using a case study of a decision made in clinical practice around amniotomy, this article explores the role of the intuitive thinking system in midwifery decision making, and highlights the importance of involving women in the decision making process.

Maternal Decision-making During Pregnancy: Parental Obligations and Cultural Differences.

PubMed

Malek, Janet

2017-08-01

Decision-making during pregnancy can be ethically complex. This paper offers a framework for maternal decision-making and clinical counseling that can be used to approach such decisions in a systematic way. Three fundamental questions are addressed: (1) Who should make decisions? (2) How should decisions be made? and (3) What is the role of the clinician? The proposed framework emphasizes the decisional authority of the pregnant woman. It draws ethical support from the concept of a good parent and the requirements of parental obligations. It also describes appropriate counseling methods for clinicians in light of those parental obligations. Finally, the paper addresses how cultural differences may shape the framework's guidance of maternal decision-making during pregnancy. Copyright © 2017. Published by Elsevier Ltd.

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.

A Middle School Principal's and Teachers' Perceptions of Leadership Practices in Data-Driven Decision Making

ERIC Educational Resources Information Center

Godreau Cimma, Kelly L.

2011-01-01

The purpose of this qualitative case study was to describe one Connecticut middle school's voluntary implementation of a data-driven decision making process in order to improve student academic performance. Data-driven decision making is a component of Connecticut's accountability system to assist schools in meeting the requirements of the No…

Computational Complexity and Human Decision-Making.

PubMed

Bossaerts, Peter; Murawski, Carsten

2017-12-01

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

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.

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

Using basic geographic information systems functionality to support sustainable forest management decision making and post-decision assessments

Treesearch

Ronald E. McRoberts; R. James Barbour; Krista M. Gebert; Greg C. Liknes; Mark D. Nelson; Dacia M. Meneguzzo; et al.

2006-01-01

Sustainable management of natural resources requires informed decision making and post-decision assessments of the results of those decisions. Increasingly, both activities rely on analyses of spatial data in the forms of maps and digital data layers. Fortunately, a variety of supporting maps and data layers rapidly are becoming available. Unfortunately, however, user-...

Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory.

PubMed

Dunn, Jennifer A; Hay-Smith, E Jean C; Whitehead, Lisa C; Keeling, Sally

2013-07-01

To explore, from the perspective of the person with tetraplegia, the issues that influenced decision making about upper limb surgery and develop a conceptual framework describing the decision making process. Purposive and theoretical sampling of 22 people with tetraplegia, followed by interviews. Ten people had upper limb surgery and 12 had not. Verbatim transcripts were analyzed with constructivist grounded theory. Participants responded to the offer of surgery in one of three ways: yes, let me have it; no thanks; or possibly. Many influences on the decision about surgery had a temporal element, such as hope for the cure or recovery from SCI, inadequate physical or social supports while rehabilitating, life roles and goals, and the avoidance of re-hospitalization. The conceptual framework illustrated that many participants entered a liminal state within which they required a stimulus to review their decision about upper limb surgery. Decision making is a temporal process, and for some the process was a prolonged and liminal one. Therefore, multiple offers for surgery are required to allow for changing thoughts and circumstances throughout an individual's lifetime. Flexibility with regard to timing for surgery and type of rehabilitation may increase the uptake, especially for women. • Multiple offers for upper limb surgery are required throughout an individual's lifetime to account for changing thoughts and priorities. • Identification of the type of support required (informational, emotional) may assist in decreasing the time taken to make the decision about surgery. • Flexibility in surgical and rehabilitation options, especially for women, may increase the uptake of surgery.

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

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

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

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

Increasing independent decision-making skills of women with mental retardation in simulated interpersonal situations of abuse.

PubMed

Khemka, I

2000-09-01

The effectiveness of two decision-making training approaches in increasing independent decision-making skills of 36 women with mild mental retardation in response to hypothetical social interpersonal situations involving abuse was evaluated. Participants were randomly assigned to a control or one of two training conditions (a decision-making training approach that either addressed both cognitive and motivational aspects of decision-making or included only instruction on the cognitive aspect of decision-making). Although both approaches were effective relative to a control condition, the combined cognitive and motivational training approach was superior to the cognitive only training approach. The superiority of this approach was also reflected on a verbally presented generalization task requiring participants to respond to a decision-making situation involving abuse from their own perspective and on a locus of control scale that measured perceptions of control.

Shared decision-making in medication management: development of a training intervention

PubMed Central

Stead, Ute; Morant, Nicola; Ramon, Shulamit

2017-01-01

Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training. PMID:28811918

Shared decision-making in medication management: development of a training intervention.

PubMed

Stead, Ute; Morant, Nicola; Ramon, Shulamit

2017-08-01

Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

Teaching Bioethics

ERIC Educational Resources Information Center

Russo, Michael T.; Sunal, Cynthia Szymanski; Sunal, Dennis W.

2004-01-01

All citizens will make bioethics decisions as a result of today's biotechnology revolution. The decisions made require citizens to find possible acceptable solutions to dilemmas that have become public issues. In this activity, students practice making decisions in ethical dilemmas after evaluating the influences of their own ethical beliefs and…

Using National Data to Make Decisions as a Solo Librarian: A Conversation with NCES

ERIC Educational Resources Information Center

Andrews, Sandra D.

2011-01-01

School libraries have increasingly seen the number of school librarians in each school decrease, creating more solo librarian positions in schools. While this is not a new dilemma, it is one that requires initiative and persistence on the part of the school librarian to accomplish tasks and make decisions. Making decisions about individual school…

Co-Constructing Distributed Leadership: District and School Connections in Data-Driven Decision-Making

ERIC Educational Resources Information Center

Park, Vicki; Datnow, Amanda

2009-01-01

The purpose of this paper is to examine leadership practices in school systems that are implementing data-driven decision-making employing the theory of distributed leadership. With the advent of No Child Left Behind Act of 2001 (NCLB) in the US, educational leaders are now required to analyse, interpret and use data to make informed decisions in…

School-Based Management: An Approach to Decision-Making Quality in Egyptian General Secondary Schools

ERIC Educational Resources Information Center

Elmelegy, Reda Ibrahim

2015-01-01

The current research aims at clarifying how school-based management (SBM) can contribute to achieve the decision-making quality in Egyptian general secondary schools and determine the requirements of quality decision-making. It depends on the descriptive method in order to acknowledge the basics of the SBM and its relationship with the quality of…

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.

Using the Networked Fire Chief for ego-depletion research: measuring dynamic decision-making effort and performance.

PubMed

Barber, Larissa K; Smit, Brandon W

2014-01-01

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

Enhancing clinical decision making: development of a contiguous definition and conceptual framework.

PubMed

Tiffen, Jennifer; Corbridge, Susan J; Slimmer, Lynda

2014-01-01

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice. Copyright © 2014 Elsevier Inc. All rights reserved.

14 CFR § 1216.303 - NEPA process in NASA planning and decision making.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false NEPA process in NASA planning and decision... Act (NEPA) § 1216.303 NEPA process in NASA planning and decision making. (a) NEPA requires the... integration of the NEPA process with NASA project and program planning improves Agency decisions and ensures...

Iowa pavement asset management decision-making framework : [tech transfer summary].

DOT National Transportation Integrated Search

2015-10-01

A structured framework and tool that can reflect local requirements, : practices, and operational conditions would greatly assist local : agencies in making consistent and defensible pavement treatment : selection decisions.

The cerebellum and decision making under uncertainty.

PubMed

Blackwood, Nigel; Ffytche, Dominic; Simmons, Andrew; Bentall, Richard; Murray, Robin; Howard, Robert

2004-06-01

This study aimed to identify the neural basis of probabilistic reasoning, a type of inductive inference that aids decision making under conditions of uncertainty. Eight normal subjects performed two separate two-alternative-choice tasks (the balls in a bottle and personality survey tasks) while undergoing functional magnetic resonance imaging (fMRI). The experimental conditions within each task were chosen so that they differed only in their requirement to make a decision under conditions of uncertainty (probabilistic reasoning and frequency determination required) or under conditions of certainty (frequency determination required). The same visual stimuli and motor responses were used in the experimental conditions. We provide evidence that the neo-cerebellum, in conjunction with the premotor cortex, inferior parietal lobule and medial occipital cortex, mediates the probabilistic inferences that guide decision making under uncertainty. We hypothesise that the neo-cerebellum constructs internal working models of uncertain events in the external world, and that such probabilistic models subserve the predictive capacity central to induction. Copyright 2004 Elsevier B.V.

Development of a requirements management system for technical decision - making processes in the geological disposal project

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

Hiroyoshi Ueda; Katsuhiko Ishiguro; Kazumi Kitayama

2007-07-01

NUMO (Nuclear Waste Management Organization of Japan) has a responsibility for implementing geological disposal of vitrified HLW (High-Level radioactive Waste) in the Japanese nuclear waste management programme. Its staged siting procedure was initiated in 2002 by an open call for volunteer sites. Careful management strategy and methodology for the technical decision-making at every milestone are required to prepare for the volunteer site application and the site investigation stages after that. The formal Requirement Management System (RMS) is planned to support the computerized implementation of the specific management methodology, termed the NUMO Structured Approach (NSA). This planned RMS will help formore » comprehensive management of the decision-making processes in the geological disposal project, change management towards the anticipated project deviations, efficient project driving such as well programmed R and D etc. and structured record-keeping regarding the past decisions, which leads to soundness of the project in terms of the long-term continuity. The system should have handling/management functions for the database including the decisions/requirements in the project in consideration, their associated information and the structures composed of them in every decision-making process. The information relating to the premises, boundary conditions and time plan of the project should also be prepared in the system. Effective user interface and efficient operation on the in-house network are necessary. As a living system for the long-term formal use, flexibility to updating is indispensable. In advance of the formal system development, two-year activity to develop the preliminary RMS was already started. The purpose of this preliminary system is to template the decision/requirement structure, prototype the decision making management and thus show the feasibility of the innovative RMS. The paper describes the current status of the development, focusing on the initial stage including work analysis/modeling and the system conceptualization. (authors)« less

Decision-Making Competence, Social Orientation, Time Style, and Perceived Stress.

PubMed

Geisler, Martin; Allwood, Carl Martin

2018-01-01

Peoples' decision-making competence, defined as tendency to follow normative rational principles in their decision making, is important as it may influence the extent that requirements are met and levels of perceived stress. In addition, perceived stress could be influenced by social orientation and time style; for example, decisions need to comply with given deadlines and the expectations of others. In two studies, with students ( n = 118) and professionals (police investigators, n = 90), we examined how the three individual difference features: decision-making competence, social orientation, and time approach relate to perceived stress. Results showed that social orientation and time approach were related to levels of perceived stress, but decision-making competence was not. These results indicate that social orientation and time approach are important to consider in relation to perceived stress, but the role of decision-making competence may be less important for perceived stress. However, the role of decision-making competence for perceived stress needs to be further researched.

Decision-Making Competence, Social Orientation, Time Style, and Perceived Stress

PubMed Central

Geisler, Martin; Allwood, Carl Martin

2018-01-01

Peoples’ decision-making competence, defined as tendency to follow normative rational principles in their decision making, is important as it may influence the extent that requirements are met and levels of perceived stress. In addition, perceived stress could be influenced by social orientation and time style; for example, decisions need to comply with given deadlines and the expectations of others. In two studies, with students (n = 118) and professionals (police investigators, n = 90), we examined how the three individual difference features: decision-making competence, social orientation, and time approach relate to perceived stress. Results showed that social orientation and time approach were related to levels of perceived stress, but decision-making competence was not. These results indicate that social orientation and time approach are important to consider in relation to perceived stress, but the role of decision-making competence may be less important for perceived stress. However, the role of decision-making competence for perceived stress needs to be further researched. PMID:29686634

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.

Revisiting the best interest standard: uses and misuses.

PubMed

Diekema, Douglas S

2011-01-01

The best interest standard is the threshold most frequently employed by physicians and ethics consultants in challenging a parent's refusal to provide consent for a child's medical care. In this article, I will argue that the best interest standard has evolved to serve two different functions, and that these functions differ sufficiently that they require separate standards. While the best interest standard is appropriate for choosing among alternative treatment options for children, making recommendations to parents, and making decisions on behalf of a child when the legal decision makers are either unable to make a decision or are in dispute, a different standard is required for deciding when to seek state interference with parental decision-making authority. I will suggest that the harm principle provides a more appropriate threshold for determining when to seek state intervention than the best interest standard.

Evaluation and selection of decision-making methods to assess landfill mining projects.

PubMed

Hermann, Robert; Baumgartner, Rupert J; Vorbach, Stefan; Ragossnig, Arne; Pomberger, Roland

2015-09-01

For the first time in Austria, fundamental technological and economic studies on recovering secondary raw materials from large landfills have been carried out, based on the 'LAMIS - Landfill Mining Austria' pilot project. A main focus of the research - and the subject of this article - was to develop an assessment or decision-making procedure that allows landfill owners to thoroughly examine the feasibility of a landfill mining project in advance. Currently there are no standard procedures that would sufficiently cover all the multiple-criteria requirements. The basic structure of the multiple attribute decision making process was used to narrow down on selection, conceptual design and assessment of suitable procedures. Along with a breakdown into preliminary and main assessment, the entire foundation required was created, such as definitions of requirements to an assessment method, selection and accurate description of the various assessment criteria and classification of the target system for the present 'landfill mining' vs. 'retaining the landfill in after-care' decision-making problem. Based on these studies, cost-utility analysis and the analytical-hierarchy process were selected from the range of multiple attribute decision-making procedures and examined in detail. Overall, both methods have their pros and cons with regard to their use for assessing landfill mining projects. Merging these methods or connecting them with single-criteria decision-making methods (like the net present value method) may turn out to be reasonable and constitute an appropriate assessment method. © The Author(s) 2015.

A cognitive prosthesis for complex decision-making.

PubMed

Tremblay, Sébastien; Gagnon, Jean-François; Lafond, Daniel; Hodgetts, Helen M; Doiron, Maxime; Jeuniaux, Patrick P J M H

2017-01-01

While simple heuristics can be ecologically rational and effective in naturalistic decision making contexts, complex situations require analytical decision making strategies, hypothesis-testing and learning. Sub-optimal decision strategies - using simplified as opposed to analytic decision rules - have been reported in domains such as healthcare, military operational planning, and government policy making. We investigate the potential of a computational toolkit called "IMAGE" to improve decision-making by developing structural knowledge and increasing understanding of complex situations. IMAGE is tested within the context of a complex military convoy management task through (a) interactive simulations, and (b) visualization and knowledge representation capabilities. We assess the usefulness of two versions of IMAGE (desktop and immersive) compared to a baseline. Results suggest that the prosthesis helped analysts in making better decisions, but failed to increase their structural knowledge about the situation once the cognitive prosthesis is removed. Copyright © 2016 Elsevier Ltd. All rights reserved.

44 CFR 9.8 - Public notice requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for review and comment at the earliest possible time and throughout the decision-making process; and upon completion of this process, provide the public with an accounting of its final decisions (see § 9... for public involvement in the decision-making process through the provision of public notice upon...

Assessing potential future environmental legal events

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

Tonn, B.; Petrich, C.

1997-10-28

This report addresses the topic of environmental citizenship in the United States. The term refers to responsibilities each of us have with respect to helping our communities and nation make sound environmental decisions. This research centers on the citizens and what we ought to be doing, as opposed to what the government ought to be doing for us, to improve environmental citizenship. This report examines four central questions: What are the requirements (i.e., responsibilities) of citizenship vis-a-vis environmental decision- making processes; what constraints limit people`s ability to meet these requirements; what does our form of governance do to help ormore » hinder in meeting these requirements; and what recommendations can be put forth to improve public participation in environmental decision making?« less

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

PubMed Central

2012-01-01

Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making. PMID:23114289

Gunslingers, poker players, and chickens 3: Decision making under mental performance pressure in junior elite athletes.

PubMed

Parkin, Beth L; Walsh, Vincent

2017-01-01

Having investigated the decision making of world class elite and subelite athletes (see Parkin and Walsh, 2017; Parkin et al., 2017), here the abilities of those at the earliest stage of entry to elite sport are examined. Junior elite athletes have undergone initial national selection and are younger than athletes examined previously (mean age 13 years). Decision making under mental pressure is explored in this sample. During performance an athlete encounters a wide array of mental pressures; these include the psychological impact of errors, negative feedback, and requirements for sustained attention in a dynamic environment (Anshel and Wells, 2000; Mellalieu et al., 2009). Such factors increase the cognitive demands of the athletes, inducing distracting anxiety-related thoughts known as rumination (Beilock and Gray, 2007). Mental pressure has been shown to reduce performance of decision-making tasks where reward and loss contingencies are explicit, with a shift toward increased risk taking (Pabst et al., 2013; Starcke et al., 2011). Mental pressure has been shown to be detrimental to decision-making speed in comparison to physical stress, highlighting the importance of considering a range of different pressures encountered by athletes (Hepler, 2015). To investigate the influence of mental pressure on key indicators of decision making in junior elite athletes. This chapter concludes a wider project examining decision making across developmental stages in elite sport. The work further explores how psychological insights can be applied in an elite sporting environment and in particular tailored to the requirements of junior athletes. Seventeen junior elite athletes (10 males, mean age: 13.80 years) enrolled on a national youth athletic development program participated in the study. Performance across three categories of decision making was assessed under conditions of low and high mental pressure. Decision making under risk was measured via the Cambridge Gambling Task (CGT; Rogers et al., 1999), decision making under uncertainty via the Balloon Analogue Risk Task (BART; Lejuez et al., 2002), and fast reactive responses to perceptual stimuli via the Visual Search Task (Treisman, 1982). Mental pressure was induced with the addition of a concurrent verbal memory task, used to increase cognitive load and mimic the distracting effects of anxiety-related rumination. In junior elite athletes, fast reactive responses to perceptual stimuli (on the Visual Search Task) were slower under conditions of mental pressure. For decision making under risk there was an interaction of mental pressure and gender on the amount of points gambled, under pressure there was a higher level of risk taking in male athletes compared to females. There was no influence of mental pressure on decision making under uncertainity. There were no significant correlations in the degree to which individual's responses changed under pressure across the three measures of decision making. When assessing the applicability of results based on group averages there were no junior elite athletes who showed an "average" response (within 1SD of the mean) to mental pressure across all the three decision-making tasks. Mental pressure affects decision making in a sample of junior elite athletes, with a slowing of response times, and modulations to performance of decision making under risk that have a high requirement for working memory. In relation to sport, these findings suggest that novel situations that place high cognitive demands on the athlete may be particularly influenced by mental pressure. The application of this work in junior elite athletes included the feedback of individual results and the implementation of a decision-making taxonomy. © 2017 Elsevier B.V. All rights reserved.

Information in medical decision making: how consistent is our management?

PubMed

Lorence, Daniel P; Spink, Amanda; Jameson, Robert

2002-01-01

The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

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.

30 CFR 250.270 - What decisions will MMS make on the DPP or DOCD and within what timeframe?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Review and Decision Process for the Dpp Or Docd § 250.270 What decisions will MMS make... decision and may require you to meet certain conditions, including those to provide monitoring information...

Automatically updating predictive modeling workflows support decision-making in drug design.

PubMed

Muegge, Ingo; Bentzien, Jörg; Mukherjee, Prasenjit; Hughes, Robert O

2016-09-01

Using predictive models for early decision-making in drug discovery has become standard practice. We suggest that model building needs to be automated with minimum input and low technical maintenance requirements. Models perform best when tailored to answering specific compound optimization related questions. If qualitative answers are required, 2-bin classification models are preferred. Integrating predictive modeling results with structural information stimulates better decision making. For in silico models supporting rapid structure-activity relationship cycles the performance deteriorates within weeks. Frequent automated updates of predictive models ensure best predictions. Consensus between multiple modeling approaches increases the prediction confidence. Combining qualified and nonqualified data optimally uses all available information. Dose predictions provide a holistic alternative to multiple individual property predictions for reaching complex decisions.

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

The capacity of people with a 'mental disability' to make a health care decision.

PubMed

Wong, J G; Clare, C H; Holland, A J; Watson, P C; Gunn, M

2000-03-01

Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a 'mental disability' (i.e. mental illness (chronic schizophrenia), 'learning disability' ('mental retardation', or intellectual or developmental disability), or, dementia) and a fourth, comparison group. The three 'mental disability' groups (N = 20 in the 'learning disability' group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the 'general population' comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability. Compared with the 'general population' group, capacity to make the particular decision was significantly more impaired in the 'learning disability' and 'dementia' groups. Importantly, however, it was not more impaired among the 'mental illness' group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the 'mental disability' groups, one participant benefited only when responding did not require any expensive verbal ability. Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a 'mental disability'. The methodology may be extended to assess capacity to make other legally-significant decisions.

Information support for decision making on dispatching control of water distribution in irrigation

NASA Astrophysics Data System (ADS)

Yurchenko, I. F.

2018-05-01

The research has been carried out on developing the technique of supporting decision making for on-line control, operational management of water allocation for the interfarm irrigation projects basing on the analytical patterns of dispatcher control. This technique provides an increase of labour productivity as well as higher management quality due to the improved level of automation, as well as decision making optimization taking into account diagnostics of the issues, solutions classification, information being required to the decision makers.

Guardianship and End-of-Life Decision Making

PubMed Central

Cohen, Andrew B.; Wright, Megan S.; Cooney, Leo; Fried, Terri

2015-01-01

As the population ages, more adults will develop impaired decision-making capacity and have no family members or friends available to make medical decisions on their behalf. In such situations, a professional guardian is often appointed by the court. This is an official who has no pre-existing relationship with the impaired individual but is paid to serve as a surrogate decision-maker. When a professional guardian is faced with decisions concerning life-sustaining treatment, substituted judgment may be impossible, and reports have repeatedly suggested that guardians are reluctant to make the decision to limit care. Clinicians are well positioned to assist guardians with these decisions and safeguard the rights of the vulnerable persons they represent. Doing so effectively requires knowledge of the laws governing end-of-life decisions by guardians. Clinicians, however, are often uncertain about whether guardians are empowered to withhold treatment and when their decisions require judicial review. To address this issue, we analyzed state guardianship statutes and reviewed recent legal cases in order to characterize the authority of a guardian over choices about end-of-life treatment. We found that a large majority of state guardianship statutes have no language about end-of-life decisions and identified just five legal cases over the past decade that addressed a guardian’s authority over these decisions, with only one case providing a broad framework applicable to clinical practice. Work to improve end-of-life decision-making by guardians may benefit from a multi-disciplinary effort to develop comprehensive standards that can guide clinicians and guardians when treatment decisions need to be made. PMID:26258634

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

12 CFR 614.4255 - Independence requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... collateral supporting a loan shall subsequently participate in any decision related to the loan purchase. ... approve a loan decision on which such person performed a collateral evaluation; or (3) As a director... required to make a credit decision. (b) Officers and employees. If the institution's internal control...

Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting.

PubMed

Brogan, Paula; Hasson, Felicity; McIlfatrick, Sonja

2018-01-01

Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. Qualitative design using focus groups, transcribed verbatim and analysed thematically. A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited. While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making. Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.

Structuring Disaster Recovery Infrastructure Decisions: Lessons from Boulder County's 2013 Flood Recovery

NASA Astrophysics Data System (ADS)

Clavin, C.; Petropoulos, Z.

2017-12-01

Recovery phase decision making processes, as compared to mitigation and response phase decision making processes, require communities make significant financial and capital decisions in the months after a disaster. Collectively, these investments may significantly contribute to the resilience of a community to future hazards. Pre-disaster administrative decisions are well-established within existing planning processes. Post-event recovery requires community decision makers to quickly evaluate technical proposals and manage significant recovery financial resources to ensure their community rebuilds in a manner that will be more resilient to future events. These technical and administrative hurdles in the aftermath of a disaster create a challenging atmosphere to make sound, scientifically-informed decisions leading to resilient recovery. In September 2013, a 1,000-year rain event that resulted in flooding throughout the Front Range of Colorado, significantly impacting Boulder County. While the event is long past, disaster recovery efforts still continue in parts of Boulder County. Boulder County officials formed a county collaborative that adapted the NIST Community Resilience Planning Guide for Buildings and Infrastructure Systems to facilitate a goals-based multi-criteria decision making process. Rather than use hazard-based information to guide infrastructure design, the county's decision process established time-to-recovery goals for infrastructure systems that were used as criteria for project design. This presentation explores the decision-making process employed by Boulder County to specify design standards for resilient rebuilding of infrastructure systems and examine how this infrastructure planning model could be extrapolated to other situations where there is uncertainty regarding future infrastructure design standards.

Bridging the gap between science and decision making.

PubMed

von Winterfeldt, Detlof

2013-08-20

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

Bridging the gap between science and decision making

PubMed Central

von Winterfeldt, Detlof

2013-01-01

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

What you don't know about making decisions.

PubMed

Garvin, D A; Roberto, M A

2001-09-01

Most executives think of decision making as a singular event that occurs at a particular point in time. In reality, though, decision making is a process fraught with power plays, politics, personal nuances, and institutional history. Leaders who recognize this make far better decisions than those who persevere in the fantasy that decisions are events they alone control. That said, some decision-making processes are far more effective than others. Most often, participants use an advocacy process, possibly the least productive way to get things done. They view decision making as a contest, arguing passionately for their preferred solutions, presenting information selectively, withholding relevant conflicting data so they can make a convincing case, and standing firm against opposition. Much more powerful is an inquiry process, in which people consider a variety of options and work together to discover the best solution. Moving from advocacy to inquiry requires careful attention to three critical factors: fostering constructive, rather than personal, conflict; making sure everyone knows that their viewpoints are given serious consideration even if they are not ultimately accepted; and knowing when to bring deliberations to a close. The authors discuss in detail strategies for moving from an advocacy to an inquiry process, as well as for fostering productive conflict, true consideration, and timely closure. And they offer a framework for assessing the effectiveness of your process while you're still in the middle of it. Decision making is a job that lies at the very heart of leadership and one that requires a genius for balance: the ability to embrace the divergence that may characterize early discussions and to forge the unity needed for effective implementation.

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.

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.

How Expert Pilots Think Cognitive Processes in Expert Decision Making

DTIC Science & Technology

1993-02-01

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

Neural Correlates of Sequence Learning with Stochastic Feedback

ERIC Educational Resources Information Center

Averbeck, Bruno B.; Kilner, James; Frith, Christopher D.

2011-01-01

Although much is known about decision making under uncertainty when only a single step is required in the decision process, less is known about sequential decision making. We carried out a stochastic sequence learning task in which subjects had to use noisy feedback to learn sequences of button presses. We compared flat and hierarchical behavioral…

So You Want to Link Your State Data

DOT National Transportation Integrated Search

1996-07-01

This technical report discusses the advantages of linking state accident and : medical data to enhance decision making on highway safety and injury control : activities. Such data linkage for decision making support requires a systematic : approach t...

Distinct roles of dopamine and subthalamic nucleus in learning and probabilistic decision making.

PubMed

Coulthard, Elizabeth J; Bogacz, Rafal; Javed, Shazia; Mooney, Lucy K; Murphy, Gillian; Keeley, Sophie; Whone, Alan L

2012-12-01

Even simple behaviour requires us to make decisions based on combining multiple pieces of learned and new information. Making such decisions requires both learning the optimal response to each given stimulus as well as combining probabilistic information from multiple stimuli before selecting a response. Computational theories of decision making predict that learning individual stimulus-response associations and rapid combination of information from multiple stimuli are dependent on different components of basal ganglia circuitry. In particular, learning and retention of memory, required for optimal response choice, are significantly reliant on dopamine, whereas integrating information probabilistically is critically dependent upon functioning of the glutamatergic subthalamic nucleus (computing the 'normalization term' in Bayes' theorem). Here, we test these theories by investigating 22 patients with Parkinson's disease either treated with deep brain stimulation to the subthalamic nucleus and dopaminergic therapy or managed with dopaminergic therapy alone. We use computerized tasks that probe three cognitive functions-information acquisition (learning), memory over a delay and information integration when multiple pieces of sequentially presented information have to be combined. Patients performed the tasks ON or OFF deep brain stimulation and/or ON or OFF dopaminergic therapy. Consistent with the computational theories, we show that stopping dopaminergic therapy impairs memory for probabilistic information over a delay, whereas deep brain stimulation to the region of the subthalamic nucleus disrupts decision making when multiple pieces of acquired information must be combined. Furthermore, we found that when participants needed to update their decision on the basis of the last piece of information presented in the decision-making task, patients with deep brain stimulation of the subthalamic nucleus region did not slow down appropriately to revise their plan, a pattern of behaviour that mirrors the impulsivity described clinically in some patients with subthalamic nucleus deep brain stimulation. Thus, we demonstrate distinct mechanisms for two important facets of human decision making: first, a role for dopamine in memory consolidation, and second, the critical importance of the subthalamic nucleus in successful decision making when multiple pieces of information must be combined.

Effects of Gain/Loss Framing in Cyber Defense Decision-Making

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

Bos, Nathan; Paul, Celeste; Gersh, John

Cyber defense requires decision making under uncertainty. Yet this critical area has not been a strong focus of research in judgment and decision-making. Future defense systems, which will rely on software-defined networks and may employ ‘moving target’ defenses, will increasingly automate lower level detection and analysis, but will still require humans in the loop for higher level judgment. We studied the decision making process and outcomes of 17 experienced network defense professionals who worked through a set of realistic network defense scenarios. We manipulated gain versus loss framing in a cyber defense scenario, and found significant effects in one ofmore » two focal problems. Defenders that began with a network already in quarantine (gain framing) used a quarantine system more than those that did not (loss framing). We also found some difference in perceived workload and efficacy. Alternate explanations of these findings and implications for network defense are discussed.« less

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments

PubMed Central

2013-01-01

Background Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. Methods This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration’s review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. Results The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Conclusions Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness. PMID:24625035

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments.

PubMed

Sepucha, Karen R; Borkhoff, Cornelia M; Lally, Joanne; Levin, Carrie A; Matlock, Daniel D; Ng, Chirk Jenn; Ropka, Mary E; Stacey, Dawn; Joseph-Williams, Natalie; Wills, Celia E; Thomson, Richard

2013-01-01

Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration's review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.

[A model for shared decision-making with frail older patients: consensus reached using Delphi technique].

PubMed

van de Pol, M H J; Fluit, C R M G; Lagro, J; Lagro-Janssen, A L M; Olde Rikkert, M G M

2017-01-01

To develop a model for shared decision-making with frail older patients. Online Delphi forum. We used a three-round Delphi technique to reach consensus on the structure of a model for shared decision-making with older patients. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the panel of experts was asked about important steps in the process of shared decision-making and the draft model was introduced. Rounds 2 and 3 were used to adapt the model and test it for 'importance' and 'feasibility'. Consensus for the dynamic shared decision-making model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). Shared decision-making with older patients is a dynamic process. It requires a continuous supportive dialogue between health care professional and patient.

Communicating with the coroner: how religion, culture, and family concerns may influence autopsy decision making.

PubMed

Carpenter, Belinda; Adkins, Glenda; Barnes, Michael; Naylor, Charles; Begum, Nelufa

2011-04-01

Based on coronial data gathered in the state of Queensland in 2004, this article reviews how a change in legislation may have impacted autopsy decision making by coroners. More specifically, the authors evaluated whether the requirement that coronial autopsy orders specify the level of invasiveness of an autopsy to be performed by a pathologist was affected by the further requirement that coroners take into consideration a known religion, culture, and/or raised family concern before making such an order. Preliminary data reveal that the cultural status of the deceased did not affect coronial autopsy decision making. However, a known religion with a proscription against autopsy and a raised family concern appeared to be taken into account by coroners when making autopsy decisions and tended to decrease the invasiveness of the autopsy ordered from a full internal examination to either a partial internal examination or an external-only examination of the body. The impact of these findings is briefly discussed.

An intelligent, knowledge-based multiple criteria decision making advisor for systems design

NASA Astrophysics Data System (ADS)

Li, Yongchang

In systems engineering, design and operation of systems are two main problems which always attract researcher's attentions. The accomplishment of activities in these problems often requires proper decisions to be made so that the desired goal can be achieved, thus, decision making needs to be carefully fulfilled in the design and operation of systems. Design is a decision making process which permeates through out the design process, and is at the core of all design activities. In modern aircraft design, more and more attention is paid to the conceptual and preliminary design phases so as to increase the odds of choosing a design that will ultimately be successful at the completion of the design process, therefore, decisions made during these early design stages play a critical role in determining the success of a design. Since aerospace systems are complex systems with interacting disciplines and technologies, the Decision Makers (DMs) dealing with such design problems are involved in balancing the multiple, potentially conflicting attributes/criteria, transforming a large amount of customer supplied guidelines into a solidly defined set of requirement definitions. Thus, one could state with confidence that modern aerospace system design is a Multiple Criteria Decision Making (MCDM) process. A variety of existing decision making methods are available to deal with this type of decision problems. The selection of the most appropriate decision making method is of particular importance since inappropriate decision methods are likely causes of misleading engineering design decisions. With no sufficient knowledge about each of the methods, it is usually difficult for the DMs to find an appropriate analytical model capable of solving their problems. In addition, with the complexity of the decision problem and the demand for more capable methods increasing, new decision making methods are emerging with time. These various methods exacerbate the difficulty of the selection of an appropriate decision making method. Furthermore, some DMs may be exclusively using one or two specific methods which they are familiar with or trust and not realizing that they may be inappropriate to handle certain classes of the problems, thus yielding erroneous results. These issues reveal that in order to ensure a good decision a suitable decision method should be chosen before the decision making process proceeds. The first part of this dissertation proposes an MCDM process supported by an intelligent, knowledge-based advisor system referred to as Multi-Criteria Interactive Decision-Making Advisor and Synthesis process (MIDAS), which is able to facilitate the selection of the most appropriate decision making method and which provides insight to the user for fulfilling different preferences. The second part of this dissertation presents an autonomous decision making advisor which is capable of dealing with ever-evolving real time information and making autonomous decisions under uncertain conditions. The advisor encompasses a Markov Decision Process (MDP) formulation which takes uncertainty into account when determines the best action for each system state. (Abstract shortened by UMI.)

A synthesis of drug reimbursement decision-making processes in organisation for economic co-operation and development countries.

PubMed

Barnieh, Lianne; Manns, Braden; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Clement, Fiona

2014-01-01

The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures. To describe the processes in drug reimbursement decision-making systems currently used in national publicly funded outpatient prescription drug insurance plans. By using the Organisation for Economic Co-operation and Development (OECD) nations as the sampling frame, a search was done in the published literature, followed by the gray literature. Collected data were verified by a system expert within the prescription drug insurance plan in each country to ensure the accuracy of key data elements across countries. All but one country provided at least one publicly funded prescription drug formulary. Many systems have adopted similar processes of drug reimbursement decision making. All but three systems required additional consideration of clinical evidence within the decision-making process. Transparency of recommendations varied between systems, from having no information publicly available (three systems) to all information available and accessible to the public (16 systems). Only four countries did not consider cost within the drug reimbursement decision-making process. There were similarities in the decision-making process for drug reimbursement across the systems; however, only five countries met the highest standard of transparency, requirement of evidence, and ability to appeal. Future work should focus on examining how these processes may affect formulary listing decisions for drugs between countries. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Cognitive processes in anesthesiology decision making.

PubMed

Stiegler, Marjorie Podraza; Tung, Avery

2014-01-01

The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

The United Nations Convention on the Rights of Persons with Disabilities: a new approach to decision-making in mental health law.

PubMed

Morrissey, Fiona

2012-12-01

The UN Convention on the Rights of Persons with Disabilities (CRPD) requires us to engage in new approaches to decision-making in mental health law. The reclassification of mental health rights to the realm of disability rights is an important step towards equal treatment for persons with psychosocial disabilities. Law reformers worldwide are beginning to consider the implications of the provisions. Legislators will be required to understand the underlying philosophy of the CRPD to realise the rights set out in it. The CRPD possesses a number of innovative provisions which can transform decision-making in the mental health context. Article 12 provides a new conceptualisation of persons with disabilities and their capacity to participate by requiring support to exercise legal capacity. While good practice exists, the provision has yet to be fully implemented by many State Parties. This article discusses the impact of the CRPD on mental health law, legal capacity law and describes examples of supported decision-making models for mental health care.

Who decides? The decision-making process of juvenile judges concerning minors with mental disorders.

PubMed

Cappon, Leen

2016-01-01

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

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

PubMed Central

2017-01-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

Outbreak Column 16: Cognitive errors in outbreak decision making.

PubMed

Curran, Evonne T

2015-01-01

During outbreaks, decisions must be made without all the required information. People, including infection prevention and control teams (IPCTs), who have to make decisions during uncertainty use heuristics to fill the missing data gaps. Heuristics are mental model short cuts that by-and-large enable us to make good decisions quickly. However, these heuristics contain biases and effects that at times lead to cognitive (thinking) errors. These cognitive errors are not made to deliberately misrepresent any given situation; we are subject to heuristic biases when we are trying to perform optimally. The science of decision making is large; there are over 100 different biases recognised and described. Outbreak Column 16 discusses and relates these heuristics and biases to decision making during outbreak prevention, preparedness and management. Insights as to how we might recognise and avoid them are offered.

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

PubMed

Nantha, Yogarabindranath Swarna

2017-11-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

The Wisdom of Tacit Knowing-in-Action and Mission Command

ERIC Educational Resources Information Center

Moilanen, Jon H.

2015-01-01

Adult learners regularly confront complex and dynamic challenges in moments of crisis that require self-efficacy of intuition and immediate decision. Such "snap decision-making" requires highly developed critical thinking skills to effectively operate in the midst of chaos. This decisiveness is particularly challenging in the military…

75 FR 16895 - Reports, Forms and Record Keeping Requirements; Agency Information Collection Activity Under OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

...., treadwear) in making their purchase decisions. Description of the Need for the Information and Use of the...), safety (i.e., wet traction), and durability (i.e., treadwear) in making their purchase decisions...

Dissociated neural processing for decisions in managers and non-managers.

PubMed

Caspers, Svenja; Heim, Stefan; Lucas, Marc G; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing.

Dissociated Neural Processing for Decisions in Managers and Non-Managers

PubMed Central

Caspers, Svenja; Heim, Stefan; Lucas, Marc G.; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing. PMID:22927984

Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands.

PubMed

Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris

2013-01-01

Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

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.

21 CFR 111.140 - Under this subpart F, what records must you make and keep?

Code of Federal Regulations, 2010 CFR

2010-04-01

... and making a disposition decision and written procedures for approving or rejecting any reprocessing... perform the quality control operation, who conducted the material review and made the disposition decision... System: Requirements for Quality Control § 111.140 Under this subpart F, what records must you make and...

Due Process and Higher Education: A Systemic Approach to Fair Decision Making. ERIC Digest.

ERIC Educational Resources Information Center

Stevens, Ed

University officials and faculty are frequently required to make decisions based on interpretations of disputed facts. By applying the concept of due process within the context of higher education, they can meet legal challenges of contract and constitutional law and the pedagogical demand for justice. To guide their efforts, decision makers can…

Separating Wheat from Chaff: How Secondary School Principals' Core Values and Beliefs Influence Decision-Making Related to Mandates

ERIC Educational Resources Information Center

Larsen, Donald E.; Hunter, Joseph E.

2014-01-01

Research conducted by Larsen and Hunter (2013, February) identified a clear pattern in secondary school principals' decision-making related to mandated change: more than half of participants' decisions were based on core values and beliefs, requiring value judgments. Analysis of themes revealed that more than half of administrative decisions…

Application of Grey Relational Analysis to Decision-Making during Product Development

ERIC Educational Resources Information Center

Hsiao, Shih-Wen; Lin, Hsin-Hung; Ko, Ya-Chuan

2017-01-01

A multi-attribute decision-making (MADM) approach was proposed in this study as a prediction method that differs from the conventional production and design methods for a product. When a client has different dimensional requirements, this approach can quickly provide a company with design decisions for each product. The production factors of a…

Decision-making process of prenatal screening described by pregnant women and their partners.

PubMed

Wätterbjörk, Inger; Blomberg, Karin; Nilsson, Kerstin; Sahlberg-Blom, Eva

2015-10-01

Pregnant women are often faced with having to decide about prenatal screening for Down's syndrome. However, the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners. The aim of this study was to explore the couples' processes of decision making about prenatal screening. A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description. The study was carried out in Maternal health-care centres, Örebro County Council, Sweden. Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed. Three different patterns of decision making were identified. For the couples in 'The open and communicative decision-making process', the process was straightforward and rational, and the couples discussed the decision with each other. 'The closed and personal decision-making process' showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing 'The searching and communicative decision-making process' followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result. The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration. © 2013 John Wiley & Sons Ltd.

Training for Aviation Decision Making: The Naturalistic Decision Making Perspective

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

This paper describes the implications of a naturalistic decision making (NDM) perspective for training air crews to make flight-related decisions. The implications are based on two types of analyses: (a) identification of distinctive features that serve as a basis for classifying a diverse set of decision events actually encountered by flight crews, and (b) performance strategies that distinguished more from less effective crews flying full-mission simulators, as well as performance analyses from NTSB accident investigations. Six training recommendations are offered: (1) Because of the diversity of decision situations, crews need to be aware that different strategies may be appropriate for different problems; (2) Given that situation assessment is essential to making a good decision, it is important to train specific content knowledge needed to recognize critical conditions, to assess risks and available time, and to develop strategies to verify or diagnose the problem; (3) Tendencies to oversimplify problems may be overcome by training to evaluate options in terms of goals, constraints, consequences, and prevailing conditions; (4) In order to provide the time to gather information and consider options, it is essential to manage the situation, which includes managing crew workload, prioritizing tasks, contingency planning, buying time (e.g., requesting holding or vectors), and using low workload periods to prepare for high workload; (5) Evaluating resource requirements ("What do I need?") and capabilities ("'What do I have?" ) are essential to making good decisions. Using resources to meet requirements may involve the cabin crew, ATC, dispatchers, and maintenance personnel; (6) Given that decisions must often be made under high risk, time pressure, and workload, train under realistic flight conditions to promote the development of robust decision skills.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

PubMed Central

Whitney, Paul; Hinson, John M.; Jackson, Melinda L.; Van Dongen, Hans P.A.

2015-01-01

Study Objectives: To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Design: Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Setting: Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Subjects: Twenty-six subjects (22–40 y of age; 10 women). Interventions: Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Results: Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Conclusions: Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. Citation: Whitney P, Hinson JM, Jackson ML, Van Dongen HPA. Feedback blunting: total sleep deprivation impairs decision making that requires updating based on feedback. SLEEP 2015;38(5):745–754. PMID:25515105

System Sketch: A Visualization Tool to Improve Community Decision Making

EPA Science Inventory

Making decisions in coastal and estuarine management requires a comprehensive understanding of the linkages between environmental, social, and economic systems. SystemSketch is a web-based scoping tool designed to assist resource managers in characterizing their systems, explorin...

U.S. Offshore Wind Port Readiness

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

C. Elkinton, A. Blatiak, H. Ameen

2013-10-13

This study will aid decision-makers in making informed decisions regarding the choice of ports for specific offshore projects, and the types of investments that would be required to make individual port facilities suitable to serve offshore wind manufacturing, installation and/or operations.

Patients' Values in Clinical Decision-Making.

PubMed

Faggion, Clovis Mariano; Pachur, Thorsten; Giannakopoulos, Nikolaos Nikitas

2017-09-01

Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

Health decision making: lynchpin of evidence-based practice.

PubMed

Spring, Bonnie

2008-01-01

Health decision making is both the lynchpin and the least developed aspect of evidence-based practice. The evidence-based practice process requires integrating the evidence with consideration of practical resources and patient preferences and doing so via a process that is genuinely collaborative. Yet, the literature is largely silent about how to accomplish integrative, shared decision making. for evidence-based practice are discussed for 2 theories of clinician decision making (expected utility and fuzzy trace) and 2 theories of patient health decision making (transtheoretical model and reasoned action). Three suggestions are offered. First, it would be advantageous to have theory-based algorithms that weight and integrate the 3 data strands (evidence, resources, preferences) in different decisional contexts. Second, patients, not providers, make the decisions of greatest impact on public health, and those decisions are behavioral. Consequently, theory explicating how provider-patient collaboration can influence patient lifestyle decisions made miles from the provider's office is greatly needed. Third, although the preponderance of data on complex decisions supports a computational approach, such an approach to evidence-based practice is too impractical to be widely applied at present. More troublesomely, until patients come to trust decisions made computationally more than they trust their providers' intuitions, patient adherence will remain problematic. A good theory of integrative, collaborative health decision making remains needed.

Health Decision Making: Lynchpin of Evidence-Based Practice

PubMed Central

Spring, Bonnie

2008-01-01

Health decision making is both the lynchpin and the least developed aspect of evidence-based practice. The evidence-based practice process requires integrating the evidence with consideration of practical resources and patient preferences and doing so via a process that is genuinely collaborative. Yet, the literature is largely silent about how to accomplish integrative, shared decision making. Implications for evidence-based practice are discussed for 2 theories of clinician decision making (expected utility and fuzzy trace) and 2 theories of patient health decision making (transtheoretical model and reasoned action). Three suggestions are offered. First, it would be advantageous to have theory-based algorithms that weight and integrate the 3 data strands (evidence, resources, preferences) in different decisional contexts. Second, patients, not providers, make the decisions of greatest impact on public health, and those decisions are behavioral. Consequently, theory explicating how provider-patient collaboration can influence patient lifestyle decisions made miles from the provider's office is greatly needed. Third, although the preponderance of data on complex decisions supports a computational approach, such an approach to evidence-based practice is too impractical to be widely applied at present. More troublesomely, until patients come to trust decisions made computationally more than they trust their providers’ intuitions, patient adherence will remain problematic. A good theory of integrative, collaborative health decision making remains needed. PMID:19015288

On Decision-Making Among Multiple Rule-Bases in Fuzzy Control Systems

NASA Technical Reports Server (NTRS)

Tunstel, Edward; Jamshidi, Mo

1997-01-01

Intelligent control of complex multi-variable systems can be a challenge for single fuzzy rule-based controllers. This class of problems cam often be managed with less difficulty by distributing intelligent decision-making amongst a collection of rule-bases. Such an approach requires that a mechanism be chosen to ensure goal-oriented interaction between the multiple rule-bases. In this paper, a hierarchical rule-based approach is described. Decision-making mechanisms based on generalized concepts from single-rule-based fuzzy control are described. Finally, the effects of different aggregation operators on multi-rule-base decision-making are examined in a navigation control problem for mobile robots.

Patient Decision Control and the Use of Cardiac Catheterization

PubMed Central

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

2015-01-01

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

Biased and unbiased perceptual decision-making on vocal emotions.

PubMed

Dricu, Mihai; Ceravolo, Leonardo; Grandjean, Didier; Frühholz, Sascha

2017-11-24

Perceptual decision-making on emotions involves gathering sensory information about the affective state of another person and forming a decision on the likelihood of a particular state. These perceptual decisions can be of varying complexity as determined by different contexts. We used functional magnetic resonance imaging and a region of interest approach to investigate the brain activation and functional connectivity behind two forms of perceptual decision-making. More complex unbiased decisions on affective voices recruited an extended bilateral network consisting of the posterior inferior frontal cortex, the orbitofrontal cortex, the amygdala, and voice-sensitive areas in the auditory cortex. Less complex biased decisions on affective voices distinctly recruited the right mid inferior frontal cortex, pointing to a functional distinction in this region following decisional requirements. Furthermore, task-induced neural connectivity revealed stronger connections between these frontal, auditory, and limbic regions during unbiased relative to biased decision-making on affective voices. Together, the data shows that different types of perceptual decision-making on auditory emotions have distinct patterns of activations and functional coupling that follow the decisional strategies and cognitive mechanisms involved during these perceptual decisions.

RADC (Rome Air Development Center) System/Software Requirements Engineering Testbed Research and Development Program

DTIC Science & Technology

1988-06-01

analyze requirements to investigate assumptions, decisions , irplications, and requirements quality: (1) expected cost and risk of developing the...the requirements Including the rationale and Implications of decisions that were made. Tool Integration and Evaluation In the Integration and...ly. Instead of stating his needs and making decisions at the mission level, the user is forced to work at a design level or use the English language

South Huntington's Evolution to Shared Decision Making.

ERIC Educational Resources Information Center

Domenech, Daniel A.

School administrative decisions must be based on a broad range of input; the power of group thinking is required to ensure that the best decisions are made. The necessary transition from the old, closed autocratic administrative decisionmaking system to a new, open democratic organization requires not a radical leap, but a gradual transition. The…

25 CFR 517.4 - Requirements for making requests.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INFORMATION ACT PROCEDURES § 517.4 Requirements for making requests. (a) How to make a FOIA request. Requests... additional information. If the requester is making a request for records about another individual, the..., the requester will be notified of this decision and advised that fees associated with the processing...

Take the first heuristic, self-efficacy, and decision-making in sport.

PubMed

Hepler, Teri J; Feltz, Deborah L

2012-06-01

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 students (N = 72) participated in the study and performed 13 trials in each of two video-based basketball decision tasks. One task required participants to verbally generate options before making a final decision on what to do next, while the other task simply asked participants to make a decision regarding the next move as quickly as possible. Decision-making self-efficacy was assessed using a 10-item questionnaire comprising various aspects of decision-making in basketball. Participants also rated their confidence in the final decision. Results supported many of the tenets of the TTF heuristic, such that people used the heuristic on a majority of the trials (70%), earlier generated options were better than later ones, first options were meaningfully generated, and final options were meaningfully selected. Results did not support differences in dynamic inconsistency or decision confidence based on the number of options. Findings also supported the link between self-efficacy and the TTF heuristic. Participants with higher self-efficacy beliefs used TTF more frequently and generated fewer options than those with low self-efficacy. Thus, not only is TTF an important heuristic when making decisions in dynamic, time-pressure situations, but self-efficacy plays an influential role in TTF.

Neurophysiology and Rationality in Political Thinking.

ERIC Educational Resources Information Center

Peterson, Steven A.

Research both in cognitive psychology and psychobiology suggests that political behavior is often less rational than individuals believe it to be. Information processing, memory, and decision making are interlinked processes. Studies in cognitive psychology reveal that even though decision making requires rationality, individuals often adopt…

The Role of Patients: Shared Decision-Making.

PubMed

Beers, Emily; Lee Nilsen, Marci; Johnson, Jonas T

2017-08-01

Shared decision-making affords patients and their families the autonomy to make difficult decisions after receiving comprehensive information about medical facts and treatment options. It is essential that patients' values are respected. The essential steps include first informing patients of the need for a decision, then explaining the various facts involved; after which, it is important to elicit patients' preferences and goals. Once the treatment options and outcomes important to patients are identified, an actual decision can be made. This activity is complex and requires a commitment of time and is enhanced through employment of a multidisciplinary team approach. Copyright © 2017 Elsevier Inc. All rights reserved.

Deciding together? Best interests and shared decision-making in paediatric intensive care.

PubMed

Birchley, Giles

2014-09-01

In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child's best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child's interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential, should no such advantages be demonstrable we have cause to revise our commitment to either shared decision making or the paramountcy of the child in these circumstances.

A Framework to Determine New System Requirements Under Design Parameter and Demand Uncertainties

DTIC Science & Technology

2015-04-30

relegates quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the...quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the approach...play a critical role in determining new system requirements. Scope and Method of Approach The early stages of the design process have substantial

36 CFR 1250.26 - How quickly will NARA respond to my FOIA request?

Code of Federal Regulations, 2010 CFR

2010-07-01

... making a decision within 20 working days, we will inform you in writing how long it will take us to... requesters of any complexity in processing their request, which may lengthen the time required to reach a final decision on the release of the records. (b) In most cases, NARA will make a decision on the...

30 CFR 550.270 - What decisions will BOEM make on the DPP or DOCD and within what timeframe?

Code of Federal Regulations, 2014 CFR

2014-07-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Review and Decision Process for the Dpp Or Docd § 550.270 What decisions... provide monitoring information. (2) Require you to modify your proposed DPP or DOCD, It fails to make...

A mechanism for value-sensitive decision-making.

PubMed

Pais, Darren; Hogan, Patrick M; Schlegel, Thomas; Franks, Nigel R; Leonard, Naomi E; Marshall, James A R

2013-01-01

We present a dynamical systems analysis of a decision-making mechanism inspired by collective choice in house-hunting honeybee swarms, revealing the crucial role of cross-inhibitory 'stop-signalling' in improving the decision-making capabilities. We show that strength of cross-inhibition is a decision-parameter influencing how decisions depend both on the difference in value and on the mean value of the alternatives; this is in contrast to many previous mechanistic models of decision-making, which are typically sensitive to decision accuracy rather than the value of the option chosen. The strength of cross-inhibition determines when deadlock over similarly valued alternatives is maintained or broken, as a function of the mean value; thus, changes in cross-inhibition strength allow adaptive time-dependent decision-making strategies. Cross-inhibition also tunes the minimum difference between alternatives required for reliable discrimination, in a manner similar to Weber's law of just-noticeable difference. Finally, cross-inhibition tunes the speed-accuracy trade-off realised when differences in the values of the alternatives are sufficiently large to matter. We propose that the model, and the significant role of the values of the alternatives, may describe other decision-making systems, including intracellular regulatory circuits, and simple neural circuits, and may provide guidance in the design of decision-making algorithms for artificial systems, particularly those functioning without centralised control.

40 CFR 1054.255 - What decisions may EPA make regarding my certificate of conformity?

Code of Federal Regulations, 2010 CFR

2010-07-01

...-IGNITION ENGINES AND EQUIPMENT Certifying Emission Families § 1054.255 What decisions may EPA make... emission family meets all the requirements of this part and the Clean Air Act, we will issue a certificate of conformity for your emission family for that model year. We may make the approval subject to...

The Minimal Control Principle Predicts Strategy Shifts in the Abstract Decision Making Task

ERIC Educational Resources Information Center

Taatgen, Niels A.

2011-01-01

The minimal control principle (Taatgen, 2007) predicts that people strive for problem-solving strategies that require as few internal control states as possible. In an experiment with the Abstract Decision Making task (ADM task; Joslyn & Hunt, 1998) the reward structure was manipulated to make either a low-control strategy or a high-strategy…

'My kidneys, my choice, decision aid': supporting shared decision making.

PubMed

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

2015-06-01

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

Memory-based decision-making with heuristics: evidence for a controlled activation of memory representations.

PubMed

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

2011-11-01

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

Rational decision-making about treatment and care in dementia: a contradiction in terms?

PubMed

Wolfs, Claire A G; de Vugt, Marjolein E; Verkaaik, Mike; Haufe, Marc; Verkade, Paul-Jeroen; Verhey, Frans R J; Stevens, Fred

2012-04-01

To gain caregivers' insights into the decision-making process in dementia patients with regard to treatment and care. Four focus group interviews (n=29). The decision-making process consists of three elementary components: (1) identifying an individual's needs; (2) exploring options; and (3) making a choice. The most important phase is the exploration phase as it is crucial for the acceptance of the disease. Furthermore, the decision is experienced more as an emotional choice than a rational one. It is influenced by personal preferences whereas practical aspects do not seem to play a substantial role. Several aspects make decision-making in dementia different from decision-making in the context of other chronic diseases: (1) the difficulty accepting dementia; (2) the progressive nature of dementia; (3) patient's reliance on surrogate decision-making; and (4) strong emotions. Due to these aspects, the decision-making process is very time-consuming, especially the crucial exploration phase. A more active role is required of both the caregiver and the health care professional especially in the exploration phase, enabling easier acceptance and adjustment to the disease. Acceptance is an important condition for reducing anxiety and resistance to care that may offer significant benefits in the future. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

A Decision Support System for effective use of probability forecasts

NASA Astrophysics Data System (ADS)

De Kleermaeker, Simone; Verkade, Jan

2013-04-01

Often, water management decisions are based on hydrological forecasts. These forecasts, however, are affected by inherent uncertainties. It is increasingly common for forecasting agencies to make explicit estimates of these uncertainties and thus produce probabilistic forecasts. Associated benefits include the decision makers' increased awareness of forecasting uncertainties and the potential for risk-based decision-making. Also, a stricter separation of responsibilities between forecasters and decision maker can be made. However, simply having probabilistic forecasts available is not sufficient to realise the associated benefits. Additional effort is required in areas such as forecast visualisation and communication, decision making in uncertainty and forecast verification. Also, revised separation of responsibilities requires a shift in institutional arrangements and responsibilities. A recent study identified a number of additional issues related to the effective use of probability forecasts. When moving from deterministic to probability forecasting, a dimension is added to an already multi-dimensional problem; this makes it increasingly difficult for forecast users to extract relevant information from a forecast. A second issue is that while probability forecasts provide a necessary ingredient for risk-based decision making, other ingredients may not be present. For example, in many cases no estimates of flood damage, of costs of management measures and of damage reduction are available. This paper presents the results of the study, including some suggestions for resolving these issues and the integration of those solutions in a prototype decision support system (DSS). A pathway for further development of the DSS is outlined.

The roles of the anterior cingulate cortex and its dopamine receptors in self-paced cost-benefit decision making in rats.

PubMed

Wang, Shuai; Hu, Shan-Hu; Shi, Yi; Li, Bao-Ming

2017-03-01

It has been shown that the anterior cingulate cortex (ACC) and its dopamine system are crucial for decision making that requires physical/emotional effort, but not for all forms of cost-benefit decision making. Previous studies had mostly employed behavioral tasks with two competing cost-reward options that were preset by the experimenters. However, few studies have been conducted using scenarios in which the subjects have full control over the energy/time expenditure required to obtain a proportional reward. Here, we assessed the roles of the ACC and its dopamine system in cost-benefit decision making by utilizing a "do more get more" (DMGM) task and a time-reward trade-off (TRTO) task, wherein the animals were able to self-determine how much effort or time to expend at a nosepoke operandum for a proportional reward. Our results showed that (1) ACC inactivation severely impaired DMGM task performance, with a reduction in the rate of correct responses and a decrease in the effort expended, but did not affect the TRTO task; and (2) blocking ACC D2 receptors had no impact on DMGM task performance in the baseline cost-benefit scenario, but it significantly reduced the attempts to invest increased effort for a large reward when the benefit-cost ratio was reduced by half. In contrast, blocking ACC D1 receptors had no effect on DMGM task performance. These findings suggest that the ACC is required for self-paced effort-based but not for time-reward trade-off decision making. Furthermore, ACC dopamine D2 but not D1 receptors are involved in DMGM decision making.

Spillover Effects of Loss of Control on Risky Decision-Making

PubMed Central

Beisswingert, Birgit M.; Zhang, Keshun; Goetz, Thomas; Fischbacher, Urs

2016-01-01

Decision making in risky situations is frequently required in our everyday lives and has been shown to be influenced by various factors, some of which are independent of the risk context. Based on previous findings and theories about the central role of perceptions of control and their impact on subsequent settings, spillover effects of subjective loss of control on risky decision-making are assumed. After developing an innovative experimental paradigm for inducing loss of control, its hypothesized effects on risky decision-making are investigated. Partially supporting the hypotheses, results demonstrated no increased levels of risk perceptions but decreased risk-taking behavior following experiences of loss of control. Thus, this study makes a methodological contribution by proposing a newly developed experimental paradigm facilitating further research on the effects of subjective loss of control, and additionally provides partial evidence for the spillover effects of loss of control experiences on risky decision-making. PMID:26930066

The Monsoon-90 / SALSA / EOS / SUDMED / SAHRA / HELP / USPP Experience: A Progression of Interdisciplinary Integration of Science and Decision Making over 20 years.

NASA Astrophysics Data System (ADS)

Chehbouni, G.; Goodrich, D.; Kustas, B.; Sorooshian, S.; Shuttleworth, J.; Richter, H.

2008-12-01

The Monsoon'90 Experiment conducted at the USDA-ARS Walnut Gulch Experimental Watershed in southeast Arizona was the start of a long arc of subsequent experiments and research that were larger, longer-term, more international, more interdisciplinary, and led to more direct integration of science for decision making and watershed management. In this era, much of our research and science must be more directly relevant to decision-makers and natural resource managers as they increasingly require sophisticated levels of expert findings and scientific results (e.g. interdisciplinary) to make informed decisions. Significant effort beyond focused, single disciplinary research is required conduct interdisciplinary science typical in large scale field experiments. Even greater effort is required to effectively integrate our research across the physical and ecological sciences for direct use by policy and decision makers. This presentation will provide an overview of the evolution of this arc of experiments and long-term projects into a mature integrated science and decision making program. It will discuss the transition in project focus from science and research for understanding; through science for addressing a need; to integrated science and policy development. At each stage the research conducted became more interdisciplinary, first across abiotic disciplines (hydrology, remote sensing, atmospheric science), then by merging abiotic and biotic disciplines (adding ecology and plant physiology), and finally a further integration of economic and social sciences with and policy and decision making for resource management. Lessons learned from this experience will be reviewed with the intent providing guidance to ensure that the resulting research is socially and scientifically relevant and will not only result in cutting edge science but will also directly address the needs of policy makers and resource managers.

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

Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group.

PubMed

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

2013-01-01

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. Copyright © 2013 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

The amygdala and decision-making.

PubMed

Gupta, Rupa; Koscik, Timothy R; Bechara, Antoine; Tranel, Daniel

2011-03-01

Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain involved in emotion (e.g., amygdala, ventromedial prefrontal cortex) and memory (e.g., hippocampus, dorsolateral prefrontal cortex). In this article, we will present findings related to the amygdala's role in decision-making, and differentiate the contributions of the amygdala from those of other structurally and functionally connected neural regions. Decades of research have shown that the amygdala is involved in associating a stimulus with its emotional value. This tradition has been extended in newer work, which has shown that the amygdala is especially important for decision-making, by triggering autonomic responses to emotional stimuli, including monetary reward and punishment. Patients with amygdala damage lack these autonomic responses to reward and punishment, and consequently, cannot utilize "somatic marker" type cues to guide future decision-making. Studies using laboratory decision-making tests have found deficient decision-making in patients with bilateral amygdala damage, which resembles their real-world difficulties with decision-making. Additionally, we have found evidence for an interaction between sex and laterality of amygdala functioning, such that unilateral damage to the right amygdala results in greater deficits in decision-making and social behavior in men, while left amygdala damage seems to be more detrimental for women. We have posited that the amygdala is part of an "impulsive," habit type system that triggers emotional responses to immediate outcomes. Copyright © 2010 Elsevier Ltd. All rights reserved.

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

PubMed

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

2016-01-01

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

Collaborative Manufacturing for Small-Medium Enterprises

NASA Astrophysics Data System (ADS)

Irianto, D.

2016-02-01

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

Information giving and decision-making in patients with advanced cancer: a systematic review.

PubMed

Gaston, Christine M; Mitchell, Geoffrey

2005-11-01

Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement.

Diagnostic decision-making and strategies to improve diagnosis.

PubMed

Thammasitboon, Satid; Cutrer, William B

2013-10-01

A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable. © 2013 Mosby, Inc. All rights reserved.

Embodied Choice: How Action Influences Perceptual Decision Making

PubMed Central

Lepora, Nathan F.; Pezzulo, Giovanni

2015-01-01

Embodied Choice considers action performance as a proper part of the decision making process rather than merely as a means to report the decision. The central statement of embodied choice is the existence of bidirectional influences between action and decisions. This implies that for a decision expressed by an action, the action dynamics and its constraints (e.g. current trajectory and kinematics) influence the decision making process. Here we use a perceptual decision making task to compare three types of model: a serial decision-then-action model, a parallel decision-and-action model, and an embodied choice model where the action feeds back into the decision making. The embodied model incorporates two key mechanisms that together are lacking in the other models: action preparation and commitment. First, action preparation strategies alleviate delays in enacting a choice but also modify decision termination. Second, action dynamics change the prospects and create a commitment effect to the initially preferred choice. Our results show that these two mechanisms make embodied choice models better suited to combine decision and action appropriately to achieve suitably fast and accurate responses, as usually required in ecologically valid situations. Moreover, embodied choice models with these mechanisms give a better account of trajectory tracking experiments during decision making. In conclusion, the embodied choice framework offers a combined theory of decision and action that gives a clear case that embodied phenomena such as the dynamics of actions can have a causal influence on central cognition. PMID:25849349

Embodied choice: how action influences perceptual decision making.

PubMed

Lepora, Nathan F; Pezzulo, Giovanni

2015-04-01

Embodied Choice considers action performance as a proper part of the decision making process rather than merely as a means to report the decision. The central statement of embodied choice is the existence of bidirectional influences between action and decisions. This implies that for a decision expressed by an action, the action dynamics and its constraints (e.g. current trajectory and kinematics) influence the decision making process. Here we use a perceptual decision making task to compare three types of model: a serial decision-then-action model, a parallel decision-and-action model, and an embodied choice model where the action feeds back into the decision making. The embodied model incorporates two key mechanisms that together are lacking in the other models: action preparation and commitment. First, action preparation strategies alleviate delays in enacting a choice but also modify decision termination. Second, action dynamics change the prospects and create a commitment effect to the initially preferred choice. Our results show that these two mechanisms make embodied choice models better suited to combine decision and action appropriately to achieve suitably fast and accurate responses, as usually required in ecologically valid situations. Moreover, embodied choice models with these mechanisms give a better account of trajectory tracking experiments during decision making. In conclusion, the embodied choice framework offers a combined theory of decision and action that gives a clear case that embodied phenomena such as the dynamics of actions can have a causal influence on central cognition.

Risk communication and decision-making in the prevention of invasive breast cancer.

PubMed

Partridge, Ann H

2017-08-01

Risk communication surrounding the prevention of invasive breast cancer entails not only understanding of the disease, risks and opportunities for intervention. But it also requires understanding and implementation of optimal strategies for communication with patients who are making these decisions. In this article, available evidence for the issues surrounding risk communication and decision making in the prevention of invasive breast cancer are reviewed and strategies for improvement are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing decision quality in patient-centred care requires a preference-sensitive measure

PubMed Central

Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient’s record. PMID:24335587

[The role of information in public health decision-making].

PubMed

Cecchi, Catherine

2008-01-01

Public health, prevention, health education and health promotion are inseparable from the concepts of information and communication. Information should respond as much as possible to the needs of professionals, decision-makers, and consumers who are more and more concerned and conscious of its importance in light of "information overload", various dissemination channels and the multiplicity of its sources. There are numerous issues at stake ranging from comprehension, to the validation of health information, health education, health promotion, prevention, decision-making, as well as issues related to knowledge and power. Irrespective of the type of choice to be made, the need for information, knowledge, and know-how is inseparable from that of other tools or regulatory measures required for decision-making. Information is the same as competence, epidemiological and population data, health data, scientific opinion, and expert conferences--all are needed to assist in decision-making. Based on the principle of precaution, information must increasingly take into account the rejection of a society which often reasons on the basis of a presumption of zero-risk, in an idealistic manner, and which also excludes the possibility of new risks. The consumer positions himself as the regulator of decisions, specifically those with regard to the notion of acceptable level of risk. All of the actors involved in the health system are or become at one moment or another public health decision-makers. Their decision might be based either on an analytical approach, or on an intuitive approach. Although the act of decision-making is the least visible part of public health policy, it is certainly the driving force. This process should integrate the perspective of all of the relevant players, including consumers, who are currently situated more and more frequently at the heart of the health system. Public health decision-making is conducted as a function of political, strategic and environmental issues; of lobbies and their power; and of social maturation. Decision-making is a necessity. Making the right choice at the right time requires high quality information, and it is often necessary to respect a certain amount of time for reflection and ripening of an issue in order to make the best possible decision. The media and consumers play an increasingly significant role in public health decision-making and in the ensuing legislative consequences and debates which come as a result. Access to information is changing, especially thanks to the Internet which is completely modifying the global scenery of knowledge and know-how. Information supports decision-making with calculated risk, and it offers the opportunity to make choices and decisions, recognising that "to choose, is sometimes to relinquish".

Use of Remote Sensing for Decision Support in Africa

NASA Technical Reports Server (NTRS)

Policelli, Frederick S.

2007-01-01

Over the past 30 years, the scientific community has learned a great deal about the Earth as an integrated system. Much of this research has been enabled by the development of remote sensing technologies and their operation from space. Decision makers in many nations have begun to make use of remote sensing data for resource management, policy making, and sustainable development planning. This paper makes an attempt to provide a survey of the current state of the requirements and use of remote sensing for sustainable development in Africa. This activity has shown that there are not many climate data ready decision support tools already functioning in Africa. There are, however, endusers with known requirements who could benefit from remote sensing data.

Intelligent Work Process Engineering System

NASA Technical Reports Server (NTRS)

Williams, Kent E.

2003-01-01

Optimizing performance on work activities and processes requires metrics of performance for management to monitor and analyze in order to support further improvements in efficiency, effectiveness, safety, reliability and cost. Information systems are therefore required to assist management in making timely, informed decisions regarding these work processes and activities. Currently information systems regarding Space Shuttle maintenance and servicing do not exist to make such timely decisions. The work to be presented details a system which incorporates various automated and intelligent processes and analysis tools to capture organize and analyze work process related data, to make the necessary decisions to meet KSC organizational goals. The advantages and disadvantages of design alternatives to the development of such a system will be discussed including technologies, which would need to bedesigned, prototyped and evaluated.

"I Think We Should Take This Offline...": Conversational Patterns that Undermine Effective Decision Making in Action Learning Sets

ERIC Educational Resources Information Center

Donovan, Paul

2011-01-01

Collective decision making is an increasing requirement in organizations where the emphasis is on team work at every level. It is, however, very complex and difficult to achieve in practice. Too frequently, important discussions are bypassed or, while the majority of the meeting participants remain mute, decisions are being made by a vocal few. In…

26 CFR 301.7701-7 - Trusts-domestic and foreign.

Code of Federal Regulations, 2010 CFR

2010-04-01

... more United States persons have the authority to control all substantial decisions of the trust... decisions. The term substantial decisions means those decisions that persons are authorized or required to make under the terms of the trust instrument and applicable law and that are not ministerial. Decisions...

78 FR 46325 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... to facilitate informed decision making regarding deposit accounts offered at depository institutions... information, such as account numbers or social security numbers, should not be included. FOR FURTHER... consumer ability to make informed decisions regarding deposit accounts by requiring uniformity in the...

ASSESSING THE EFFECTS OF DICHLOROACETIC ACID (DCA) USING A MULTI-ENDPOINT MEDAKA ASSAY

EPA Science Inventory

In regulating the safety of water, EPA makes decisions on what chemical contaminants to regulate and at what levels. To make these decisions, the EPA needs hazard identification and dose-response information. Current rodent methods for generating required information have limita...

Medical Decision-Making by Psychiatry Residents

ERIC Educational Resources Information Center

El-Mallakh, Rif; Zinner, Jill; Mackey, Amanda; Tamas, Rebecca L.; Martin, Chanley M.; Dalton, Jerad; Dhaliwal, Nitu; Luddington, Nicole; Numan, Farhad U.; Nunes, Ross; Taylor, Stephen; Ye, Lu

2007-01-01

Objective: Several conspiring factors have resulted in an increase in the level of medical burden in psychiatric patients. Psychiatry residents require increasing levels of medical sophistication. To assess the medical decision-making of psychiatry residents, the authors examined the outcome in subjects initially seen in the emergency psychiatric…

Professionalizing the Nation's Cybersecurity Workforce?: Criteria for Decision-Making

ERIC Educational Resources Information Center

National Academies Press, 2013

2013-01-01

"Professionalizing the Nation's Cybersecurity Workforce? Criteria for Decision-Making" considers approaches to increasing the professionalization of the nation's cybersecurity workforce. This report examines workforce requirements for cybersecurity and the segments and job functions in which professionalization is most needed;…

Probing the neurochemical correlates of motivation and decision making.

PubMed

Wassum, Kate M; Phillips, Paul E M

2015-01-21

Online electrochemical detection techniques are the state-of-the-art for evaluating chemical communication in the brain underlying motivated behavior and decision making. In this Viewpoint, we discuss avenues for future technological development, as well as the requirement for increasingly sophisticated and interdisciplinary behavioral analysis.

Fifth Dimension Parallel Thinking and Velocity Squared

DTIC Science & Technology

2006-12-20

whether people can make rapid decisions. Regarding time, C.R. Gallistel and Rochel Gelman show that even pigeons can make decisions that require time...Facility may lead to uncharacteristic or illegal behavioral choices, even if these emotions are caused by unrelated incidents. 35 R.J. Gallistel and

Implementing CER: what will it take?

PubMed

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

2012-06-01

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

The impact of sleep deprivation on decision making: a review.

PubMed

Harrison, Y; Horne, J A

2000-09-01

Few sleep deprivation (SD) studies involve realism or high-level decision making, factors relevant to managers, military commanders, and so forth, who are undergoing prolonged work during crises. Instead, research has favored simple tasks sensitive to SD mostly because of their dull monotony. In contrast, complex rule-based, convergent, and logical tasks are unaffected by short-term SD, seemingly because of heightened participant interest and compensatory effort. However, recent findings show that despite this effort, SD still impairs decision making involving the unexpected, innovation, revising plans, competing distraction, and effective communication. Decision-making models developed outside SD provide useful perspectives on these latter effects, as does a neuropsychological explanation of sleep function. SD presents particular difficulties for sleep-deprived decision makers who require these latter skills during emergency situations.

UML Profiles for Design Decisions and Non-Functional Requirements

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

Zhu, Liming; Gorton, Ian

2007-06-30

A software architecture is composed of a collection of design decisions. Each design decision helps or hinders certain Non-Functional Requirements (NFR). Current software architecture views focus on expressing components and connectors in the system. Design decisions and their relationships with non-functional requirements are often captured in separate design documentation, not explicitly expressed in any views. This disassociation makes architecture comprehension and architecture evolution harder. In this paper, we propose a UML profile for modeling design decisions and an associated UML profile for modeling non-functional requirements in a generic way. The two UML profiles treat design decisions and nonfunctional requirements asmore » first-class elements. Modeled design decisions always refer to existing architectural elements and thus maintain traceability between the two. We provide a mechanism for checking consistency over this traceability. An exemplar is given as« less

Risky decision-making in children with and without ADHD: A prospective study.

PubMed

Humphreys, Kathryn L; Tottenham, Nim; Lee, Steve S

2018-02-01

Learning from past decisions can enhance successful decision-making. It is unclear whether difficulties in learning from experience may contribute to risky decision-making, which may be altered among individuals with attention-deficit/hyperactivity disorder (ADHD). This study follows 192 children with and without ADHD aged 5 to 10 years for approximately 2.5 years and examines their risky decision-making using the Balloon Emotional Learning Task (BELT), a computerized assessment of sequential risky decision-making in which participants pump up a series of virtual balloons for points. The BELT contains three task conditions: one with a variable explosion point, one with a stable and early explosion point, and one with a stable and late explosion point. These conditions may be learned via experience on the task. Contrary to expectations, ADHD status was not found to be related to greater risk-taking on the BELT, and among younger children ADHD status is in fact associated with reduced risk-taking. In addition, the typically-developing children without ADHD showed significant learning-related gains on both stable task conditions. However, the children with ADHD demonstrated learning on the condition with a stable and early explosion point, but not on the condition with the stable and late explosion point, in which more pumps are required before learning when the balloon will explode. Learning during decision-making may be more difficult for children with ADHD. Because adapting to changing environmental demands requires the use of feedback to guide future behavior, negative outcomes associated with childhood ADHD may partially reflect difficulties in learning from experience.

Decision-making among patients and their family in ALS care: a review.

PubMed

Foley, Geraldine; Hynes, Geralyn

2018-05-01

Practice guidelines in ALS care emphasise the role of the patient and their family in the decision-making process. We aimed to examine the ALS patient/family relationship in the decision-making process and to ascertain how patients and their family can shape one another's decisions pertaining to care. We conducted a review of peer-reviewed empirical research, published in full and in English between January 2007 and January 2017, relating to care decision-making among ALS patients and their family. Database sources included: Medline; CINAHL; AMED; PsycINFO; PsycARTICLES; and Social Sciences Full Text. A narrative synthesis was undertaken. Forty-seven studies from the empirical literature were extracted. The family viewpoint was captured primarily from family members with direct care-giving duties. Patients' cognitive status was not routinely assessed. The findings revealed that the decision-making process in ALS care can be contoured by patients' and family caregivers' perceived responsibilities to one another and to the wider family. Greater attention to family member roles beyond the primary caregiver role is needed. Strategies that integrate cognitively-impaired patients into the family decision-making process require investigation. Identification of the domains in which ALS patients and their family members support one another in the decision-making process could facilitate the development of patient/family decision-making tools in ALS care.

Chronic work stress and decreased vagal tone impairs decision making and reaction time in jockeys.

PubMed

Landolt, Kathleen; Maruff, Paul; Horan, Ben; Kingsley, Michael; Kinsella, Glynda; O'Halloran, Paul D; Hale, Matthew W; Wright, Bradley J

2017-10-01

The inverse relationship between acute stress and decision-making is well documented, but few studies have investigated the impact of chronic stress. Jockeys work exhaustive schedules and have extremely dangerous occupations, with safe performance requiring quick reaction time and accurate decision-making. We used the effort reward imbalance (ERI) occupational stress model to assess the relationship of work stress with indices of stress physiology and decision-making and reaction time. Jockeys (N=32) completed computerised cognitive tasks (Cogstate) on two occasions; September and November (naturally occurring lower and higher stress periods), either side of an acute stress test. Higher ERI was correlated with the cortisol awakening responses (high stress r=-0.37; low stress r=0.36), and with decrements in decision-making comparable to having a blood alcohol concentration of 0.08 in the high stress period (p<0.001) The LF/HF ratio of heart rate variability impacted the association of ERI with decision-making. Potentially, this may be attributed to a 'tipping point' whereby the higher ERI reported by jockeys in the high stress period decreases vagal tone, which may contribute to reduced decision-making abilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

PubMed

Goold, S D

1996-01-01

Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

Who Chokes Under Pressure? The Big Five Personality Traits and Decision-Making under Pressure.

PubMed

Byrne, Kaileigh A; Silasi-Mansat, Crina D; Worthy, Darrell A

2015-02-01

The purpose of the present study was to examine whether the Big Five personality factors could predict who thrives or chokes under pressure during decision-making. The effects of the Big Five personality factors on decision-making ability and performance under social (Experiment 1) and combined social and time pressure (Experiment 2) were examined using the Big Five Personality Inventory and a dynamic decision-making task that required participants to learn an optimal strategy. In Experiment 1, a hierarchical multiple regression analysis showed an interaction between neuroticism and pressure condition. Neuroticism negatively predicted performance under social pressure, but did not affect decision-making under low pressure. Additionally, the negative effect of neuroticism under pressure was replicated using a combined social and time pressure manipulation in Experiment 2. These results support distraction theory whereby pressure taxes highly neurotic individuals' cognitive resources, leading to sub-optimal performance. Agreeableness also negatively predicted performance in both experiments.

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.

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

PubMed

Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

2016-01-01

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

42 CFR 423.44 - Involuntary disenrollment by the PDP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... expertise reviews the case before making a final decision. The PDP sponsor is required to provide a... deems necessary. CMS notifies the PDP sponsor within 5 working days after making its decision. (vi... disenroll affected enrollees in accordance with the procedures for disenrollment set forth at § 423.507...

Mental capacity Act 2005: assessing decision-making capacity.

PubMed

Griffith, Richard; Tengnah, Cassam

2008-06-01

In last month's article on the Mental Capacity Act 2005 Richard Griffith and Cassam Tengnah outlined the statutory principles and key powers that underpin the Act. This month's article considers one of the fundamental requirements of the Mental Capacity Act 2005, how and when should district nurses assess decision making capacity.

The System Dynamics Model User Sustainability Explorer (SD-MUSE) user interface: a user-friendly tool for interpreting system dynamic models

EPA Science Inventory

Sustainability-based decision making is a challenging process that requires balancing trade-offs among social, economic, and environmental components. System Dynamic (SD) models can be useful tools to inform sustainability-based decision making because they provide a holistic co...

Group Participation and Satisfaction: Results from a PBL Computer-Supported Module

ERIC Educational Resources Information Center

Ochoa, Theresa A.; Gottschall, Holly; Stuart, Shannon K.

2004-01-01

Special education policy requires schools to make disciplinary decisions concerning students with disabilities within a multidisciplinary team. In order to respond to this mandate, teacher educators must ensure that teachers have group collaboration and decision making skills. This article describes a multimedia problem-based learning module…

Data-Driven Decision Making in Practice: The NCAA Injury Surveillance System

ERIC Educational Resources Information Center

Klossner, David; Corlette, Jill; Agel, Julie; Marshall, Stephen W.

2009-01-01

Putting data-driven decision making into practice requires the use of consistent and reliable data that are easily accessible. The systematic collection and maintenance of accurate information is an important component in developing policy and evaluating outcomes. Since 1982, the National Collegiate Athletic Association (NCAA) has been collecting…

Critical Thinking as a Leadership Attribute.

PubMed

Werner, Stacy H; Bleich, Michael R

2017-01-01

Leaders are tasked with making decisions that have substantial impact on an organization's well-being. Decision making requires critical thinking and requisite action taking. The nature of critical thinking and how professional development educators can strengthen this attribute are presented. J Contin Educ Nurs. 2017;48(1):9-11. Copyright 2017, SLACK Incorporated.

41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process: Upon... Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO...

Ecological function as a target for ecosystem-based management: Defining when change matters in decision making

EPA Science Inventory

Ecosystem-based management (EBM) accounts for both direct and indirect drivers of ecological change for decision making. Just as with direct management of a resource, EBM requires a definition of management thresholds that define when change in function is sufficient to merit ma...

Sustainability as an Ethical Principle: Ensuring Its Systematic Place in Professional Nursing Practice

PubMed Central

Riedel, Annette

2015-01-01

Alongside the central focus on the persons requiring nursing care in professional nursing practice, the perspective of the sustainability of interventions and the use of materials (for example, nursing aids and hygiene articles) is gaining prominence in nursing decision-making processes. This contribution makes the principle of sustainability concrete and delineates its importance in the context of professional nursing practice and decision-making. It further suggests the development of an ethical policy in order to systematically ensure that sustainability has a place in ethical reflection and decision-making, and describes the elements involved. Finally, a synthesis is made between the importance of the principle of sustainability, suggested ethical policies (system of ethical reflection) as they affect nursing practice and professional reflection, decision-making, and practice. PMID:27417590

Sustainability as an Ethical Principle: Ensuring Its Systematic Place in Professional Nursing Practice.

PubMed

Riedel, Annette

2015-12-30

Alongside the central focus on the persons requiring nursing care in professional nursing practice, the perspective of the sustainability of interventions and the use of materials (for example, nursing aids and hygiene articles) is gaining prominence in nursing decision-making processes. This contribution makes the principle of sustainability concrete and delineates its importance in the context of professional nursing practice and decision-making. It further suggests the development of an ethical policy in order to systematically ensure that sustainability has a place in ethical reflection and decision-making, and describes the elements involved. Finally, a synthesis is made between the importance of the principle of sustainability, suggested ethical policies (system of ethical reflection) as they affect nursing practice and professional reflection, decision-making, and practice.

A systematic approach to embedded biomedical decision making.

PubMed

Song, Zhe; Ji, Zhongkai; Ma, Jian-Guo; Sputh, Bernhard; Acharya, U Rajendra; Faust, Oliver

2012-11-01

An embedded decision making is a key feature for many biomedical systems. In most cases human life directly depends on correct decisions made by these systems, therefore they have to work reliably. This paper describes how we applied systems engineering principles to design a high performance embedded classification system in a systematic and well structured way. We introduce the structured design approach by discussing requirements capturing, specifications refinement, implementation and testing. Thereby, we follow systems engineering principles and execute each of these processes as formal as possible. The requirements, which motivate the system design, describe an automated decision making system for diagnostic support. These requirements are refined into the implementation of a support vector machine (SVM) algorithm which enables us to integrate automated decision making in embedded systems. With a formal model we establish functionality, stability and reliability of the system. Furthermore, we investigated different parallel processing configurations of this computationally complex algorithm. We found that, by adding SVM processes, an almost linear speedup is possible. Once we established these system properties, we translated the formal model into an implementation. The resulting implementation was tested using XMOS processors with both normal and failure cases, to build up trust in the implementation. Finally, we demonstrated that our parallel implementation achieves the speedup, predicted by the formal model. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

PubMed

Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

2017-06-01

Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

A dataset of human decision-making in teamwork management.

PubMed

Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

2017-01-17

Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members' capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches.

A dataset of human decision-making in teamwork management

PubMed Central

Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

2017-01-01

Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members’ capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches. PMID:28094787

A dataset of human decision-making in teamwork management

NASA Astrophysics Data System (ADS)

Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

2017-01-01

Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members' capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches.

20 CFR 10.609 - How does OWCP decide whether new evidence requires modification of the prior decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How does OWCP decide whether new evidence requires modification of the prior decision? 10.609 Section 10.609 Employees' Benefits OFFICE OF WORKERS.... (b) A claims examiner who did not participate in making the contested decision will conduct the merit...

Institutionalizing telemedicine applications: the challenge of legitimizing decision-making.

PubMed

Zanaboni, Paolo; Lettieri, Emanuele

2011-09-28

During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.

Neural systems analysis of decision making during goal-directed navigation.

PubMed

Penner, Marsha R; Mizumori, Sheri J Y

2012-01-01

The ability to make adaptive decisions during goal-directed navigation is a fundamental and highly evolved behavior that requires continual coordination of perceptions, learning and memory processes, and the planning of behaviors. Here, a neurobiological account for such coordination is provided by integrating current literatures on spatial context analysis and decision-making. This integration includes discussions of our current understanding of the role of the hippocampal system in experience-dependent navigation, how hippocampal information comes to impact midbrain and striatal decision making systems, and finally the role of the striatum in the implementation of behaviors based on recent decisions. These discussions extend across cellular to neural systems levels of analysis. Not only are key findings described, but also fundamental organizing principles within and across neural systems, as well as between neural systems functions and behavior, are emphasized. It is suggested that studying decision making during goal-directed navigation is a powerful model for studying interactive brain systems and their mediation of complex behaviors. Copyright © 2011. Published by Elsevier Ltd.

Collective decision-making in microbes

PubMed Central

Ross-Gillespie, Adin; Kümmerli, Rolf

2014-01-01

Microbes are intensely social organisms that routinely cooperate and coordinate their activities to express elaborate population level phenotypes. Such coordination requires a process of collective decision-making, in which individuals detect and collate information not only from their physical environment, but also from their social environment, in order to arrive at an appropriately calibrated response. Here, we present a conceptual overview of collective decision-making as it applies to all group-living organisms; we introduce key concepts and principles developed in the context of animal and human group decisions; and we discuss, with appropriate examples, the applicability of each of these concepts in microbial contexts. In particular, we discuss the roles of information pooling, control skew, speed vs. accuracy trade-offs, local feedbacks, quorum thresholds, conflicts of interest, and the reliability of social information. We conclude that collective decision-making in microbes shares many features with collective decision-making in higher taxa, and we call for greater integration between this fledgling field and other allied areas of research, including in the humanities and the physical sciences. PMID:24624121

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

Bernard, Michael Lewis; Smith, Bruce W., 1959-

Understanding the role of emotional states is critical for predicting the kind of decisions people will make in risky situations. Currently, there is little understanding as to how emotion influences decision-making in situations such as terrorist attacks, natural disasters, pandemics, and combat. To help address this, we used behavioral and neuroimaging methods to examine how emotion states and traits influence decisions. Specifically, this study used a wheel of fortune behavioral task and functional magnetic resonance imaging (fMRI) to examine the effects of emotional states and traits on decision-making pertaining to the degree of risk people are willing to make inmore » specific situations. The behavioral results are reported here. The neural data requires additional time to analyze and will be reported at a future date. Biases caused by emotion states and traits were found regarding the likelihood of making risky decisions. The behavioral results will help provide a solid empirical foundation for modeling the effects of emotion on decision in risky situations.« less

Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

PubMed

Andrea Sullivan, E

2012-11-01

Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

IBM's Health Analytics and Clinical Decision Support.

PubMed

Kohn, M S; Sun, J; Knoop, S; Shabo, A; Carmeli, B; Sow, D; Syed-Mahmood, T; Rapp, W

2014-08-15

This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation.

From science to action: Principles for undertaking environmental research that enables knowledge exchange and evidence-based decision-making.

PubMed

Cvitanovic, C; McDonald, J; Hobday, A J

2016-12-01

Effective conservation requires knowledge exchange among scientists and decision-makers to enable learning and support evidence-based decision-making. Efforts to improve knowledge exchange have been hindered by a paucity of empirically-grounded guidance to help scientists and practitioners design and implement research programs that actively facilitate knowledge exchange. To address this, we evaluated the Ningaloo Research Program (NRP), which was designed to generate new scientific knowledge to support evidence-based decisions about the management of the Ningaloo Marine Park in north-western Australia. Specifically, we evaluated (1) outcomes of the NRP, including the extent to which new knowledge informed management decisions; (2) the barriers that prevented knowledge exchange among scientists and managers; (3) the key requirements for improving knowledge exchange processes in the future; and (4) the core capacities that are required to support knowledge exchange processes. While the NRP generated expansive and multidisciplinary science outputs directly relevant to the management of the Ningaloo Marine Park, decision-makers are largely unaware of this knowledge and little has been integrated into decision-making processes. A range of barriers prevented efficient and effective knowledge exchange among scientists and decision-makers including cultural differences among the groups, institutional barriers within decision-making agencies, scientific outputs that were not translated for decision-makers and poor alignment between research design and actual knowledge needs. We identify a set of principles to be implemented routinely as part of any applied research program, including; (i) stakeholder mapping prior to the commencement of research programs to identify all stakeholders, (ii) research questions to be co-developed with stakeholders, (iii) implementation of participatory research approaches, (iv) use of a knowledge broker, and (v) tailored knowledge management systems. Finally, we articulate the individual, institutional and financial capacities that must be developed to underpin successful knowledge exchange strategies. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Understandings of the nature of science and decision making on science and technology based issues

NASA Astrophysics Data System (ADS)

Bell, Randy L.; Lederman, Norman G.

2003-05-01

The purpose of this investigation was to explicate the role of the nature of science in decision making on science and technology based issues and to delineate factors and reasoning associated with these types of decisions. Twenty-one volunteer participants purposively selected from the faculty of geographically diverse universities completed an open-ended questionnaire and follow-up interview designed to assess their decision making on science and technology based issues. Participants were subsequently placed in one of two groups based upon their divergent views of the nature of science as assessed by a second open-ended questionnaire and follow-up interview. Profiles of each group's decision making were then constructed, based on participants' previous responses to the decision making questionnaire and follow-up interviews. Finally, the two groups' decisions, decision influencing factors, and decision making strategies were compared. No differences were found between the decisions of the two groups, despite their disparate views of the nature of science. Participants in both groups based their decisions primarily on personal values, morals/ethics, and social concerns. While all participants considered scientific evidence in their decision making, most did not require absolute proof, even though many participants held absolute conceptions of the nature of science. Overall, the nature of science did not figure prominently in either group's decisions. These findings contrast with basic assumptions of current science education reform efforts and call for a re-examination of the goals of nature of science instruction. Developing better decision making skills - even on science and technology based issues - may involve other factors, including more value-based instruction and attention to intellectual/moral development.

Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra.

PubMed

Claxton, Karl; Sculpher, Mark; McCabe, Chris; Briggs, Andrew; Akehurst, Ron; Buxton, Martin; Brazier, John; O'Hagan, Tony

2005-04-01

Recently the National Institute for Clinical Excellence (NICE) updated its methods guidance for technology assessment. One aspect of the new guidance is to require the use of probabilistic sensitivity analysis with all cost-effectiveness models submitted to the Institute. The purpose of this paper is to place the NICE guidance on dealing with uncertainty into a broader context of the requirements for decision making; to explain the general approach that was taken in its development; and to address each of the issues which have been raised in the debate about the role of probabilistic sensitivity analysis in general. The most appropriate starting point for developing guidance is to establish what is required for decision making. On the basis of these requirements, the methods and framework of analysis which can best meet these needs can then be identified. It will be argued that the guidance on dealing with uncertainty and, in particular, the requirement for probabilistic sensitivity analysis, is justified by the requirements of the type of decisions that NICE is asked to make. Given this foundation, the main issues and criticisms raised during and after the consultation process are reviewed. Finally, some of the methodological challenges posed by the need fully to characterise decision uncertainty and to inform the research agenda will be identified and discussed. Copyright (c) 2005 John Wiley & Sons, Ltd.

Generalized Cartographic and Simultaneous Representation of Utility Networks for Decision-Support Systems and Crisis Management in Urban Environments

NASA Astrophysics Data System (ADS)

Becker, T.; König, G.

2015-10-01

Cartographic visualizations of crises are used to create a Common Operational Picture (COP) and enforce Situational Awareness by presenting relevant information to the involved actors. As nearly all crises affect geospatial entities, geo-data representations have to support location-specific analysis throughout the decision-making process. Meaningful cartographic presentation is needed for coordinating the activities of crisis manager in a highly dynamic situation, since operators' attention span and their spatial memories are limiting factors during the perception and interpretation process. Situational Awareness of operators in conjunction with a COP are key aspects in decision-making process and essential for making well thought-out and appropriate decisions. Considering utility networks as one of the most complex and particularly frequent required systems in urban environment, meaningful cartographic presentation of multiple utility networks with respect to disaster management do not exist. Therefore, an optimized visualization of utility infrastructure for emergency response procedures is proposed. The article will describe a conceptual approach on how to simplify, aggregate, and visualize multiple utility networks and their components to meet the requirements of the decision-making process and to support Situational Awareness.

Certainty, leaps of faith, and tradition: rethinking clinical interventions.

PubMed

Dzurec, L C

1998-12-01

Clinical decision making requires that clinicians think quickly and in ways that will foster optimal, safe client care. Tradition influences clinical decision making, enhancing efficiency of resulting nursing action; however, since many decisions must be based on data that are either uncertain, incomplete, or indirect, clinicians are readily ensnared in processes involving potentially faulty logic associated with tradition. The author addresses the tenacity of tradition and then focuses on three processes--consensus formation, the grounding of certainty in inductive reasoning, and affirming the consequent--that have affected clinical decision making. For some recipients of care, tradition has had a substantial and invalid influence on their ability to access care.

Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study.

PubMed

Fain, Kevin M; Rosenberg, Paul B; Pirard, Sandrine; Bogunovic, Olivera; Spira, Adam P

2015-07-01

Many nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. Participants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. After controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood ["mild" odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23-1.58; "severe" OR = 2.69, 95% CI = 2.27-3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52-5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82-16.75); length of nursing home stay [101-365 days (OR = 1.60, 95% CI = 1.36-1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34-1.90); >2 years (OR = 2.25, 95% CI = 1.92-2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07-1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52-0.66). We found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored further to help identify residents with impaired decision making. Copyright © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

abstraction hierarchy, three levels of information requirement for designing emergency training interface are recognized. These are epistemological ...support human decision making process is considered to be decision-centric. A typical decision-centric interface is supported by at least four design ... Designing Emergency Training Interface ......................................................................................... 5 Epistemological

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

PubMed

Simoens, Steven

2010-10-22

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

Adult-Onset Type 1 Diabetes: A Qualitative Study of Decision-Making Needs.

PubMed

Jull, Janet; Witteman, Holly O; Ferne, Judi; Yoganathan, Manosila; Stacey, Dawn

2016-04-01

Type 1 diabetes is an autoimmune disease resulting from insulin deficiency and must be carefully managed to prevent serious health complications. Diabetes education and management strategies usually focus on meeting the decision-making needs of children and their families, but little is known about the decisional needs of people with adult-onset type 1 diabetes. The aim of this study was to explore the diabetes-related decision-making needs of people diagnosed with adult-onset type 1 diabetes. An interpretive descriptive qualitative study was conducted. Participants who self-identified as having adult-onset type 1 diabetes were interviewed using a semistructured interview guide. Transcripts were coded to identify needs, supports and barriers using thematic analysis. Participating in the study were 8 adults (2 men, 6 women), ages 33 to 57, with type 1 diabetes for durations of 1 to 20 or more years. Their decision-making needs are summarized in 6 broad themes: 1) people diagnosed with type 1 diabetes are launched into a process of decision-making; 2) being diagnosed with type 1 diabetes means you will always have to make decisions; 3) knowledge is crucial; 4) personal preferences matter; 5) support is critical for decisions about self-care in type 1 diabetes; 6) living with type 1 diabetes means making very individualized decisions about daily life. The findings describe the sudden and ubiquitous nature of type 1 diabetes decision-making and the need to tailor approaches for making care decisions in type 1 diabetes. People diagnosed with adult-onset type 1 diabetes require access to reliable information, support and opportunities for participation in decision-making. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

"I've never been a yes person": Decision-making participation and self-conceptualization after severe traumatic brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2017-11-01

Although adults who sustain a severe traumatic brain injury (TBI) require support to make decisions in their lives, little is known about their experience of this process. The aim of this study was to explore how participation in decision making contributes to self-conceptualization in adults with severe TBI. We used constructivist grounded theory methods. Data included 20 in-depth interviews with adults with severe TBI. Through a process of constant comparison, analysis involved open and focused coding until clear categories emerged and data saturation was achieved. Self-conceptualization emerged as a complex and multifaceted process, as individuals with TBI aimed to reestablish a sense of autonomy. We describe a recursive relationship in which decision-making participation assists the dynamic construction of self, and self-concept contributes to the experience of making decisions. The role of an individual's social support network in acting as a bridge between participation and self-conceptualization is presented. Findings emphasize that contributing to decisions about one's own goals across a range of life areas can reinforce a positive self-concept. It is vital that supporters understand that participation in decision making provides a pathway to conceptualizing self and aim to maximize the person's participation in the decision-making process. Implications for Rehabilitation Previous research has identified that the experience of sustaining TBI has a significant impact on a person's conceptualization of self. This study identified that decision-making experiences play an important role in the ongoing process of self-conceptualization after injury. Decision-making experiences can reinforce a person's self-concept or lead them to revise (positively or negatively) their sense of self. By maximizing the person's decision-making participation, those around them can support them to develop positive self-attributes and contribute to shaping their future goals.

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

PubMed Central

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

2014-01-01

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

The ethics of sham surgery on research subjects with cognitive impairments that affect decision-making capacity.

PubMed

Resnik, David B; Miller, Frank

2010-09-01

Populations recruited to participate in sham surgery clinical trials sometimes include patients with cognitive impairments that affect decision-making capacity. In this commentary we examine arguments for and against including these patients in sham surgery clinical trials. We argue that patients with cognitive impairments that affect decision-making capacity should not be excluded from a sham surgery clinical trial if there are scientific reasons for including them in the study and basic ethical requirements for clinical research are met. Published by Elsevier Inc.

Passenger comfort technology for system decision making

NASA Technical Reports Server (NTRS)

Conner, D. W.

1980-01-01

Decisions requiring passenger comfort technology were shown to depend on: the relationship between comfort and other factors (e.g., cost, urgency, alternate modes) in traveler acceptance of the systems, serving a selected market require technology to quantify effects of comfort versus offsetting factors in system acceptance. Public predict the maximum percentage of travelers who willingly accept the overall comfort of any trip ride. One or the other of these technology requirements apply to decisions on system design, operation and maintenance.

Impairment in risk-sensitive decision-making in older suicide attempters with depression

PubMed Central

Clark, L; Dombrovski, AY; Siegle, GJ; Butters, MA; Shollenberger, CL; Sahakian, BJ; Szanto, K

2010-01-01

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory (“Cambridge Gamble Task”) in four groups of older adults: 1) individuals with major depression and a history of suicide attempt (n=25), 2) individuals with major depression with active suicidal ideation but no suicide attempt (n=13), 3) individuals with major depression without suicidality (n=35), and 4) non-depressed control subjects (n=22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the non-suicidal depressed and non-depressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions. PMID:21443349

Steps to consider for effective decision making when selecting and prioritizing eHealth services.

PubMed

Vimarlund, Vivian; Davoody, Nadia; Koch, Sabine

2013-01-01

Making the best choice for an organization when selecting IT applications or eHealth services is not always easy as there are a lot of parameters to take into account. The aim of this paper is to explore some steps to support effective decision making when selecting and prioritizing eHealth services prior to implementation and/or procurement. The steps presented in this paper were identified by interviewing nine key stakeholders at Stockholm County Council. They are supposed to work as a guide for decision making and aim to identify objectives and expected effects, technical, organizational, and economic requirements, and opportunities important to consider before decisions are taken. The steps and their respective issues and variables are concretized in a number of templates to be filled in by decision makers when selecting and prioritizing eHealth services.

Criminal decision making: the development of adolescent judgment, criminal responsibility, and culpability.

PubMed

Fried, C S; Reppucci, N D

2001-02-01

Theories of judgment in decision making hypothesize that throughout adolescence, judgment is impaired because the development of several psychosocial factors that are presumed to influence decision making lags behind the development of the cognitive capacities that are required to make mature decisions. This study uses an innovative video technique to examine the role of several psychosocial factors--temporal perspective, peer influence, and risk perception--in adolescent criminal decision making. Results based on data collected from 56 adolescents between the ages of 13 and 18 years revealed that detained youth were more likely to think of future-oriented consequences of engaging in the depicted delinquent act and less likely to anticipate pressure from their friends than nondetained youth. Examination of the developmental functions of the psychosocial factors indicates age-based differences on standardized measures of temporal perspective and resistance to peer influence and on measures of the role of risk perception in criminal decision making. Assessments of criminal responsibility and culpability were predicted by age and ethnicity. Implications for punishment in the juvenile justice system are discussed.

Developing an institutional framework to incorporate ecosystem services into decision making-Proceedings of a workshop

USGS Publications Warehouse

Hogan, Dianna; Arthaud, Greg; Brookshire, David; Gunther, Tom; Pincetl, Stephanie; Shapiro, Carl; Van Horne, Bea

2011-01-01

The appropriate use of institutional structures, including markets, to integrate ecosystem services into decision making depends on the players and characteristics of the specific situation (such as stakeholders, the ecosystem, resources, and the political environment). Incorporating ecosystem service values into decisions requires consideration of place-based social, cultural, economic, and landscape characteristics and institutions. Thus, a single, prescribed solution will not work-various institutional strategies must be used in different situations. Market-based approaches require appropriate regulations, monitoring, and enforcement, depending on the situation and place. Further, market approaches will need to be coupled with nonmarket approaches into an integrated institutional framework.

[How to decide with precision, justice, and equity? Reflections on decision-making in the context of extreme prematurity. Part two: moving toward making the best possible decision: defining conditions for putting decisions into practice].

PubMed

Azria, E; Tsatsaris, V; Moriette, G; Hirsch, E; Schmitz, T; Cabrol, D; Goffinet, F

2007-05-01

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those children remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care" is crucial. This work is focused on this problematic of decision-making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.

Evidence Based Medicine and Shared Decision Making: the challenge of getting both evidence and preferences into health care.

PubMed

Barratt, Alexandra

2008-12-01

Evidence Based Medicine (EBM) and Shared Medical Decision Making (SDM) are changing the nature of health care decisions. It is broadly accepted that health care decisions require the integration of research evidence and individual preferences. These approaches are justified on both efficacy grounds (that evidence based practice and Shared Decision Making should lead to better health outcomes and may lead to a more cost-effective use of health care resources) and ethical grounds (patients' autonomy should be respected in health care). However, despite endorsement by physicians and consumers of these approaches, implementation remains limited in practice, particularly outside academic and tertiary health care centres. There are practical problems of implementation, which include training, access to research, and development of and access to tools to display evidence and support decision making. There may also be philosophical difficulties, and some have even suggested that the two approaches (evidence based practice and Shared Decision Making) are fundamentally incompatible. This paper look at the achievements of EBM and SDM so far, the potential tensions between them, and how things might progress in the future.

Effects of Age, Sex, and Neuropsychological Performance on Financial Decision-Making

PubMed Central

Shivapour, Sara K.; Nguyen, Christopher M.; Cole, Catherine A.; Denburg, Natalie L.

2012-01-01

The capacity to make sound financial decisions across the lifespan is critical for interpersonal, occupational, and psychological health and success. In the present study, we explored how healthy younger and older adults make a series of increasingly complex financial decisions. One-hundred sixteen healthy older adults, aged 56–90 years, and 102 college undergraduates, completed the Financial Decision-Making Questionnaire, which requires selecting and justifying financial choices across four hypothetical scenarios and answering questions pertaining to financial knowledge. Results indicated that Older participants significantly outperformed Younger participants on a multiple-choice test of acquired financial knowledge. However, after controlling for such pre-existing knowledge, several age effects were observed. For example, Older participants were more likely to make immediate investment decisions, whereas Younger participants exhibited a preference for delaying decision-making pending additional information. Older participants also rated themselves as more concerned with avoiding monetary loss (i.e., a prevention orientation), whereas Younger participants reported greater interest in financial gain (i.e., a promotion orientation). In terms of sex differences, Older Males were more likely to pay credit card bills and utilize savings accounts than were Older Females. Multiple positive correlations were observed between Older participants’ financial decision-making ability and performance on neuropsychological measures of non-verbal intellect and executive functioning. Lastly, the ability to justify one’s financial decisions declined with age, among the Older participants. Several of the aforementioned results parallel findings from the medical decision-making literature, suggesting that older adults make decisions in a manner that conserves diminishing cognitive resources. PMID:22715322

Influence of acute stress on decision outcomes and heuristics.

PubMed

Hepler, Teri J; Kovacs, Attila J

2017-03-01

The purpose of this study was to examine the take-the-first (TTF) heuristic and decision outcomes in sports under conditions of no, mental, and physical stress. Participants (N.=68) performed 8 video decision-making trials under each of 3 stress conditions: no stress (counting backwards), mental stress (mental serial subtraction), and physical stress (running on treadmill at 13 RPE). Prior to each decision-making trial, participants were exposed to 30 seconds of stress. The decision-making task required participants to watch a video depicting an offensive situation in basketball and then decide what the player with the ball should do next. No differences were found between the 3 stress conditions on TTF frequency, number of options generated, quality of first generated option, or final decision quality. However, participants performing under conditions of no stress and physical stress generated their first option and made their final decision faster than they did when making decisions under mental stress. Overall, results suggest that mental stress impairs decision speed and that TTF is an ecologically rationale heuristic in dynamic, time-pressured situations.

"Decisions, decisions, decisions": transfer and specificity of decision-making skill between sports.

PubMed

Causer, Joe; Ford, Paul R

2014-08-01

The concept of transfer of learning holds that previous practice or experience in one task or domain will enable successful performance in another related task or domain. In contrast, specificity of learning holds that previous practice or experience in one task or domain does not transfer to other related tasks or domains. The aim of the current study is to examine whether decision-making skill transfers between sports that share similar elements, or whether it is specific to a sport. Participants (n = 205) completed a video-based temporal occlusion decision-making test in which they were required to decide on which action to execute across a series of 4 versus 4 soccer game situations. A sport engagement questionnaire was used to identify 106 soccer players, 43 other invasion sport players and 58 other sport players. Positive transfer of decision-making skill occurred between soccer and other invasion sports, which are related and have similar elements, but not from volleyball, supporting the concept of transfer of learning.

Making Good Decisions in Healthcare with Multi-Criteria Decision Analysis: The Use, Current Research and Future Development of MCDA.

PubMed

Mühlbacher, Axel C; Kaczynski, Anika

2016-02-01

Healthcare decision making is usually characterized by a low degree of transparency. The demand for transparent decision processes can be fulfilled only when assessment, appraisal and decisions about health technologies are performed under a systematic construct of benefit assessment. The benefit of an intervention is often multidimensional and, thus, must be represented by several decision criteria. Complex decision problems require an assessment and appraisal of various criteria; therefore, a decision process that systematically identifies the best available alternative and enables an optimal and transparent decision is needed. For that reason, decision criteria must be weighted and goal achievement must be scored for all alternatives. Methods of multi-criteria decision analysis (MCDA) are available to analyse and appraise multiple clinical endpoints and structure complex decision problems in healthcare decision making. By means of MCDA, value judgments, priorities and preferences of patients, insurees and experts can be integrated systematically and transparently into the decision-making process. This article describes the MCDA framework and identifies potential areas where MCDA can be of use (e.g. approval, guidelines and reimbursement/pricing of health technologies). A literature search was performed to identify current research in healthcare. The results showed that healthcare decision making is addressing the problem of multiple decision criteria and is focusing on the future development and use of techniques to weight and score different decision criteria. This article emphasizes the use and future benefit of MCDA.

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

PubMed

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

2018-02-21

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

41 CFR 60-741.44 - Required contents of affirmative action programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... individuals with disabilities. (7) The contractor, in making hiring decisions, should consider applicants with... employment decisions are based only on valid job requirements. The policy shall state that employees and.... Individuals with disabilities should be made available for participation in career days, youth motivation...

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

PubMed

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

2014-06-01

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

CRIS Case Study Materials in Ethical Decision Making.

ERIC Educational Resources Information Center

Blanning, James R.

Designed for secondary-level classroom discussion, these materials contain nine, short case studies of ethical dilemmas. The cast studies focus mainly on incidents and issues relevant to high school students. Discussion questions for each case study require students to examine the case, discuss the issue, and make an ethical decision about how…

41 CFR 102-117.295 - Who makes the decisions on temporary nonuse, suspension and debarment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... nature of suspension and debarment requires that these sanctions be imposed only in the public interest... on temporary nonuse, suspension and debarment? 102-117.295 Section 102-117.295 Public Contracts and... § 102-117.295 Who makes the decisions on temporary nonuse, suspension and debarment? (a) The...

Decision Making. Level Two/Three. Career Guidance.

ERIC Educational Resources Information Center

Cooper, Irene; And Others

Materials contained in this career guidance unit are designed to provide the seven-, eight-, or nine-year-old student with a framework of logical steps for decision making and problem solving. The seventeen activities included in the unit vary in length from thirty to sixty minutes; the entire unit requires approximately ten hours of instructional…

Improving Decision Making Skill Using an Online Volcanic Crisis Simulation: Impact of Data Presentation Format

ERIC Educational Resources Information Center

Barclay, Elizabeth J.; Renshaw, Carl E.; Taylor, Holly A.; Bilge, A. Reyan

2011-01-01

Creating effective computer-based learning exercises requires an understanding of optimal user interface designs for improving higher order cognitive skills. Using an online volcanic crisis simulation previously shown to improve decision making skill, we find that a user interface using a graphical presentation of the volcano monitoring data…

Instructional Design for Advanced Learners: Training Recognition Skills to Hasten Expertise

ERIC Educational Resources Information Center

Fadde, Peter Jae

2009-01-01

Expertise in domains ranging from sports to surgery involves a process of recognition-primed decision-making (RPD) in which experts make rapid, intuitive decisions based on recognizing critical features of dynamic performance situations. While the development of expert RPD is assumed to require years of domain experience, the transition from…

Evaluating the best available social science for natural resource management decision-making

Treesearch

Susan Charnley; Courtney Carothers; Terre Satterfield; Arielle Levine; Melissa R. Poe; Karma Norman; Jamie Donatuto; Sara Jo Breslow; Michael B. Mascia; Phillip S. Levin; Xavier Basurto; Christina C. Hicks; Carlos García-Quijano; Kevin St. Martin

2017-01-01

Increasing recognition of the human dimensions of natural resource management issues, and of social and ecological sustainability and resilience as being inter-related, highlights the importance of applying social science to natural resource management decision-making. Moreover, a number of laws and regulations require natural resource management agencies to consider...

Shared Decision-Making as the Future of Emergency Cardiology.

PubMed

Probst, Marc A; Noseworthy, Peter A; Brito, Juan P; Hess, Erik P

2018-02-01

Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

A Navy Officer Assignment Model

DTIC Science & Technology

1982-03-01

replace the routine administrative tasks required of both assignment and placement officers without reducing their role in making the essential decisions ...individual has no desire to serve there. This last aspect of the detailer’s job can be the most difficult, since he must both make the decision of who is...34Billet Fill Decision " has been made by a third party, an officer whose primary responsibility is to oversee this program, according to the previous

Rapid Decision-Making with Side-Specific Perceptual Discrimination in Ants

PubMed Central

Stroeymeyt, Nathalie; Guerrieri, Fernando J.; van Zweden, Jelle S.; d'Ettorre, Patrizia

2010-01-01

Background Timely decision making is crucial for survival and reproduction. Organisms often face a speed-accuracy trade-off, as fully informed, accurate decisions require time-consuming gathering and treatment of information. Optimal strategies for decision-making should therefore vary depending on the context. In mammals, there is mounting evidence that multiple systems of perceptual discrimination based on different neural circuits emphasize either fast responses or accurate treatment of stimuli depending on the context. Methodology/Principal Findings We used the ant Camponotus aethiops to test the prediction that fast information processing achieved through direct neural pathways should be favored in situations where quick reactions are adaptive. Social insects discriminate readily between harmless group-members and dangerous strangers using easily accessible cuticular hydrocarbons as nestmate recognition cues. We show that i) tethered ants display rapid aggressive reactions upon presentation of non-nestmate odor (120 to 160 ms); ii) ants' aggressiveness towards non-nestmates can be specifically reduced by exposure to non-nestmate odor only, showing that social interactions are not required to alter responses towards non-nestmates; iii) decision-making by ants does not require information transfer between brain hemispheres, but relies on side-specific decision rules. Conclusions/Significance Our results strongly suggest that first-order olfactory processing centers (up to the antennal lobes) are likely to play a key role in ant nestmate recognition. We hypothesize that the coarse level of discrimination achieved in the antennal lobes early in odor processing provides enough information to determine appropriate behavioral responses towards non-nestmates. This asks for a reappraisal of the mechanisms underlying social recognition in insects. PMID:20808782

Identifying Non-Sustainable Courses of Action: A Prerequisite for Decision-Making in Education for Sustainable Development

NASA Astrophysics Data System (ADS)

Gresch, Helge; Bögeholz, Susanne

2013-04-01

Students are faced with a multitude of decisions as consumers and in societal debates. Because of the scarcity of resources, the destruction of ecosystems and social injustice in a globalized world, it is vital that students are able to identify non-sustainable courses of action when involved in decision-making. The application of decision-making strategies is one approach to enhancing the quality of decisions. Options that do not meet ecological, social or economic standards should be excluded using non-compensatory strategies whereas other tasks may require a complete trade-off of all the evidence, following a compensatory approach. To enhance decision-making competence, a computer-based intervention study was conducted that focused on the use of decision-making strategies. While the results of the summative evaluation are reported by Gresch et al. (International Journal of Science Education, 2011), in-depth analyses of process-related data collected during the information processing are presented in this paper to reveal insights into the mechanisms of the intervention. The quality of high school students' ( n = 120) metadecision skills when selecting a decision-making strategy was investigated using qualitative content analyses combined with inferential statistics. The results reveal that the students offered elaborate reflections on the sustainability of options. However, the characteristics that were declared non-sustainable differed among the students because societal norms and personal values were intertwined. One implication for education for sustainable development is that students are capable of reflecting on decision-making tasks and on corresponding favorable decision-making strategies at a metadecision level. From these results, we offer suggestions for improving learning environments and constructing test instruments for decision-making competence.

Examining Challenges Related to the Production of Actionable Climate Knowledge for Adaptation Decision-Making: A Focus on Climate Knowledge System Producers

NASA Astrophysics Data System (ADS)

Ernst, K.; Preston, B. L.; Tenggren, S.; Klein, R.; Gerger-Swartling, Å.

2017-12-01

Many challenges to adaptation decision-making and action have been identified across peer-reviewed and gray literature. These challenges have primarily focused on the use of climate knowledge for adaptation decision-making, the process of adaptation decision-making, and the needs of the decision-maker. Studies on climate change knowledge systems often discuss the imperative role of climate knowledge producers in adaptation decision-making processes and stress the need for producers to engage in knowledge co-production activities and to more effectively meet decision-maker needs. While the influence of climate knowledge producers on the co-production of science for adaptation decision-making is well-recognized, hardly any research has taken a direct approach to analyzing the challenges that climate knowledge producers face when undertaking science co-production. Those challenges can influence the process of knowledge production and may hinder the creation, utilization, and dissemination of actionable knowledge for adaptation decision-making. This study involves semi-structured interviews, focus groups, and participant observations to analyze, identify, and contextualize the challenges that climate knowledge producers in Sweden face as they endeavor to create effective climate knowledge systems for multiple contexts, scales, and levels across the European Union. Preliminary findings identify complex challenges related to education, training, and support; motivation, willingness, and culture; varying levels of prioritization; professional roles and responsibilities; the type and amount of resources available; and professional incentive structures. These challenges exist at varying scales and levels across individuals, organizations, networks, institutions, and disciplines. This study suggests that the creation of actionable knowledge for adaptation decision-making is not supported across scales and levels in the climate knowledge production landscape. Additionally, enabling the production of actionable knowledge for adaptation decision-making requires multi-level effort beyond the individual level.

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2012-01-01

Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.

Understandings of the nature of science and decision making on science and technology-based issues

NASA Astrophysics Data System (ADS)

Bell, Randy Lee

Current reforms emphasize the development of scientific literacy as the principal goal of science education. The nature of science is considered a critical component of scientific literacy and is assumed to be an important factor in decision making on science and technology based issues. However, little research exists that delineates the role of the nature of science in decision making. The purpose of this investigation was to explicate the role of the nature of science in decision making on science and technology based issues and to delineate the reasoning and factors associated with these types of decisions. The 15-item, open-ended "Decision Making Questionnaire" (DMQ) based on four different scenarios concerning science and technology issues was developed to assess decision making. Twenty-one volunteer participants purposively selected from the faculty of geographically diverse universities completed the questionnaire and follow-up interviews. Participants were subsequently grouped according to their understandings of the nature of science, based on responses to a second open-ended questionnaire and follow-up interview. Profiles of each group's decision making were constructed, based on their previous responses to the DMQ and follow-up interviews. Finally, the two groups' decisions, decision making factors, and decision making strategies were compared. No differences were found between the decisions of the two groups, despite their disparate views of the nature of science. While their reasoning did not follow formal lines of argumentation, several influencing factors and general reasoning patterns were identified. Participants in both groups based their decisions primarily on personal values, morals/ethics, and social concerns. While all participants said they considered scientific evidence in their decision making, most did not require absolute "proof," even though Group B participants held more absolute conceptions of the nature of science. Overall, the nature of science did not figure prominently in either group's decisions. These findings contrast with the assumptions of the science education community and current reform efforts and call for a reexamination of the goals of nature of science instruction. Developing better decision making skills---even on science and technology based issues---may involve other factors, including more values-based instruction and attention to intellectual/moral development.

Monitoring supports performance in a dual-task paradigm involving a risky decision-making task and a working memory task

PubMed Central

Gathmann, Bettina; Schiebener, Johannes; Wolf, Oliver T.; Brand, Matthias

2015-01-01

Performing two cognitively demanding tasks at the same time is known to decrease performance. The current study investigates the underlying executive functions of a dual-tasking situation involving the simultaneous performance of decision making under explicit risk and a working memory task. It is suggested that making a decision and performing a working memory task at the same time should particularly require monitoring—an executive control process supervising behavior and the state of processing on two tasks. To test the role of a supervisory/monitoring function in such a dual-tasking situation we investigated 122 participants with the Game of Dice Task plus 2-back task (GDT plus 2-back task). This dual task requires participants to make decisions under risk and to perform a 2-back working memory task at the same time. Furthermore, a task measuring a set of several executive functions gathered in the term concept formation (Modified Card Sorting Test, MCST) and the newly developed Balanced Switching Task (BST), measuring monitoring in particular, were used. The results demonstrate that concept formation and monitoring are involved in the simultaneous performance of decision making under risk and a working memory task. In particular, the mediation analysis revealed that BST performance partially mediates the influence of MCST performance on the GDT plus 2-back task. These findings suggest that monitoring is one important subfunction for superior performance in a dual-tasking situation including decision making under risk and a working memory task. PMID:25741308

Decision-Making in Management of the Complex Trauma Patient: Changing the Mindset of the non-trauma Surgeon.

PubMed

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

2018-01-16

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

78 FR 54862 - Information Collection; General Program Administration

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... projection used in loan making and servicing decisions; information needed to establish joint bank accounts... requirements that are applicable to making and servicing direct loans. Information and collections required are... DEPARTMENT OF AGRICULTURE Farm Service Agency Information Collection; General Program...

Perturbations in Effort-Related Decision-Making Driven by Acute Stress and Corticotropin-Releasing Factor.

PubMed

Bryce, Courtney A; Floresco, Stan B

2016-07-01

Acute stress activates numerous systems in a coordinated effort to promote homeostasis, and can exert differential effects on mnemonic and cognitive functions depending on a myriad of factors. Stress can alter different forms of cost/benefit decision-making, yet the mechanisms that drive these effects, remain unclear. In the present study, we probed how corticotropin-releasing factor (CRF) may contribute to stress-induced alterations in cost/benefit decision-making, using an task where well-trained rats chose between a low effort/low reward lever (LR; two pellets) and a high effort/high reward lever (HR; four pellets), with the effort requirement increasing over a session (2, 5, 10, and 20 presses). One-hour restraint stress markedly reduced preference for the HR option, but this effect was attenuated by infusions of the CRF antagonist, alpha-helical CRF. Conversely, central CRF infusion mimicked the effect of stress on decision-making, as well as increased decision latencies and reduced response vigor. CRF infusions did not alter preference for larger vs smaller rewards, but did reduce responding for food delivered on a progressive ratio, suggesting that these treatments may amplify perceived effort costs that may be required to obtain rewards. CRF infusions into the ventral tegmental area recapitulated the effect of central CRF treatment and restraint on choice behavior, suggesting that these effects may be mediated by perturbations in dopamine transmission. These findings highlight the involvement of CRF in regulating effort-related decisions and suggest that increased CRF activity may contribute to motivational impairments and abnormal decision-making associated with stress-related psychiatric disorders such as depression.

Perturbations in Effort-Related Decision-Making Driven by Acute Stress and Corticotropin-Releasing Factor

PubMed Central

Bryce, Courtney A; Floresco, Stan B

2016-01-01

Acute stress activates numerous systems in a coordinated effort to promote homeostasis, and can exert differential effects on mnemonic and cognitive functions depending on a myriad of factors. Stress can alter different forms of cost/benefit decision-making, yet the mechanisms that drive these effects, remain unclear. In the present study, we probed how corticotropin-releasing factor (CRF) may contribute to stress-induced alterations in cost/benefit decision-making, using an task where well-trained rats chose between a low effort/low reward lever (LR; two pellets) and a high effort/high reward lever (HR; four pellets), with the effort requirement increasing over a session (2, 5, 10, and 20 presses). One-hour restraint stress markedly reduced preference for the HR option, but this effect was attenuated by infusions of the CRF antagonist, alpha-helical CRF. Conversely, central CRF infusion mimicked the effect of stress on decision-making, as well as increased decision latencies and reduced response vigor. CRF infusions did not alter preference for larger vs smaller rewards, but did reduce responding for food delivered on a progressive ratio, suggesting that these treatments may amplify perceived effort costs that may be required to obtain rewards. CRF infusions into the ventral tegmental area recapitulated the effect of central CRF treatment and restraint on choice behavior, suggesting that these effects may be mediated by perturbations in dopamine transmission. These findings highlight the involvement of CRF in regulating effort-related decisions and suggest that increased CRF activity may contribute to motivational impairments and abnormal decision-making associated with stress-related psychiatric disorders such as depression. PMID:26830960

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback.

PubMed

Whitney, Paul; Hinson, John M; Jackson, Melinda L; Van Dongen, Hans P A

2015-05-01

To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Twenty-six subjects (22-40 y of age; 10 women). Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. © 2015 Associated Professional Sleep Societies, LLC.

The influence of fatigue on decision-making in athletes: a systematic review.

PubMed

Almonroeder, Thomas Gus; Tighe, Sarah Marie; Miller, Taylor Matthew; Lanning, Christopher Ray

2018-06-14

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.

Cognitive reflection vs. calculation in decision making

PubMed Central

Sinayev, Aleksandr; Peters, Ellen

2015-01-01

Scores on the three-item Cognitive Reflection Test (CRT) have been linked with dual-system theory and normative decision making (Frederick, 2005). In particular, the CRT is thought to measure monitoring of System 1 intuitions such that, if cognitive reflection is high enough, intuitive errors will be detected and the problem will be solved. However, CRT items also require numeric ability to be answered correctly and it is unclear how much numeric ability vs. cognitive reflection contributes to better decision making. In two studies, CRT responses were used to calculate Cognitive Reflection and numeric ability; a numeracy scale was also administered. Numeric ability, measured on the CRT or the numeracy scale, accounted for the CRT's ability to predict more normative decisions (a subscale of decision-making competence, incentivized measures of impatient and risk-averse choice, and self-reported financial outcomes); Cognitive Reflection contributed no independent predictive power. Results were similar whether the two abilities were modeled (Study 1) or calculated using proportions (Studies 1 and 2). These findings demonstrate numeric ability as a robust predictor of superior decision making across multiple tasks and outcomes. They also indicate that correlations of decision performance with the CRT are insufficient evidence to implicate overriding intuitions in the decision-making biases and outcomes we examined. Numeric ability appears to be the key mechanism instead. PMID:25999877

Cognitive reflection vs. calculation in decision making.

PubMed

Sinayev, Aleksandr; Peters, Ellen

2015-01-01

Scores on the three-item Cognitive Reflection Test (CRT) have been linked with dual-system theory and normative decision making (Frederick, 2005). In particular, the CRT is thought to measure monitoring of System 1 intuitions such that, if cognitive reflection is high enough, intuitive errors will be detected and the problem will be solved. However, CRT items also require numeric ability to be answered correctly and it is unclear how much numeric ability vs. cognitive reflection contributes to better decision making. In two studies, CRT responses were used to calculate Cognitive Reflection and numeric ability; a numeracy scale was also administered. Numeric ability, measured on the CRT or the numeracy scale, accounted for the CRT's ability to predict more normative decisions (a subscale of decision-making competence, incentivized measures of impatient and risk-averse choice, and self-reported financial outcomes); Cognitive Reflection contributed no independent predictive power. Results were similar whether the two abilities were modeled (Study 1) or calculated using proportions (Studies 1 and 2). These findings demonstrate numeric ability as a robust predictor of superior decision making across multiple tasks and outcomes. They also indicate that correlations of decision performance with the CRT are insufficient evidence to implicate overriding intuitions in the decision-making biases and outcomes we examined. Numeric ability appears to be the key mechanism instead.

41 CFR 60-250.44 - Required contents of affirmative action programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... veterans. (8) The contractor, in making hiring decisions, should consider applicants who are known special... decisions are based only on valid job requirements. The policy shall state that employees and applicants... career days, youth motivation programs, and related activities in their communities. (6) The contractor...

41 CFR 60-300.44 - Required contents of affirmative action programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... medal veterans. (8) The contractor, in making hiring decisions, should consider applicants who are known... decisions are based only on valid job requirements. The policy shall state that employees and applicants... participation in career days, youth motivation programs, and related activities in their communities. (6) The...

Responding to and Supporting Students with Disabilities: Risk Management Considerations

ERIC Educational Resources Information Center

Lundquist, Anne; Shackelford, Allan

2011-01-01

Making the "right" risk management decisions involving students with significant psychological disabilities requires a clear and comprehensive understanding of the legal obligations and duties at issue. It also requires taking into consideration the best interests of these individual students. At the same time, decision makers must focus…

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

PubMed

Petrova, Dafina; Garcia-Retamero, Rocio; Cokely, Edward T

2015-10-01

Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making. © The Author(s) 2015.

Interactive Management and Updating of Spatial Data Bases

NASA Technical Reports Server (NTRS)

French, P.; Taylor, M.

1982-01-01

The decision making process, whether for power plant siting, load forecasting or energy resource planning, invariably involves a blend of analytical methods and judgement. Management decisions can be improved by the implementation of techniques which permit an increased comprehension of results from analytical models. Even where analytical procedures are not required, decisions can be aided by improving the methods used to examine spatially and temporally variant data. How the use of computer aided planning (CAP) programs and the selection of a predominant data structure, can improve the decision making process is discussed.

Lithium might be associated with better decision-making performance in euthymic bipolar patients.

PubMed

Adida, Marc; Jollant, Fabrice; Clark, Luke; Guillaume, Sebastien; Goodwin, Guy M; Azorin, Jean-Michel; Courtet, Philippe

2015-06-01

Bipolar disorder is associated with impaired decision-making. Little is known about how treatment, especially lithium, influences decision-making abilities in bipolar patients when euthymic. We aimed at testing for an association between lithium medication and decision-making performance in remitted bipolar patients. Decision-making was measured using the Iowa Gambling Task in 3 groups of subjects: 34 and 56 euthymic outpatients with bipolar disorder, treated with lithium (monotherapy and lithium combined with anticonvulsant or antipsychotic) and without lithium (anticonvulsant, antipsychotic and combination treatment), respectively, and 152 matched healthy controls. Performance was compared between the 3 groups. In the 90 euthymic patients, the relationship between different sociodemographic and clinical variables and decision-making was assessed by stepwise multivariate regression analysis. Euthymic patients with lithium (p=0.007) and healthy controls (p=0.001) selected significantly more cards from the safe decks than euthymic patients without lithium, with no significant difference between euthymic patients with lithium and healthy controls (p=0.9). In the 90 euthymic patients, the stepwise linear multivariate regression revealed that decision-making was significantly predicted (p<0.001) by lithium dose, level of education and no family history of bipolar disorder (all p≤0.01). Because medication was not randomized, it was not possible to discriminate the effect of different medications. Lithium medication might be associated with better decision-making in remitted bipolar patients. A randomized trial is required to test for the hypothesis that lithium, but not other mood stabilizers, may specifically improve decision-making abilities in bipolar disorder. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback.

PubMed

Turner, Simon; D'Lima, Danielle; Hudson, Emma; Morris, Stephen; Sheringham, Jessica; Swart, Nick; Fulop, Naomi J

2017-12-04

A range of evidence informs decision-making on innovation in health care, including formal research findings, local data and professional opinion. However, cultural and organisational factors often prevent the translation of evidence for innovations into practice. In addition to the characteristics of evidence, it is known that processes at the individual level influence its impact on decision-making. Less is known about the ways in which processes at the professional, organisational and local system level shape evidence use and its role in decisions to adopt innovations. A systematic scoping review was used to review the health literature on innovations within acute and primary care and map processes at the professional, organisational and local system levels which influence how evidence informs decision-making on innovation. Stakeholder feedback on the themes identified was collected via focus groups to test and develop the findings. Following database and manual searches, 31 studies reporting primary qualitative data met the inclusion criteria: 24 were of sufficient methodological quality to be included in the thematic analysis. Evidence use in decision-making on innovation is influenced by multi-level processes (professional, organisational, local system) and interactions across these levels. Preferences for evidence vary by professional group and health service setting. Organisations can shape professional behaviour by requiring particular forms of evidence to inform decision-making. Pan-regional organisations shape innovation decision-making at lower levels. Political processes at all levels shape the selection and use of evidence in decision-making. The synthesis of results from primary qualitative studies found that evidence use in decision-making on innovation is influenced by processes at multiple levels. Interactions between different levels shape evidence use in decision-making (e.g. professional groups and organisations can use local systems to validate evidence and legitimise innovations, while local systems can tailor or frame evidence to influence activity at lower levels). Organisational leaders need to consider whether the environment in which decisions are made values diverse evidence and stakeholder perspectives. Further qualitative research on decision-making practices that highlights how and why different types of evidence come to count during decisions, and tracks the political aspects of decisions about innovation, is needed.

Affective and cognitive decision-making in adolescents.

PubMed

van Duijvenvoorde, Anna C K; Jansen, Brenda R J; Visser, Ingmar; Huizenga, Hilde M

2010-01-01

Adolescents demonstrate impaired decision-making in emotionally arousing situations, yet they appear to exhibit relatively mature decision-making skills in predominantly cognitive, low-arousal situations. In this study we compared adolescents' (13-15 years) performance on matched affective and cognitive decision-making tasks, in order to determine (1) their performance level on each task and (2) whether performance on the cognitive task was associated with performance on the affective task. Both tasks required a comparison of choice dimensions characterized by frequency of loss, amount of loss, and constant gain. Results indicated that in the affective task, adolescents performed sub-optimally by considering only the frequency of loss, whereas in the cognitive task adolescents used relatively mature decision rules by considering two or all three choice dimensions. Performance on the affective task was not related to performance on the cognitive task. These results are discussed in light of neural developmental trajectories observed in adolescence.

Heuristic decision making in medicine

PubMed Central

Marewski, Julian N.; Gigerenzer, Gerd

2012-01-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care. PMID:22577307

Clinical decision-making by midwives: managing case complexity.

PubMed

Cioffi, J; Markham, R

1997-02-01

In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

Heuristic decision making in medicine.

PubMed

Marewski, Julian N; Gigerenzer, Gerd

2012-03-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care.

The neural basis of belief updating and rational decision making

PubMed Central

Achtziger, Anja; Hügelschäfer, Sabine; Steinhauser, Marco

2014-01-01

Rational decision making under uncertainty requires forming beliefs that integrate prior and new information through Bayes’ rule. Human decision makers typically deviate from Bayesian updating by either overweighting the prior (conservatism) or overweighting new information (e.g. the representativeness heuristic). We investigated these deviations through measurements of electrocortical activity in the human brain during incentivized probability-updating tasks and found evidence of extremely early commitment to boundedly rational heuristics. Participants who overweight new information display a lower sensibility to conflict detection, captured by an event-related potential (the N2) observed around 260 ms after the presentation of new information. Conservative decision makers (who overweight prior probabilities) make up their mind before new information is presented, as indicated by the lateralized readiness potential in the brain. That is, they do not inhibit the processing of new information but rather immediately rely on the prior for making a decision. PMID:22956673

The neural basis of belief updating and rational decision making.

PubMed

Achtziger, Anja; Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Steinhauser, Marco

2014-01-01

Rational decision making under uncertainty requires forming beliefs that integrate prior and new information through Bayes' rule. Human decision makers typically deviate from Bayesian updating by either overweighting the prior (conservatism) or overweighting new information (e.g. the representativeness heuristic). We investigated these deviations through measurements of electrocortical activity in the human brain during incentivized probability-updating tasks and found evidence of extremely early commitment to boundedly rational heuristics. Participants who overweight new information display a lower sensibility to conflict detection, captured by an event-related potential (the N2) observed around 260 ms after the presentation of new information. Conservative decision makers (who overweight prior probabilities) make up their mind before new information is presented, as indicated by the lateralized readiness potential in the brain. That is, they do not inhibit the processing of new information but rather immediately rely on the prior for making a decision.

5 CFR 950.301 - National and international federations eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... firms, advertising agencies or similar business organizations to perform its policy-making or decision... the eligibility requirements of this section. A federation may appeal an adverse eligibility decision...

Health technology funding decision-making processes around the world: the same, yet different.

PubMed

Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

2011-06-01

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

Knowledge Requirements and Management in Expert Decision Support Systems for (Military) Situation Assessment

DTIC Science & Technology

1983-08-01

constitutes a fundamental problem in many decision making processes. In business management we face this problem when determining the status of an...Tehiical Report 576 ( 1 ) 4 KNOWLEDGE REQUIREMENTS AND MANAGEMENT IN EXPERT DECISION SUPPORT SYSTEMS FOR (MILITARY) SITUATION ASSESSMENT MOOM sen...accomplished under contract for the Department of the Army The Israel Institute of Business Research Technical review by Robert H. Sasmor Joseph M

The Association of Patient Chronic Disease Burden and Self-Management Requirements With Shared Decision Making in Primary Care Visits

PubMed Central

Drum, Melinda; Cooper, Lisa A.

2014-01-01

Background: Shared decision making (SDM) is associated with positive health outcomes and may be particularly relevant for patients with chronic disease. Objectives: To investigate whether (1) patients with chronic diseases, particularly those requiring self-management, are more likely to engage in SDM behaviors than patients without chronic diseases and (2) patients with chronic diseases are more likely to have their physicians engage them in SDM. Design: A cross-sectional study of patients who were enrolled in a randomized controlled trial to improve patient–physician communication. Participants: Adult patients with hypertension at community health clinics in Baltimore, Maryland. Approach: We used multivariable regression models to examine the associations of the following predictor variables: (1) chronic disease burden and (2) diseases requiring self-management with the following outcome variables measuring SDM components: (1) patient information sharing, (2) patient decision making, and (3) physician SDM facilitation. Key Results: Patients with greater chronic disease burden and more diseases requiring self-management reported more information sharing (β = .07, P = .03 and β = .12, P = .046, respectively) and decision making (β = .06, P = .02 and β = .21, P < .001) as did patients who reported poor general health. Physician facilitation of SDM was not associated with chronic disease burden or with diseases requiring self-management but was associated with higher patient income. Conclusions: Patients with chronic diseases, particularly those requiring self-management, may be more likely to engage in SDM behaviors, but physicians may not be more likely to engage such patients in SDM. Targeting patients with chronic disease for SDM may improve health outcomes among the chronically ill, particularly among vulnerable patients (eg, minorities, low-income patients) who suffer disproportionately from such conditions. PMID:26640812

[Clinical decision making and critical thinking in the nursing diagnostic process].

PubMed

Müller-Staub, Maria

2006-10-01

The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".

Exploring information provision in reconstructive breast surgery: A qualitative study.

PubMed

Potter, Shelley; Mills, Nicola; Cawthorn, Simon; Wilson, Sherif; Blazeby, Jane

2015-12-01

Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS. Semi-structured interviews with a purposive sample of patients who had undergone RBS and HPs providing specialist care explored participants' experiences of information provision prior to RBS. Professionals reported providing standardised verbal, written and photographic information about the process and outcomes of surgery. Women, by contrast, reported varying levels of information provision. Some felt fully-informed but others perceived they had received insufficient information about available treatment options or possible outcomes of surgery to make an informed decision. Women need adequate information to make informed decisions about RBS and current practice may not meet women's needs. Minimum agreed standards of information provision, especially about alternative types of reconstruction, are recommended to improve decision-making in RBS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Decision-making under risk conditions is susceptible to interference by a secondary executive task.

PubMed

Starcke, Katrin; Pawlikowski, Mirko; Wolf, Oliver T; Altstötter-Gleich, Christine; Brand, Matthias

2011-05-01

Recent research suggests two ways of making decisions: an intuitive and an analytical one. The current study examines whether a secondary executive task interferes with advantageous decision-making in the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps executive functioning. One group of participants performed the original GDT solely, two groups performed either the GDT and a 1-back or a 2-back working memory task as a secondary task simultaneously. Results show that the group which performed the GDT and the secondary task with high executive load (2-back) decided less advantageously than the group which did not perform a secondary executive task. These findings give further evidence for the view that decision-making under risky conditions taps into the rational-analytical system which acts in a serial and not parallel way as performance on the GDT is disturbed by a parallel task that also requires executive resources.

Recognition Decisions from Visual Working Memory Are Mediated by Continuous Latent Strengths

ERIC Educational Resources Information Center

Ricker, Timothy J.; Thiele, Jonathan E.; Swagman, April R.; Rouder, Jeffrey N.

2017-01-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the…

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

ERIC Educational Resources Information Center

Hartley, Roger; Almuhaidib, Saud M. Y.

2007-01-01

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

Making ResourceFULL™ Decisions: A Process Model for Civic Engagement

ERIC Educational Resources Information Center

Radke, Barbara; Chazdon, Scott

2015-01-01

Many public issues are becoming more complex, interconnected, and cannot be resolved by one individual or entity. Research shows an informed decision is not enough. Addressing these issues requires authentic civic engagement (deliberative dialogue) with the public to reach resourceFULL™ decisions--a decision based on diverse sources of information…

76 FR 65512 - Record of Decision Addendum for the Department of Homeland Security Headquarters Consolidation at...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-21

... parts 1500-1508), GSA Order PBS P 1095.1F (Environmental considerations in decision-making, dated... Decision Addendum for the Department of Homeland Security Headquarters Consolidation at St. Elizabeths in...). ACTION: Record of Decision Addendum. SUMMARY: Pursuant to the requirements of the National Environmental...

The value of decision models: Using ecologically based invasive plant management as an example

USDA-ARS?s Scientific Manuscript database

Humans have both fast and slow thought processes which influence our judgment and decision-making. The fast system is intuitive and valuable for decisions which do not require multiple steps or the application of logic or statistics. However, many decisions in natural resources are complex and req...

The Mental Capacity Act 2005: implications for dietetic practice.

PubMed

Lyons, C; Brotherton, A; Stanley, N; Carrahar, M; Manthorpe, J

2007-08-01

The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts.

The Business of Co-Production: Assessing Efforts to Bridge Science and Decision-Making for Adaptation in California

NASA Astrophysics Data System (ADS)

Webber, S.; MacDonald, G. M.

2016-12-01

The last decades have seen scholars argue for a greater integration of science and decision-making in order to more effectively respond to climate change. It has been suggested that overcoming the gap between science, on the one hand, and policy-making and management, on the other, requires building bridges through methods of co-production, creating actionable science, or through boundary organizations. In this paper, we review attempts at co-production for policy-making and management in the context of climate change adaptation in California. Building on field research, including numerous interviews conducted with scientists and decision-makers who are co-producers of adaptation projects, we make three arguments. First, we show that an emphasis on co-production and science-informed climate change adaptation decision-making has bolstered a contract-oriented, and decentralized network-based model of producing climate science. Second, reviewing successes and failures in co-production - as reported in interviews - indicates that it is principally in cases of neatly defined, and spatially and temporarily narrow decision-making contexts, and with highly motivated decision-makers, that climate science is used. Finally, we suggest that the ideas of co-production and actionable science may have increased the institutional and organizational burden at the science-decision interface, lengthening the boundary-organization-chain rather than necessarily facilitating adaptive policy-making and management.

(De)centralization of social support in six Western European countries.

PubMed

Kroneman, Madelon; Cardol, Mieke; Friele, Roland

2012-06-01

Participation of disabled or chronically ill persons into the society may require support in the sense of human or technical aid. In this study we look into the decision making power of governments and the way citizens are involved in these processes. Decision making power can be political, financial and administrative and may be organized at national, regional or local level. This is a cross-sectional descriptive study of the decision making power in Belgium, France, Germany, the Netherlands, Sweden and the United Kingdom in 2010. We focused on acts and regulations for human and technical aids and for making the environment accessible. Several acts and regulations were identified in relation to social support. In the Netherlands and Sweden social support was mainly organized in one act, whereas in the other countries social support was part of several acts or regulations. Citizen's voice appeared to be represented in boards or advisory committees. Descriptions of entitlements varied from explicitly formulated to globally described. The level of decision making power varies between the countries en between the types of decision making power. Citizens' participation is mainly represented through patient associations. Countries with strongly decentralized decision making make use of framework legislation at national level to set general targets or aims. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Useful global-change scenarios: current issues and challenges

NASA Astrophysics Data System (ADS)

Parson, E. A.

2008-10-01

Scenarios are increasingly used to inform global-change debates, but their connection to decisions has been weak and indirect. This reflects the greater number and variety of potential users and scenario needs, relative to other decision domains where scenario use is more established. Global-change scenario needs include common elements, e.g., model-generated projections of emissions and climate change, needed by many users but in different ways and with different assumptions. For these common elements, the limited ability to engage diverse global-change users in scenario development requires extreme transparency in communicating underlying reasoning and assumptions, including probability judgments. Other scenario needs are specific to users, requiring a decentralized network of scenario and assessment organizations to disseminate and interpret common elements and add elements requiring local context or expertise. Such an approach will make global-change scenarios more useful for decisions, but not less controversial. Despite predictable attacks, scenario-based reasoning is necessary for responsible global-change decisions because decision-relevant uncertainties cannot be specified scientifically. The purpose of scenarios is not to avoid speculation, but to make the required speculation more disciplined, more anchored in relevant scientific knowledge when available, and more transparent.

75 FR 6237 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-08

... additional one hour after the decision making cut off time of 5:30 p.m. to submit a CEA to the various.... The Exchange will continue to enforce the 5:30 p.m. decision making requirement, while also allowing..., processing information with respect to, and facilitating transactions in securities, to remove impediments to...

Beyond the Bureaucratic Model: A Study of Power and Autonomy in Educational Decision-Making

ERIC Educational Resources Information Center

Hanson, Mark

1976-01-01

This paper argues that there are at least two decision-making systems in the school: (1) the first reflects mainly school-wide affairs and lends itself to rational, centrally controlled procedures that restrict behaviors to conform with well-programmed events; and (2) the second reflects mainly classroom affairs and requires flexibility and…

Attitudes and Factors that Influence Decision-Making in Adoption from Care in Northern Ireland

ERIC Educational Resources Information Center

Barr, Lily

2004-01-01

This is a small-scale local study aimed at exploring the thinking and attitudes that inform or influence decision-making around proceeding to adoption. It also sought to explore or establish practitioners' views of potential tensions in this area and potential supports. It included open questions, attitudinal questions and required respondents to…

Lost in Search: (Mal-)Adaptation to Probabilistic Decision Environments in Children and Adults

ERIC Educational Resources Information Center

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

2016-01-01

Adaptive decision making in probabilistic environments requires individuals to use probabilities as weights in predecisional information searches and/or when making subsequent choices. Within a child-friendly computerized environment (Mousekids), we tracked 205 children's (105 children 5-6 years of age and 100 children 9-10 years of age) and 103…

Valuing in Decision-Making Ability: Teaching, Learning, and Assessment across the Curriculum and Campus Culture at Alverno College

ERIC Educational Resources Information Center

Eastberg, Jodi R. B.

2011-01-01

For the past 40 years, Alverno College faculty, staff, and students have collaborated in the creation of an integrated learning and assessment model that requires students to demonstrate, and faculty to assess, eight core abilities: Communication, Analysis, Problem Solving, Valuing in Decision-Making, Social Interaction, Developing a Global…

The Decision-Making Process Used by Central Office Administrators as They Implement Full Day Kindergarten

ERIC Educational Resources Information Center

Palte, Suzanne C.

2014-01-01

The State of Michigan, as of 2012-2013, requires school districts to enroll students in full day kindergarten to receive full funding. This study investigated the decision-making process that was used by public school districts to determine kindergarten programs in their district. Specifically, how did administrators and staff members use the…

Treatment decision-making in ductal carcinoma in situ: A mixed methods systematic review of women's experiences and information needs.

PubMed

Rutherford, Claudia; Mercieca-Bebber, Rebecca; Butow, Phyllis; Wu, Jenny Liang; King, Madeleine T

2017-09-01

Decision-making in ductal carcinoma in situ (DCIS) is complex due to the heterogeneity of the disease. This study aimed to understand women's experience of making treatment decisions for DCIS, their information and support needs, and factors that influenced decisions. We searched six electronic databases, conference proceedings, and key authors. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Thematic analysis was used to combine and summarise findings. We identified six themes and 28 subthemes from 18 studies. Women with DCIS have knowledge deficits about DCIS, experience anxiety related to information given at diagnosis and the complexity of decision-making, and have misconceptions regarding risks and outcomes of treatment. Women's decisions are influenced by their understanding of risk, the clinical features of their DCIS, and the benefits and harms of treatment options. Women are dissatisfied with the decisional support available. Informed and shared decision-making in this complex decision setting requires clear communication of information specific to DCIS and individual's, as well as decision support for patients and clinicians. This approach would educate patients and clinicians, and assist clinicians in supporting patients to an evidence-based treatment plan that aligns with individual values and pReferences. Copyright © 2017 Elsevier B.V. All rights reserved.

IBM’s Health Analytics and Clinical Decision Support

PubMed Central

Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

2014-01-01

Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?

PubMed

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

2010-06-01

Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making. Copyright 2010 Elsevier Ltd. All rights reserved.

[How to decide with precision, justice, and equity? Reflections on decision-making in the context of extreme prematurity. Part one: the problematics of decision-making in the context of extreme prematurity].

PubMed

Azria, E; Tsatsaris, V; Moriette, G; Hirsch, E; Schmitz, T; Cabrol, D; Goffinet, F

2007-05-01

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those childs remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care?" is crucial. This work is focused on this problematic of decision making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.

A qualitative analysis of parental decision making for childhood immunisation.

PubMed

Marshall, S; Swerissen, H

1999-10-01

Achieving high rates of childhood immunisation is an important public health aim. Currently, however, immunisation uptake in Australia is disappointing. This qualitative study investigated the factors that influence parental decision making for childhood immunisation, and whether parents' experiences were better conceptualised in terms of static subjective expected utility models or in terms of a more dynamic process. Semi-structured in-depth interviews were conducted with 20 predominantly middle-class mothers--17 immunizers and three non-immunizers, in Melbourne, Victoria, in 1997. The data were then examined using thematic analysis. The results suggested that for these participants the decision regarding childhood immunization was better conceptualized as a dynamic process. The decision required initial consideration, implementation then maintenance. If a better understanding of immunization decision making is to be achieved, future studies must look beyond static frameworks. Clearer insight into the dynamic nature of immunization decision making should assist in the identification of more effective methods of promoting childhood immunization to groups at risk of non-compliance.

A comparative assessment of tools for ecosystem services quantification and valuation

USGS Publications Warehouse

Bagstad, Kenneth J.; Semmens, Darius; Waage, Sissel; Winthrop, Robert

2013-01-01

To enter widespread use, ecosystem service assessments need to be quantifiable, replicable, credible, flexible, and affordable. With recent growth in the field of ecosystem services, a variety of decision-support tools has emerged to support more systematic ecosystem services assessment. Despite the growing complexity of the tool landscape, thorough reviews of tools for identifying, assessing, modeling and in some cases monetarily valuing ecosystem services have generally been lacking. In this study, we describe 17 ecosystem services tools and rate their performance against eight evaluative criteria that gauge their readiness for widespread application in public- and private-sector decision making. We describe each of the tools′ intended uses, services modeled, analytical approaches, data requirements, and outputs, as well time requirements to run seven tools in a first comparative concurrent application of multiple tools to a common location – the San Pedro River watershed in southeast Arizona, USA, and northern Sonora, Mexico. Based on this work, we offer conclusions about these tools′ current ‘readiness’ for widespread application within both public- and private-sector decision making processes. Finally, we describe potential pathways forward to reduce the resource requirements for running ecosystem services models, which are essential to facilitate their more widespread use in environmental decision making.

On ethical (in)decisions experienced by parents of infants in neonatal intensive care.

PubMed

van Manen, Michael A

2014-02-01

This study was a phenomenological investigation of ethical decisions experienced by parents of newborns in neonatal intensive care. I explore the lived meanings of thematic events that speak to the variable ways that ethical situations may be experienced: a decision that was never a choice; a decision as looking for a way out; a decision as thinking and feeling oneself through the consequences; a decision as indecision; and a decision as something that one falls into. The concluding recommendations spell out the need for understanding the experiences of parents whose children require medical care and underscore the tactful sensitivities required of the health care team during moral-ethical decision making.

Decision support for evidence-based integration of disease control: A proof of concept for malaria and schistosomiasis

PubMed Central

Graeden, Ellie; Kerr, Justin; Sorrell, Erin M.; Katz, Rebecca

2018-01-01

Managing infectious disease requires rapid and effective response to support decision making. The decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions, the complexity of current models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available on the internet, including from mobile devices, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present a proof-of-principle method and corresponding prototype tool to provide guidance on how to optimize integration of vertical disease control programs. This method and tool demonstrate significant progress in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control. Author summary Designing and implementing effective programs for infectious disease control requires complex decision-making, informed by an understanding of the diseases, the types of disease interventions and control measures available, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions and support decision-making, the complexity of current models presents a significant barrier to on-the-ground end users. The picture is further complicated when considering approaches for integration of different disease control programs, where co-infection dynamics, treatment interactions, and other variables must also be taken into account. Here, we describe the development of an application available on the internet with a simple user interface, to support on-the-ground decision-making for integrating disease control, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap. This proof-of-concept method and tool demonstrate significant progress in effectively translating the best available scientific models to support pragmatic decision-making on the ground, with the potential to significantly increase the impact and cost-effectiveness of disease control. PMID:29649260

Housing decision making methods for initiation development phase process

NASA Astrophysics Data System (ADS)

Zainal, Rozlin; Kasim, Narimah; Sarpin, Norliana; Wee, Seow Ta; Shamsudin, Zarina

2017-10-01

Late delivery and sick housing project problems were attributed to poor decision making. These problems are the string of housing developer that prefers to create their own approach based on their experiences and expertise with the simplest approach by just applying the obtainable standards and rules in decision making. This paper seeks to identify the decision making methods for housing development at the initiation phase in Malaysia. The research involved Delphi method by using questionnaire survey which involved 50 numbers of developers as samples for the primary stage of collect data. However, only 34 developers contributed to the second stage of the information gathering process. At the last stage, only 12 developers were left for the final data collection process. Finding affirms that Malaysian developers prefer to make their investment decisions based on simple interpolation of historical data and using simple statistical or mathematical techniques in producing the required reports. It was suggested that they seemed to skip several important decision-making functions at the primary development stage. These shortcomings were mainly due to time and financial constraints and the lack of statistical or mathematical expertise among the professional and management groups in the developer organisations.

Conceptualizing Couples’ Decision Making in PGD: Emerging Cognitive, Emotional, and Moral Dimensions

PubMed Central

Hershberger, Patricia E.; Pierce, Penny F.

2009-01-01

Objective To illuminate and synthesize what is known about the underlying decision making processes surrounding couples’ preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice. Methods This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals’ perceptions of couples’ decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis. Results The conceptual framework formulated from the review demonstrates that couples’ PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments. Conclusion Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions and incorporate moral perspectives into their decision making about whether or not to use PGD. Practice Implications The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions. PMID:20060677

Age differences in the effects of conscious and unconscious thought in decision making.

PubMed

Queen, Tara L; Hess, Thomas M

2010-06-01

The roles of unconscious and conscious thought in decision making were investigated to examine both (a) boundary conditions associated with the efficacy of each type of thought and (b) age differences in intuitive versus deliberative thought. Participants were presented with 2 decision tasks, one requiring active deliberation and the other intuitive processing. Young and older adults then engaged in conscious or unconscious thought processing before making a decision. A manipulation check revealed that young adults were more accurate in their representations of the decision material than older adults, which accounted for much of the age-related variation in performance when the full sample was considered. When only accurate participants were considered, decision making was best when there was congruence between the nature of the information and the thought condition. Thus, unconscious thought was more appropriate when participants relied on intuitive rather than deliberative processing to make their decision, whereas the converse was true with conscious thought. Although older adults displayed somewhat less efficient deliberative processing, their ability to process information at the intuitive level was relatively preserved. Additionally, both young and older adults displayed choice-supportive memory. (c) 2010 APA, all rights reserved

Functional specialization of the primate frontal cortex during decision making.

PubMed

Lee, Daeyeol; Rushworth, Matthew F S; Walton, Mark E; Watanabe, Masataka; Sakagami, Masamichi

2007-08-01

Economic theories of decision making are based on the principle of utility maximization, and reinforcement-learning theory provides computational algorithms that can be used to estimate the overall reward expected from alternative choices. These formal models not only account for a large range of behavioral observations in human and animal decision makers, but also provide useful tools for investigating the neural basis of decision making. Nevertheless, in reality, decision makers must combine different types of information about the costs and benefits associated with each available option, such as the quality and quantity of expected reward and required work. In this article, we put forward the hypothesis that different subdivisions of the primate frontal cortex may be specialized to focus on different aspects of dynamic decision-making processes. In this hypothesis, the lateral prefrontal cortex is primarily involved in maintaining the state representation necessary to identify optimal actions in a given environment. In contrast, the orbitofrontal cortex and the anterior cingulate cortex might be primarily involved in encoding and updating the utilities associated with different sensory stimuli and alternative actions, respectively. These cortical areas are also likely to contribute to decision making in a social context.

Clinical decision-making described by Swedish prehospital emergency care nurse students - An exploratory study.

PubMed

Nilsson, Tomas; Lindström, Veronica

2016-07-01

The purpose of this study was to explore the PECN students' clinical decision-making during a seven-week clinical rotation in the ambulance services. Developing expertise in prehospital emergency care practices requires both theoretical and empirical learning. A prehospital emergency care nurse (PECN) is a Registered Nurse (RN) with one year of additional training in emergency care. There has been little investigation of how PECN students describe their decision-making during a clinical rotation. A qualitative study design was used, and 12 logbooks written by the Swedish PECN students were analysed using content analysis. The students wrote about 997 patient encounters - ambulance assignments during their clinical rotation. Four themes emerged as crucial for the students' decision-making: knowing the patient, the context-situation awareness in the ambulance service, collaboration, and evaluation. Based on the themes, students made decisions on how to respond to patients' illnesses. The PECN students used several variables in their decision-making. The decision- making was an on-going process during the whole ambulance assignment. The university has the responsibility to guide the students during their transition from an RN to a PECN. The findings of the study can support the educators and clinical supervisors in developing the programme of study for becoming a PECN. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of Implicit Perceptual-Motor Training on Decision-Making Skills and Underpinning Gaze Behavior in Combat Athletes.

PubMed

Milazzo, Nicolas; Farrow, Damian; Fournier, Jean F

2016-08-01

This study investigated the effect of a 12-session, implicit perceptual-motor training program on decision-making skills and visual search behavior of highly skilled junior female karate fighters (M age = 15.7 years, SD = 1.2). Eighteen participants were required to make (physical or verbal) reaction decisions to various attacks within different fighting scenarios. Fighters' performance and eye movements were assessed before and after the intervention, and during acquisition through the use of video-based and on-mat decision-making tests. The video-based test revealed that following training, only the implicit perceptual-motor group (n = 6) improved their decision-making accuracy significantly compared to a matched motor training (placebo, n = 6) group and a control group (n = 6). Further, the implicit training group significantly changed their visual search behavior by focusing on fewer locations for longer durations. In addition, the session-by-session analysis showed no significant improvement in decision accuracy between training session 1 and all the other sessions, except the last one. Coaches should devote more practice time to implicit learning approaches during perceptual-motor training program to achieve significant decision-making improvements and more efficient visual search strategy with elite athletes. © The Author(s) 2016.

Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

PubMed

Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

2017-12-01

People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

Translational Cognition for Decision Support in Critical Care Environments: A Review

PubMed Central

Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.

2008-01-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

Age Differences in the Effects of Conscious and Unconscious Thought in Decision Making

PubMed Central

Queen, Tara L.; Hess, Thomas M.

2010-01-01

The roles of unconscious and conscious thought in decision making were investigated to examine both (a) boundary conditions associated with the efficacy of each type of thought and (b) age differences in intuitive versus deliberative thought. Participants were presented with two decision tasks, one requiring active deliberation and the other intuitive processing. Younger and older adults then engaged in conscious or unconscious thought processing before making a decision. A manipulation check revealed that younger adults were more accurate in their representations of the decision material than older adults, which accounted for much of the age-related variation in performance when the full sample was considered. When only considering accurate participants, decision making was best when there was congruence between the nature of the information and the thought condition. Thus, unconscious thought was more appropriate when the decision relied on intuitive rather than deliberative processing, whereas the converse was true with conscious thought. Although older adults displayed somewhat less efficient deliberative processing, their ability to process information at the intuitive level was relatively preserved. Additionally, both young and older adults displayed choice-supportive memory. PMID:20545411

Translational cognition for decision support in critical care environments: a review.

PubMed

Patel, Vimla L; Zhang, Jiajie; Yoskowitz, Nicole A; Green, Robert; Sayan, Osman R

2008-06-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors.

PubMed

Yamamoto, Sena; Arao, Harue; Masutani, Eiko; Aoki, Miwa; Kishino, Megumi; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-05-01

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P < 0.001). Multiple regression analyses revealed that higher burden was associated with selecting a place of EOL care that differed from that desired by participants (P < 0.001) and patients (P = 0.034), decision making without knowing the patient's wishes and values (P < 0.001) and without participants sharing their wishes and values with the patient's doctors and/or nurses (P = 0.022), and making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed

Eliott, Jaklin A; Olver, Ian

2011-06-01

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

Factors influencing nurses' judgements about self-neglect cases.

PubMed

Lauder, W; Ludwick, R; Zeller, R; Winchell, J

2006-06-01

From the perspective of the practising nurse self-neglect may best be understood in terms of a set of complex and often poorly defined clinical problems in which two key clinical issues are "how do I judge whether this person has the capacity to make decisions about their lifestyle?" and "do we need to treat this person using mental health legislation?" These are taxing questions as judging if a patient has the capacity to make decisions about their lifestyle choices is difficult for even the most experienced clinicians. Such determinations require nurses to form a judgement as to mental capacity of the patient. We do not know what patient characteristics and in what combination nurses use these when making these judgements. This factorial survey aimed to identify which patient characteristics influenced Registered Nurses' judgements on decision-making capacity and decisions on the use of interventions which require statutory interventions in cases of self-neglect. Judgements on decision-making capacity were overwhelmingly predicted by information of the patients' mental health status. Nurses place patients in one of three broad categories of no mental illness, minor mental illness and severe mental illness. This categorization appears to operate as a fast and frugal heuristic indicating that nurses may use mental status as a cognitive screen to work from in judging self-neglect. Although there is a correlation between the severity of mental illness and the capacity for making decisions they are not the same. This study shows the continued work that needs done in educating nurses not only about self-neglect but also about the role a patient's mental status may have in assessment of problems.

Human Decision Making Based on Variations in Internal Noise: An EEG Study

PubMed Central

Amitay, Sygal; Guiraud, Jeanne; Sohoglu, Ediz; Zobay, Oliver; Edmonds, Barrie A.; Zhang, Yu-Xuan; Moore, David R.

2013-01-01

Perceptual decision making is prone to errors, especially near threshold. Physiological, behavioural and modeling studies suggest this is due to the intrinsic or ‘internal’ noise in neural systems, which derives from a mixture of bottom-up and top-down sources. We show here that internal noise can form the basis of perceptual decision making when the external signal lacks the required information for the decision. We recorded electroencephalographic (EEG) activity in listeners attempting to discriminate between identical tones. Since the acoustic signal was constant, bottom-up and top-down influences were under experimental control. We found that early cortical responses to the identical stimuli varied in global field power and topography according to the perceptual decision made, and activity preceding stimulus presentation could predict both later activity and behavioural decision. Our results suggest that activity variations induced by internal noise of both sensory and cognitive origin are sufficient to drive discrimination judgments. PMID:23840904

Emotion and decision making: multiple modulatory neural circuits.

PubMed

Phelps, Elizabeth A; Lempert, Karolina M; Sokol-Hessner, Peter

2014-01-01

Although the prevalent view of emotion and decision making is derived from the notion that there are dual systems of emotion and reason, a modulatory relationship more accurately reflects the current research in affective neuroscience and neuroeconomics. Studies show two potential mechanisms for affect's modulation of the computation of subjective value and decisions. Incidental affective states may carry over to the assessment of subjective value and the decision, and emotional reactions to the choice may be incorporated into the value calculation. In addition, this modulatory relationship is reciprocal: Changing emotion can change choices. This research suggests that the neural mechanisms mediating the relation between affect and choice vary depending on which affective component is engaged and which decision variables are assessed. We suggest that a detailed and nuanced understanding of emotion and decision making requires characterizing the multiple modulatory neural circuits underlying the different means by which emotion and affect can influence choices.

Medical students, clinical preventive services, and shared decision-making.

PubMed

Keefe, Carole W; Thompson, Margaret E; Noel, Mary Margaret

2002-11-01

Improving access to preventive care requires addressing patient, provider, and systems barriers. Patients often lack knowledge or are skeptical about the importance of prevention. Physicians feel that they have too little time, are not trained to deliver preventive services, and are concerned about the effectiveness of prevention. We have implemented an educational module in the required family practice clerkship (1) to enhance medical student learning about common clinical preventive services and (2) to teach students how to inform and involve patients in shared decision making about those services. Students are asked to examine available evidence-based information for preventive screening services. They are encouraged to look at the recommendations of various organizations and use such resources as reports from the U.S. Preventive Services Task Force to determine recommendations they want to be knowledgeable about in talking with their patients. For learning shared decision making, students are trained to use a model adapted from Braddock and colleagues(1) to discuss specific screening services and to engage patients in the process of making informed decisions about what is best for their own health. The shared decision making is presented and modeled by faculty, discussed in small groups, and students practice using Web-based cases and simulations. The students are evaluated using formative and summative performance-based assessments as they interact with simulated patients about (1) screening for high blood cholesterol and other lipid abnormalities, (2) screening for colorectal cancer, (3) screening for prostate cancer, and (4) screening for breast cancer. The final student evaluation is a ten-minute, videotaped discussion with a simulated patient about screening for colorectal cancer that is graded against a checklist that focuses primarily on the elements of shared decision making. Our medical students appear quite willing to accept shared decision making as a skill that they should have in working with patients, and this was the primary focus of the newly implemented module. However, we have learned that students need to deepen their understanding of screening services in order to help patients understand the associated benefits and risks. The final videotaped interaction with a simulated patient about colorectal cancer screening has been very helpful in making it more obvious to faculty what students believe and know about screening for colorectal cancer. As the students are asked to discuss clinical issues with patients and discuss the pros and cons of screening tests as part of the shared decision-making process, their thinking becomes transparent and it is evident where curricular changes and enhancements are required. We have found that an explicit model that allows students to demonstrate a process for shared decision making is a good introductory tool. We think it would be helpful to provide students with more formative feedback. We would like to develop faculty development programs around shared decision making so that more of our clinical faculty would model such a process with patients. Performance-based assessments are resource-intensive, but they appear to be worth the added effort in terms of enhanced skills development and a more comprehensive appraisal of student learning.

Structured decision making as a method for linking quantitative decision support to community fundamental objectives

EPA Science Inventory

Decision support intended to improve ecosystem sustainability requires that we link stakeholder priorities directly to quantitative tools and measures of desired outcomes. Actions taken at the community level can have large impacts on production and delivery of ecosystem service...

TYPES OF INTEGRATION IN RISK ASSESSMENT AND MANAGEMENT, AND WHY THEY ARE NEEDED

EPA Science Inventory

Risk-based decision making requires that the decision makers and stakeholders are informed of all risks that are potentially significant and relevant to the decision. The International Programme on Chemical Safety of the World Health Organization has developed a framework for int...

40 CFR 92.216 - Hearing procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... would have in making the initial decision including the discretion to require or allow briefs, oral... expedite proceedings, the Administrator may direct that the decision of the Presiding Officer (who may, but need not be, the Administrator) shall be the final EPA decision. (b)(1) Upon his/her appointment...

Dissociable contributions of anterior cingulate cortex and basolateral amygdala on a rodent cost/benefit decision-making task of cognitive effort.

PubMed

Hosking, Jay G; Cocker, Paul J; Winstanley, Catharine A

2014-06-01

Personal success often requires the choice to expend greater effort for larger rewards, and deficits in such effortful decision making accompany a number of illnesses including depression, schizophrenia, and attention-deficit/hyperactivity disorder. Animal models have implicated brain regions such as the basolateral amygdala (BLA) and anterior cingulate cortex (ACC) in physical effort-based choice, but disentangling the unique contributions of these two regions has proven difficult, and effort demands in industrialized society are predominantly cognitive in nature. Here we utilize the rodent cognitive effort task (rCET), a modification of the five-choice serial reaction-time task, wherein animals can choose to expend greater visuospatial attention to obtain larger sucrose rewards. Temporary inactivation (via baclofen-muscimol) of BLA and ACC showed dissociable effects: BLA inactivation caused hard-working rats to 'slack off' and 'slacker' rats to work harder, whereas ACC inactivation caused all animals to reduce willingness to expend mental effort. Furthermore, BLA inactivation increased the time needed to make choices, whereas ACC inactivation increased motor impulsivity. These data illuminate unique contributions of BLA and ACC to effort-based decision making, and imply overlapping yet distinct circuitry for cognitive vs physical effort. Our understanding of effortful decision making may therefore require expanding our models beyond purely physical costs.

Internet use and decision making in community-based older adults

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Yu, Lei; Bennett, David A.

2013-01-01

Use of the internet may provide tools and resources for better decision making, yet little is known about the association of internet use with decision making in older persons. We examined this relationship in 661 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Participants were asked to report if they had access to the internet and how frequently they used the internet and email. A 12-item instrument was used to assess financial and healthcare decision making using materials designed to approximate those used in real world settings. Items were summed to yield a total decision making score. Associations were tested via linear regression models adjusted for age, sex, race, education, and a measure of global cognitive function. Secondary models further adjusted for income, depression, loneliness, social networks, social support, chronic medical conditions, instrumental activities of daily living (IADLs), life space size, and health and financial literacy. Interaction terms were used to test for effect modification. Almost 70% of participants had access to the internet, and of those with access, 55% used the internet at least several times a week. Higher frequency of internet use was associated with better financial and healthcare decision making (β = 0.11, p = 0.002). The association persisted in a fully adjusted model (β = 0.08, p = 0.024). Interaction models indicated that higher frequency of internet use attenuated the relationships of older age, poorer cognitive function, and lower levels of health and financial literacy with poorer healthcare and financial decision making. These findings indicate that internet use is associated with better health and financial decision making in older persons. Future research is required to understand whether promoting the use of the internet can produce improvements in healthcare and financial decision making. PMID:24578696

How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario.

PubMed

Gregory, Paul A M; Whyte, Brenna; Austin, Zubin

2016-03-01

As the complexity of pharmacy practice increases, pharmacists are required to make more decisions under ambiguous or information-deficient conditions. There is scant literature examining how pharmacists make decisions and what factors or values influence their choices. The objective of this exploratory research was to characterize decision-making patterns in the clinical setting of community pharmacists in Ontario. The think-aloud decision-making method was used for this study. Community pharmacists with 3 or more years' experience were presented with 2 clinical case studies dealing with challenging situations and were asked to verbally reason through their decision-making process while being probed by an interviewer for clarification, justification and further explication. Verbatim transcripts were analyzed using a protocol analysis method. A total of 12 pharmacists participated in this study. Participants experienced cognitive dissonance in attempting to reconcile their desire for a clear and confrontation-free conclusion to the case discussion and the reality of the challenge presented within each case. Strategies for resolving this cognitive dissonance included strong emphasis on the educational (rather than decision-making) role of the pharmacist, the value of strong interpersonal relationships as a way to avoid conflict and achieve desired outcomes, the desire to seek external advice or defer to others' authority to avoid making a decision and the use of strict interpretations of rules to avoid ambiguity and contextual interpretation. This research was neither representative nor generalizable but was indicative of patterns of decisional avoidance and fear of assuming responsibility for outcomes that warrant further investigation. The think-aloud method functioned effectively in this context and provided insights into pharmacists' decision-making patterns in the clinical setting. Can Pharm J (Ott) 2016;149:90-98.

Who does the numbers? The role of third-party technology assessment to inform health systems' decision-making about the funding of health technologies.

PubMed

Barbieri, Marco; Hawkins, Neil; Sculpher, Mark

2009-01-01

There is an increasing number of health-care systems using economic evaluations to inform decisions about the reimbursement of health technologies. There are usually two separate elements of this process: assembling relevant evidence and undertaking analyses (technology assessment), and decision-making. In most systems, technology assessment is undertaken by the manufacturer of the technology. In a few, "third-party" assessment is used. In the United Kingdom, the National Institute for Health and Clinical Excellence used a combination of third-party and manufacturer assessments between 1999 and 2005. After this point, a Single Technology Appraisal program (using manufacturer-based assessment) was instituted for some technologies. Here the role of third-party assessment is considered in this from of decision-making. The article reviews the requirements of economic evaluation to support decision-making, and considers the extent to which each type of assessment is likely to meet these requirements. It also attempts to address whether the two forms of assessment differ in their impact on decision-making using a comparison of the decisions made by National Institute for Health and Clinical Excellence (NICE) (under its multiple-technology appraisal system) and the Scottish Medicines Consortium (SMC), which relies on manufacturer assessment. The comparison is limited by the small number of technologies considered by both bodies. Nevertheless, it suggests that there are potentially important differences between the two bodies, with NICE generally placing more restrictions of the use of technologies. The article concludes that there are potential advantages to third-party assessment, but its cost and timing may preclude its use for all new technologies. A hybrid arrangement is suggested where third-party assessment is used in particular circumstances.

Retooling the nurse executive for 21st century practice: decision support systems.

PubMed

Fralic, M F; Denby, C B

2000-01-01

Health care financing and care delivery systems are changing at almost warp speed. This requires new responses and new capabilities from contemporary nurse executives and calls for new approaches to the preparation of the next generation of nursing leaders. The premise of this article is that, in these highly unstable environments, the nurse executive faces the need to make high-impact decisions in relatively short time frames. A standardized process for objective decision making becomes essential. This article describes that process.

The evaluation of lifestyle interventions in the Netherlands.

PubMed

Rappange, David R; Brouwer, Werner B F

2012-04-01

Current investments in preventive lifestyle interventions are relatively low, despite the significant impact of unhealthy behaviour on population health. This raises the question of whether the criteria used in reimbursement decisions about healthcare interventions put preventive interventions at a disadvantage. In this paper, we highlight the decision-making framework used in the Netherlands to delineate the basic benefits package. Important criteria in that framework are 'necessity' and 'cost-effectiveness'. Several normative choices need to be made, and these choices can have an important impact on the evaluation of lifestyle interventions, especially when making these criteria operational and quantifiable. Moreover, the implementation of the decision-making framework may prove to be difficult for lifestyle interventions. Improvements of the decision-making framework in the Netherlands are required to guarantee sound evaluations of lifestyle interventions aimed at improving health.

Developing a Software for Fuzzy Group Decision Support System: A Case Study

ERIC Educational Resources Information Center

Baba, A. Fevzi; Kuscu, Dincer; Han, Kerem

2009-01-01

The complex nature and uncertain information in social problems required the emergence of fuzzy decision support systems in social areas. In this paper, we developed user-friendly Fuzzy Group Decision Support Systems (FGDSS) software. The software can be used for multi-purpose decision making processes. It helps the users determine the main and…

Mitigating Circumstances in Death Penalty Decisions: Using Evidence-Based Research to Inform Social Work Practice in Capital Trials

ERIC Educational Resources Information Center

Schroeder, Julie; Guin, Cecile C.; Pogue, Rene; Bordelon, Danna

2006-01-01

Providing an effective defense for individuals charged with capital crimes requires a diligent, thorough investigation by a mitigation specialist. However, research suggests that mitigation often plays a small role in the decision for life. Jurors often make sentencing decisions prematurely, basing those decisions on their personal reactions to…

A Tri-Reference Point Theory of Decision Making under Risk

ERIC Educational Resources Information Center

Wang, X. T.; Johnson, Joseph G.

2012-01-01

The tri-reference point (TRP) theory takes into account minimum requirements (MR), the status quo (SQ), and goals (G) in decision making under risk. The 3 reference points demarcate risky outcomes and risk perception into 4 functional regions: success (expected value of x greater than or equal to G), gain (SQ less than x less than G), loss (MR…

30 CFR 250.270 - What decisions will MMS make on the DPP or DOCD and within what timeframe?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., REGULATION, AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Review and Decision Process for the Dpp Or Docd § 250.270... provide monitoring information. (2) Require you to modify your proposed DPP or DOCD It fails to make...

RPA Field Simulations:Dilemma Training for Legal and Ethical Decision Making

DTIC Science & Technology

2015-11-07

Simulation  Two phases in RPA Field Simulation – classroom phase and field phase  Purpose: link theoretical understanding/ moral reasoning with...rapid, informed decision-making/ moral behavior IRREGULAR WARFARE  U.S. dominates conventional warfare, but irregular warfare falls under Things...aspects: Mental simulation of action Modify Implement Will it work? MORAL REASONING/BEHAVIOR Military-Leader Responsibility requires

Communicating with the Coroner: How Religion, Culture, and Family Concerns May Influence Autopsy Decision Making

ERIC Educational Resources Information Center

Carpenter, Belinda; Tait, Gordon; Adkins, Glenda; Barnes, Michael; Naylor, Charles; Begum, Nelufa

2011-01-01

Based on coronial data gathered in the state of Queensland in 2004, this article reviews how a change in legislation may have impacted autopsy decision making by coroners. More specifically, the authors evaluated whether the requirement that coronial autopsy orders specify the level of invasiveness of an autopsy to be performed by a pathologist…

Toward Accountable Discrimination-Aware Data Mining: The Importance of Keeping the Human in the Loop-and Under the Looking Glass.

PubMed

Berendt, Bettina; Preibusch, Sören

2017-06-01

"Big Data" and data-mined inferences are affecting more and more of our lives, and concerns about their possible discriminatory effects are growing. Methods for discrimination-aware data mining and fairness-aware data mining aim at keeping decision processes supported by information technology free from unjust grounds. However, these formal approaches alone are not sufficient to solve the problem. In the present article, we describe reasons why discrimination with data can and typically does arise through the combined effects of human and machine-based reasoning, and argue that this requires a deeper understanding of the human side of decision-making with data mining. We describe results from a large-scale human-subjects experiment that investigated such decision-making, analyzing the reasoning that participants reported during their task to assess whether a loan request should or would be granted. We derive data protection by design strategies for making decision-making discrimination-aware in an accountable way, grounding these requirements in the accountability principle of the European Union General Data Protection Regulation, and outline how their implementations can integrate algorithmic, behavioral, and user interface factors.

Technology Infusion Challenges from a Decision Support Perspective

NASA Technical Reports Server (NTRS)

Adumitroaie, V.; Weisbin, C. R.

2009-01-01

In a restricted science budget environment and increasingly numerous required technology developments, the technology investment decisions within NASA are objectively more and more difficult to make such that the end results are satisfying the technical objectives and all the organizational constraints. Under these conditions it is rationally desirable to build an investment portfolio, which has the highest possible technology infusion rate. Arguably the path to infusion is subject to many influencing factors, but here only the challenges associated with the very initial stages are addressed: defining the needs and the subsequent investment decision-support process. It is conceivable that decision consistency and possibly its quality suffer when the decision-making process has limited or no traceability. This paper presents a structured decision-support framework aiming to provide traceable, auditable, infusion- driven recommendations towards a selection process in which these recommendations are used as reference points in further discussions among stakeholders. In this framework addressing well-defined requirements, different measures of success can be defined based on traceability to specific selection criteria. As a direct result, even by using simplified decision models the likelihood of infusion can be probed and consequently improved.

A new decision sciences for complex systems.

PubMed

Lempert, Robert J

2002-05-14

Models of complex systems can capture much useful information but can be difficult to apply to real-world decision-making because the type of information they contain is often inconsistent with that required for traditional decision analysis. New approaches, which use inductive reasoning over large ensembles of computational experiments, now make possible systematic comparison of alternative policy options using models of complex systems. This article describes Computer-Assisted Reasoning, an approach to decision-making under conditions of deep uncertainty that is ideally suited to applying complex systems to policy analysis. The article demonstrates the approach on the policy problem of global climate change, with a particular focus on the role of technology policies in a robust, adaptive strategy for greenhouse gas abatement.

Healthy eating decisions require efficient dietary self-control in children: A mouse-tracking food decision study.

PubMed

Ha, Oh-Ryeong; Bruce, Amanda S; Pruitt, Stephen W; Cherry, J Bradley C; Smith, T Ryan; Burkart, Dominic; Bruce, Jared M; Lim, Seung-Lark

2016-10-01

Learning how to make healthy eating decisions, (i.e., resisting unhealthy foods and consuming healthy foods), enhances physical development and reduces health risks in children. Although healthy eating decisions are known to be challenging for children, the mechanisms of children's food choice processes are not fully understood. The present study recorded mouse movement trajectories while eighteen children aged 8-13 years were choosing between eating and rejecting foods. Children were inclined to choose to eat rather than to reject foods, and preferred unhealthy foods over healthy foods, implying that rejecting unhealthy foods could be a demanding choice. When children rejected unhealthy foods, mouse trajectories were characterized by large curvature toward an eating choice in the beginning, late decision shifting time toward a rejecting choice, and slowed response times. These results suggested that children exercised greater cognitive efforts with longer decision times to resist unhealthy foods, providing evidence that children require dietary self-control to make healthy eating-decisions by resisting the temptation of unhealthy foods. Developmentally, older children attempted to exercise greater cognitive efforts for consuming healthy foods than younger children, suggesting that development of dietary self-control contributes to healthy eating-decisions. The study also documents that healthy weight children with higher BMIs were more likely to choose to reject healthy foods. Overall, findings have important implications for how children make healthy eating choices and the role of dietary self-control in eating decisions. Published by Elsevier Ltd.

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

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

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

2011-04-15

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

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department

PubMed Central

Melnick, Edward R.; Lopez, Kevin; Hess, Erik P.; Abujarad, Fuad; Brandt, Cynthia A.; Shiffman, Richard N.; Post, Lori A.

2015-01-01

Context: Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider’s already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts. Case Description: This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing. Lessons Learned: We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility. Conclusions: Successful implementation of this tool will require seamless integration into the provider’s workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well. PMID:26290885

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department.

PubMed

Melnick, Edward R; Lopez, Kevin; Hess, Erik P; Abujarad, Fuad; Brandt, Cynthia A; Shiffman, Richard N; Post, Lori A

2015-01-01

Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider's already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts. This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing. We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility. Successful implementation of this tool will require seamless integration into the provider's workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well.

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

PubMed Central

Eliott, Jaklin A.; Olver, Ian

2011-01-01

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

Learning chemistry from text: The effect of decision making

NASA Astrophysics Data System (ADS)

Pedersen, Jon; J., Ronald; Alice, Bonnstetter; Corkill, J.; Glover, John A.

Two experiments examined the relative effects of questions requiring decisions, statements providing the decision information to students, questions not requiring decisions, and control procedures on students' memory for chemistry text reading materials. Experiment 1 employed immediate recall. The results of Experiment 1 indicated that students who made and justified decisions about the contents recalled significantly more information than students in any other condition. In addition, students who answered questions that did not require decisions recalled significantly more of the content than students in the control or the statements conditions. No other contrasts reached significance. Experiment 2 employed delayed recall assessed one week after reading. The results confirmed those of Experiment 1. The overall results of the study are discussed in terms of an elaboration perspective on memory.

NASA Risk-Informed Decision Making Handbook

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Stamatelatos, Michael; Maggio, Gaspare; Everett, Christopher; Youngblood, Robert; Rutledge, Peter; Benjamin, Allan; Williams, Rodney; Smith, Curtis; Guarro, Sergio

2010-01-01

This handbook provides guidance for conducting risk-informed decision making in the context of NASA risk management (RM), with a focus on the types of direction-setting key decisions that are characteristic of the NASA program and project life cycles, and which produce derived requirements in accordance with existing systems engineering practices that flow down through the NASA organizational hierarchy. The guidance in this handbook is not meant to be prescriptive. Instead, it is meant to be general enough, and contain a sufficient diversity of examples, to enable the reader to adapt the methods as needed to the particular decision problems that he or she faces. The handbook highlights major issues to consider when making decisions in the presence of potentially significant uncertainty, so that the user is better able to recognize and avoid pitfalls that might otherwise be experienced.

Decision support systems for ecosystem management: An evaluation of existing systems

Treesearch

H. Todd Mowrer; Klaus Barber; Joe Campbell; Nick Crookston; Cathy Dahms; John Day; Jim Laacke; Jim Merzenich; Steve Mighton; Mike Rauscher; Rick Sojda; Joyce Thompson; Peter Trenchi; Mark Twery

1997-01-01

This report evaluated 24 computer-aided decision support systems (DSS) that can support management decision-making in forest ecosystems. It compares the scope of each system, spatial capabilities, computational methods, development status, input and output requirements, user support availability, and system performance. Questionnaire responses from the DSS developers (...

Exploring the Decision Landscape: Integration of Human and Natural Systems Using the Driver-Pressure-State-Impact-Response Framework and Dynamic Web Application

EPA Science Inventory

Making decisions to increase community or regional sustainability requires a comprehensive understanding of the linkages between environmental, social, and economic systems. We present a visualization tool that can improve decision processes and improve interdisciplinary research...

40 CFR 86.444-78 - Hearings on certification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... have in making the initial decision including the discretion to require or allow briefs, oral argument... the decision of the Presiding Officer (who may, but need not be the Administrator himself) shall be the final EPA decision. (b)(1) Upon his appointment pursuant to paragraph (a) of this section, the...

40 CFR 89.128 - Hearing procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... he or she would have in making the initial decision, including the discretion to require or allow... proceedings, the Administrator may direct that the decision of the Presiding Officer (who may, but need not, be the Administrator) shall be the final EPA decision. (b)(1) Upon appointment pursuant to paragraph...

40 CFR 86.078-6 - Hearings on certification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... have in making the initial decision including the discretion to require or allow briefs, oral argument... decision of the Presiding Officer (who may, but need not be the Administrator himself) shall be the final EPA decision. (b)(1) Upon his appointment pursuant to paragraph (a) of this section, the Presiding...

40 CFR 94.216 - Hearing procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... would have in making the initial decision including the discretion to require or allow briefs, oral... proceedings, the Administrator may direct that the decision of the Presiding Officer (who may, but need not be the Administrator) shall be the final EPA decision. (b)(1) Upon his/her appointment pursuant to...

Systems resilience for multihazard environments: definition, metrics, and valuation for decision making.

PubMed

Ayyub, Bilal M

2014-02-01

The United Nations Office for Disaster Risk Reduction reported that the 2011 natural disasters, including the earthquake and tsunami that struck Japan, resulted in $366 billion in direct damages and 29,782 fatalities worldwide. Storms and floods accounted for up to 70% of the 302 natural disasters worldwide in 2011, with earthquakes producing the greatest number of fatalities. Average annual losses in the United States amount to about $55 billion. Enhancing community and system resilience could lead to massive savings through risk reduction and expeditious recovery. The rational management of such reduction and recovery is facilitated by an appropriate definition of resilience and associated metrics. In this article, a resilience definition is provided that meets a set of requirements with clear relationships to the metrics of the relevant abstract notions of reliability and risk. Those metrics also meet logically consistent requirements drawn from measure theory, and provide a sound basis for the development of effective decision-making tools for multihazard environments. Improving the resiliency of a system to meet target levels requires the examination of system enhancement alternatives in economic terms, within a decision-making framework. Relevant decision analysis methods would typically require the examination of resilience based on its valuation by society at large. The article provides methods for valuation and benefit-cost analysis based on concepts from risk analysis and management. © 2013 Society for Risk Analysis.

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

PubMed

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

2018-03-24

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

Fuzzy-based decision strategy in real-time strategic games

NASA Astrophysics Data System (ADS)

Volna, Eva

2017-11-01

The aim of this article is to describe our own gaming artificial intelligence for OpenTTD, which is a real-time building strategy game. A multi-agent system with fuzzy decision-making was used for the proposal itself. The multiagent system was chosen because real-time strategy games achieve great complexity and require decomposition of the problem into individual problems, which are then solved by individual cooperating agents. The system becomes then more stable and easily expandable. The fuzzy approach makes the decision-making process of strategies easier thanks to the use of uncertainty. In the conclusion, own experimental results were compared with other approaches.

Interpretation of 'Unnatural death' in coronial law: A review of the English legal process of decision making, statutory interpretation, and case law: The implications for medical cases and coronial consistency.

PubMed

Harris, Andrew; Walker, Andrew

2018-04-23

The article examines the decision-making process for medical reporting of deaths to a coroner and the statutory basis for coronial decisions whether to investigate. It analyses what is published about the consistency of decision making of coroners and discusses what should be the legal basis for determining whether a particular death is natural or unnatural in English law. There is a review of English case law, including the significance of Touche and Benton and the development of 'unnatural' as a term of art, which informs what the courts have held to be an unnatural death. What case law indicates about multiple causes and the significance of the wording in the Coroners & Justice Act 2009 that triggers an investigation are considered. It highlights the importance of considering the medical cause of death and to what extent information other than the initial death report is required, before making the decision that the coroner's duty to open an investigation is triggered. The article concludes that a two-stage test is required. Firstly, is the cause of death medically unnatural? Secondly, whether the circumstances themselves are unnatural or such as to make a medically natural cause of death unnatural. If the coroner has reason to suspect the medical cause of death is unnatural per se the statutory duty to investigate will be engaged, regardless of the circumstances.

Adolescent Health Care Decision Making: The Law and Public Policy.

ERIC Educational Resources Information Center

Gittler, Josephine; And Others

A large and complicated body of law deals primarily with required parental involvement in health care decisions concerning adolescent children. Addressing that body of legislation, Part 1 of this two-part background paper focuses on a survey of laws requiring parental consent to health services for minors or parental notification of a minor's…

Overdue choices: how information and role in decision-making influence women's preferences for induction for prolonged pregnancy.

PubMed

Stevens, Gabrielle; Miller, Yvette D

2012-09-01

Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners' communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women's preferences for induction of labor for prolonged pregnancy. A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman's involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants' general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

NASA Applied Sciences Program Rapid Prototyping Results and Conclusions

NASA Astrophysics Data System (ADS)

Cox, E. L.

2007-12-01

NASA's Applied Sciences Program seeks to expand the use of Earth science research results to benefit current and future operational systems tasked with making policy and management decisions. The Earth Science Division within the Science Mission Directorate sponsors over 1000 research projects annually to answer the fundamental research question: How is the Earth changing and what are the consequences for life on Earth? As research results become available, largely from satellite observations and Earth system model outputs, the Applied Sciences Program works diligently with scientists and researchers (internal and external to NASA) , and other government agency officials (USDA, EPA, CDC, DOE, US Forest Service, US Fish and Wildlife Service, DHS, USAID) to determine useful applications for these results in decision-making, ultimately benefiting society. The complexity of Earth science research results and the breadth of the Applied Sciences Program national priority areas dictate a broad scope and multiple approaches available to implement their use in decision-making. Over the past five years, the Applied Sciences Program has examined scientific and engineering practices and solicited the community for methods and steps that can lead to the enhancement of operational systems (Decision Support Systems - DSS) required for decision-making. In November 2006, the Applied Sciences Program launched an initiative aimed at demonstrating the applicability of NASA data (satellite observations, models, geophysical parameters from data archive centers) being incorporated into decision support systems and their related environments at a low cost and quick turnaround of results., i.e. designed rapid prototyping. Conceptually, an understanding of Earth science research (and results) coupled with decision-making requirements and needs leads to a demonstration (experiment) depicting enhancements or improvements to an operational decisions process through the use of NASA data. Five NASA centers (GSFC, LaRC, SSC, MSFC, ARC) participated and are currently conducting fifteen prototyping experiments covering eight of the twelve national priority applications - Energy, Coastal, Carbon, and Disaster Management; Agricultural Efficiency, Aviation, Air Quality, and Ecological Forecasting. Results from six experiments will be discussed highlighting purpose, expected results, enhancement to the decision-making process achieved, and the potential plans for future collaboration and sustainable projects.

The value of forecasting key-decision variables for rain-fed farming

NASA Astrophysics Data System (ADS)

Winsemius, Hessel; Werner, Micha

2013-04-01

Rain-fed farmers are highly vulnerable to variability in rainfall. Timely knowledge of the onset of the rainy season, the expected amount of rainfall and the occurrence of dry spells can help rain-fed farmers to plan the cropping season. Seasonal probabilistic weather forecasts may provide such information to farmers, but need to provide reliable forecasts of key variables with which farmers can make decisions. In this contribution, we present a new method to evaluate the value of meteorological forecasts in predicting these key variables. The proposed method measures skill by assessing whether a forecast was useful to this decision. This is done by taking into account the required accuracy of timing of the event to make the decision useful. The method progresses the estimate of forecast skill to forecast value by taking into account the required accuracy that is needed to make the decision valuable, based on the cost/loss ratio of possible decisions. The method is applied over the Limpopo region in Southern Africa. We demonstrate the method using the example of temporary water harvesting techniques. Such techniques require time to construct and must be ready long enough before the occurrence of a dry spell to be effective. The value of the forecasts to the decision used as an example is shown to be highly sensitive to the accuracy in the timing of forecasted dry spells, and the tolerance in the decision to timing error. The skill with which dry spells can be predicted is shown to be higher in some parts of the basin, indicating that these forecasts have higher value for the decision in those parts than in others. Through assessing the skill of forecasting key decision variables to the farmers we show that it is easier to understand if the forecasts have value in reducing risk, or if other adaptation strategies should be implemented.

Promoting evidence-based practice in pharmacies.

PubMed

Toklu, Hale Zerrin

2015-01-01

Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive "medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community." Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs.

Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis.

PubMed

Martin, Naomi H; Lawrence, Vanessa; Murray, Joanna; Janssen, Anna; Higginson, Irene; Lyall, Rebecca; Burman, Rachel; Leigh, P Nigel; Al-Chalabi, Ammar; Goldstein, Laura H

2016-08-01

We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers. © The Author(s) 2015.

Ovarian tissue cryopreservation (OTC) in prepubertal girls and young women: an analysis of parents' and patients' decision-making.

PubMed

Sullivan-Pyke, Chantae S; Carlson, Claire A; Prewitt, Maureen; Gracia, Clarisa R; Ginsberg, Jill P

2018-04-01

The purpose of this study was to explore the decision-making influences, perceived level of control over decision-making, and mood states of parents and patients who were offered OTC prior to gonadotoxic therapy. Parents and patients, at least 12 years old, who required gonadotoxic therapy and were offered OTC prior to therapy, were asked to complete questionnaires. Two validated instruments were also used: the Decision-Making Control Instrument (DMCI) and the Profile of Mood States (POMS). The factors that influenced decision-making were compared using Student's t test, and the scores of DMCI and POMS were compared using the Mann-Whitney test. Thirty-six parents and 16 patients who elected ovarian tissue cryopreservation (OTC) completed questionnaires. Five parents who declined OTC also completed questionnaires. Accepters thought OTC was a good idea and that, in the future, science would enable cryopreserved ovarian tissue to be used to restore fertility (100% parents, 93.8% patients). Among accepters, the desire for genetically related children and prevention of the stress of infertility drove parents' and patients' decisions (90.9 and 100%, respectively). The desire to prevent the stress of infertility was important to parents, but patients were less likely to report that a desire to prevent the stress of infertility factored into their decision-making (66.7 vs. 50.0%; p < 0.001). All respondents felt in control of their decision and displayed low levels of mood disturbance. Though the decision to undergo experimental OTC is difficult and often urgent, this study suggests that families feel in control of their decision-making and report little emotional disturbance.

75 FR 57285 - BOEMRE Information Collection Activity: 1010-0172, Open and Nondiscriminatory Access to Oil and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... BOEMRE decision. $7,500 processing fee. 106(b), 109 Request waiver or reduction 1 4. of fee. 104(b), 107... BOEMRE decision. 110 Submit required information for BOEMRE to make a decision. 114, 115(a) Submit appeal on BOEMRE final decision. Estimated Annual Reporting and Recordkeeping Non-Hour Cost Burden: We have...

Linking Space Weather Science and Decision Making (Invited)

NASA Astrophysics Data System (ADS)

Fisher, G. M.

2009-12-01

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

Precautionary principles: a jurisdiction-free framework for decision-making under risk.

PubMed

Ricci, Paolo F; Cox, Louis A; MacDonald, Thomas R

2004-12-01

Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives--defined as a choice that makes preferred consequences more likely--requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial (and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.

A strategy for monitoring and managing declines in an amphibian community.

PubMed

Grant, Evan H Campbell; Zipkin, Elise F; Nichols, James D; Campbell, J Patrick

2013-12-01

Although many taxa have declined globally, conservation actions are inherently local. Ecosystems degrade even in protected areas, and maintaining natural systems in a desired condition may require active management. Implementing management decisions under uncertainty requires a logical and transparent process to identify objectives, develop management actions, formulate system models to link actions with objectives, monitor to reduce uncertainty and identify system state (i.e., resource condition), and determine an optimal management strategy. We applied one such structured decision-making approach that incorporates these critical elements to inform management of amphibian populations in a protected area managed by the U.S. National Park Service. Climate change is expected to affect amphibian occupancy of wetlands and to increase uncertainty in management decision making. We used the tools of structured decision making to identify short-term management solutions that incorporate our current understanding of the effect of climate change on amphibians, emphasizing how management can be undertaken even with incomplete information. Estrategia para Monitorear y Manejar Disminuciones en una Comunidad de Anfibios. © 2013 Society for Conservation Biology.

Defense Acquisitions: Assessments of Selected Weapon Programs

DTIC Science & Technology

2008-03-01

system configuration changes could enable department officials to make more informed decisions in the early stages of a program and better match...accountability in the execution of each program would alleviate untimely decision making when programs do get into trouble. The current DOD leadership has...require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions

Computers for Command and Control: An Airland Battle Requirement!

DTIC Science & Technology

1984-05-01

systems can enhance communications, improve data management, and support decision making through information display (SEE REVERSE) JAN 173 E~lNOS~SIISLT...organizations to improve communications, enhance data management, and support decision making through graphical display techniques and mathematical...tactical commander’s control of maneuver forces. There are many reasons for the Army’s apparent inability to develop and field these systems. Among the

Middle Level Teachers' Perceptions of Interim Reading Assessments: An Exploratory Study of Data-Based Decision Making

ERIC Educational Resources Information Center

Reed, Deborah K.

2015-01-01

This study explored the data-based decision making of 12 teachers in grades 6-8 who were asked about their perceptions and use of three required interim measures of reading performance: oral reading fluency (ORF), retell, and a benchmark comprised of released state test items. Focus group participants reported they did not believe the benchmark or…

48 CFR 1652.204-72 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... beyond his or her control from making the request within the time limit. (2) The Carrier has 30 days... information is required to make a decision on the claim; (iii) Specify the time limit (60 days after the date... that time and give a written notice of its decision to the covered individual and to the Carrier. (f...

An Analysis of the Academic Behaviors and Beliefs of Division I Student-Athletes: The Impact of the Increased Percentage toward Degree Requirements

ERIC Educational Resources Information Center

Kulics, Jennifer M.; Kornspan, Alan S.; Kretovics, Mark

2015-01-01

The purpose of the present study was to assess the academic decision making beliefs of National Collegiate Athletic Association (NCAA) Division I Football Bowl Championship Series (FBS) student-athletes and to determine if the variables of gender and type of sport related to academic decision making behavior of student-athletes. Participants…

The role of flight planning in aircrew decision performance

NASA Technical Reports Server (NTRS)

Pepitone, Dave; King, Teresa; Murphy, Miles

1989-01-01

The role of flight planning in increasing the safety and decision-making performance of the air transport crews was investigated in a study that involved 48 rated airline crewmembers on a B720 simulator with a model-board-based visual scene and motion cues with three degrees of freedom. The safety performance of the crews was evaluated using videotaped replays of the flight. Based on these evaluations, the crews could be divided into high- and low-safety groups. It was found that, while collecting information before flights, the high-safety crews were more concerned with information about alternative airports, especially the fuel required to get there, and were characterized by making rapid and appropriate decisions during the emergency part of the flight scenario, allowing these crews to make an early diversion to other airports. These results suggest that contingency planning that takes into account alternative courses of action enhances rapid and accurate decision-making under time pressure.

The interaction between state and dispositional emotions in decision making: An ERP study.

PubMed

Wang, Yingying; Gu, Ruolei; Luo, Yue-Jia; Zhou, Chenglin

2017-02-01

In this study, to investigate the influence of incidental emotions on decision making in high-anxious individuals, participants were required to perform a monetary gambling task. Behavioral and electroencephalography responses were recorded to explore the stages of option assessment and outcome evaluation during decision making, respectively. Incidental emotions were elicited by facial expression pictures presented on the background, which included four conditions (control, neutral, fearful, and happy). Results showed smaller feedback-related negativity (FRN) amplitudes in high-anxious participants than low-anxious participants in the control, neutral, and fearful conditions, but not in the happy condition, for small outcomes. The P3 amplitudes were larger in high-anxious participants compared to their counterparts in the fearful and happy conditions, but not in the other conditions. In short, the interaction effects between trait anxiety and facial emotions manifested on the outcome evaluation stage of decision making. Copyright © 2016 Elsevier B.V. All rights reserved.

Hippocampal-cortical interaction in decision making

PubMed Central

Yu, Jai Y.; Frank, Loren M.

2014-01-01

When making a decision it is often necessary to consider the available alternatives in order to choose the most appropriate option. This deliberative process, where the pros and cons of each option are considered, relies on memories of past actions and outcomes. The hippocampus and prefrontal cortex are required for memory encoding, memory retrieval and decision making, but it is unclear how these areas support deliberation. Here we examine the potential neural substrates of these processes in the rat. The rat is a powerful model to investigate the network mechanisms underlying deliberation in the mammalian brain given the anatomical and functional conservation of its hippocampus and prefrontal cortex to other mammalian systems. Importantly, it is amenable to large scale neural recording while performing laboratory tasks that exploit its natural decisionmaking behavior. Focusing on findings in the rat, we discuss how hippocampal-cortical interactions could provide a neural substrate for deliberative decision making. PMID:24530374

American College of Emergency Physicians Ethics Manual.

PubMed

1991-10-01

Ethical concerns are a major part of the clinical practice of emergency medicine. The emergency physician must make hard choices, not only with regard to the scientific/technical aspects but also with regard to the moral aspects of caring for emergency patients. By the nature of the specialty, emergency physicians face ethical dilemmas often requiring prompt decisions with limited information. This manual identifies important moral principles and values in emergency medicine. The underlying assumption is that a knowledge of moral principles and ethical values helps the emergency physician make responsible moral choices. Neither the scientific nor the moral aspects of clinical decision making can be reduced to simple formulas. Nevertheless, decisions must be made. Emergency physicians should, therefore, be cognizant of the ethical principles that are important for emergency medicine, understand the process of ethical reasoning, and be capable of making rational moral decisions based on a stable framework of values.

Planetary protection, legal ambiguity and the decision making process for Mars sample return

NASA Technical Reports Server (NTRS)

Race, M. S.

1996-01-01

As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.

Getting the Balance Right: Conceptual Considerations Concerning Legal Capacity and Supported Decision-Making.

PubMed

Parker, Malcolm

2016-09-01

The United Nations Convention on the Rights of Persons with Disabilities urges and requires changes to how signatories discharge their duties to people with intellectual disabilities, in the direction of their greater recognition as legal persons with expanded decision-making rights. Australian jurisdictions are currently undertaking inquiries and pilot projects that explore how these imperatives should be implemented. One of the important changes advocated is to move from guardianship models to supported or assisted models of decision-making. A driving force behind these developments is a strong allegiance to the social model of disability, in the formulation of the Convention, in inquiries and pilot projects, in implementation and in the related academic literature. Many of these instances suffer from confusing and misleading statements and conceptual misinterpretations of certain elements such as legal capacity, decision-making capacity, and support for decision-making. This paper analyses some of these confusions and their possible negative implications for supported decision-making instruments and those whose interests these instruments would serve, and advises a more incremental development of existing guardianship regimes. This provides a more realistic balance between neglecting the real limits of those with mental disabilities and thereby ignoring their identity and particularity, and continuing to bring them equally and fully into society.

The Mental Capacity Act: 'Best interests'-a review of the literature.

PubMed

Marshall, Helen; Sprung, Sally

2017-08-02

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 in order to provide a consistent, robust framework with the aim to protect and empower people to make decisions themselves. However, an assessment as per the MCA may demonstrate that a person is lacking mental capacity and therefore unable to make an autonomous decision at the time it needs to be made. In this case, a 'best interests' decision may be made on their behalf, ensuring their wishes and beliefs are at the centre of the decision-making process. When making a best interests decision, a health practitioner must follow the guidance as set out in the MCA legislation to ensure fair and consistent approaches to safeguard and provide assurance that the outcome is truly the best decision for the individual. This review of the literature supports the findings of a 2014 post-legislative review by the House of Lords, which concluded the principles of the MCA are not sufficiently embedded into the practice of all health practitioners, due to a lack of knowledge, awareness and understanding. However, the evidence base also appreciates making a decision on behalf of another person can be a stressful, complex and intricate process when further support may be required from the wider multidisciplinary team, including potentially seeking legal advice.

A Monte-Carlo game theoretic approach for Multi-Criteria Decision Making under uncertainty

NASA Astrophysics Data System (ADS)

Madani, Kaveh; Lund, Jay R.

2011-05-01

Game theory provides a useful framework for studying Multi-Criteria Decision Making problems. This paper suggests modeling Multi-Criteria Decision Making problems as strategic games and solving them using non-cooperative game theory concepts. The suggested method can be used to prescribe non-dominated solutions and also can be used as a method to predict the outcome of a decision making problem. Non-cooperative stability definitions for solving the games allow consideration of non-cooperative behaviors, often neglected by other methods which assume perfect cooperation among decision makers. To deal with the uncertainty in input variables a Monte-Carlo Game Theory (MCGT) approach is suggested which maps the stochastic problem into many deterministic strategic games. The games are solved using non-cooperative stability definitions and the results include possible effects of uncertainty in input variables on outcomes. The method can handle multi-criteria multi-decision-maker problems with uncertainty. The suggested method does not require criteria weighting, developing a compound decision objective, and accurate quantitative (cardinal) information as it simplifies the decision analysis by solving problems based on qualitative (ordinal) information, reducing the computational burden substantially. The MCGT method is applied to analyze California's Sacramento-San Joaquin Delta problem. The suggested method provides insights, identifies non-dominated alternatives, and predicts likely decision outcomes.

A Briefing on Metrics and Risks for Autonomous Decision-Making in Aerospace Applications

NASA Technical Reports Server (NTRS)

Frost, Susan; Goebel, Kai Frank; Galvan, Jose Ramon

2012-01-01

Significant technology advances will enable future aerospace systems to safely and reliably make decisions autonomously, or without human interaction. The decision-making may result in actions that enable an aircraft or spacecraft in an off-nominal state or with slightly degraded components to achieve mission performance and safety goals while reducing or avoiding damage to the aircraft or spacecraft. Some key technology enablers for autonomous decision-making include: a continuous state awareness through the maturation of the prognostics health management field, novel sensor development, and the considerable gains made in computation power and data processing bandwidth versus system size. Sophisticated algorithms and physics based models coupled with these technological advances allow reliable assessment of a system, subsystem, or components. Decisions that balance mission objectives and constraints with remaining useful life predictions can be made autonomously to maintain safety requirements, optimal performance, and ensure mission objectives. This autonomous approach to decision-making will come with new risks and benefits, some of which will be examined in this paper. To start, an account of previous work to categorize or quantify autonomy in aerospace systems will be presented. In addition, a survey of perceived risks in autonomous decision-making in the context of piloted aircraft and remotely piloted or completely autonomous unmanned autonomous systems (UAS) will be presented based on interviews that were conducted with individuals from industry, academia, and government.

Information and decision-making needs among people with affective disorders - results of an online survey.

PubMed

Liebherz, Sarah; Tlach, Lisa; Härter, Martin; Dirmaier, Jörg

2015-01-01

Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions. This paper aims to describe patients' information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders. We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses. A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey. Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired. Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients' requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice.

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

PubMed Central

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

2011-01-01

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

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

PubMed

Stepanovich, P L; Uhrig, J D

1999-01-01

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

Facilitating access to pre-processed research evidence in public health

PubMed Central

2010-01-01

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

Gunslingers, poker players, and chickens 1: Decision making under physical performance pressure in elite athletes.

PubMed

Parkin, Beth L; Warriner, Katie; Walsh, Vincent

2017-01-01

The cognitive skills required during sport are highly demanding; accurate decisions based on the processing of dynamic environments are made in a fraction of a second (Walsh, 2014). Optimal decision-making abilities are crucial for success in sporting competition (Bar-Eli et al., 2011; Kaya, 2014). Moreover, for the elite athlete, decision making is required under conditions of intense mental and physical pressure (Anshel and Wells, 2000), yet much of the work in this area has largely ignored the highly stressful context in which athletes operate. A number of studies have shown that conditions of elevated pressure influence athletes' decision quality (Kinrade et al., 2015; Smith et al., 2016), response times (Hepler, 2015; Smith et al., 2016) and risk taking (Pighin et al., 2015). However, almost all of this work has been undertaken in nonelite athletes and participants who do not routinely operate under conditions of high stress. Thus, there is very little known about the influence of pressure on decision making in elite athletes. This study investigated the influence of physical performance pressure on decision making in a sample of world-class elite athletes. This allowed an examination of whether findings from the previous work in nonelite athletes extend to those who routinely operate under conditions of high stress. How this work could be applied to improve insight and understanding of decision making among sport professionals is examined. We sought to introduce a categorization of decision making useful to practitioners in sport: gunslingers, poker players, and chickens. Twenty-three elite athletes who compete and have frequent success at an international level (including six Olympic medal winners) performed tasks relating to three categories of decision making under conditions of low and high physical pressure. Decision making under risk was measured with performance on the Cambridge Gambling Task (CGT; Rogers et al., 1999), decision making under uncertainty with the Balloon Analogue Risk Task (BART; Lejuez et al., 2002), and fast reactive responses and interference with the Stroop Task (Stroop, 1935). Performance pressures of physical exhaustion was induced via an exercise protocol consisting of intervals of maximal exertion undertaken on a watt bike. At a group level, under physical pressure elite athletes were faster to respond to control trials on the Stroop Task and to simple probabilistic choices on the CGT. Physical pressure was also found to increase risk taking for decisions where probability outcomes were explicit (on the CGT), but did not affect risk taking when probability outcomes were unknown (on the BART). There were no significant correlations in the degree to which individuals' responses changed under pressure across the three tasks, suggesting that elite athletes did not show consistent responses to physical pressure across measures of decision making. When assessing the applicability of results based on group averages to individual athletes, none of the sample showed an "average" response (within 1 SD of the mean) to pressure across all three decision-making tasks. There are three points of conclusion. First, an immediate scientific point that highlights a failure of transfer of work reported from nonelite athletes to elite athletes in the area of decision making under pressure. Second, a practical conclusion with respect to the application of this work to the elite sporting environment, which highlights the limitations of statistical approaches based on group averages and thus the beneficial use of individualized profiling in feedback sessions. Third, the application of this work in a sports setting is described, in particular the development and implementation of a decision-making taxonomy as a framework to conceptualize and communicate psychological skills among elite sporting professionals. © 2017 Elsevier B.V. All rights reserved.

Future decision-making without episodic mental time travel.

PubMed

Kwan, Donna; Craver, Carl F; Green, Leonard; Myerson, Joel; Boyer, Pascal; Rosenbaum, R Shayna

2012-06-01

Deficits in episodic memory are associated with deficits in the ability to imagine future experiences (i.e., mental time travel). We show that K.C., a person with episodic amnesia and an inability to imagine future experiences, nonetheless systematically discounts the value of future rewards, and his discounting is within the range of controls in terms of both rate and consistency. Because K.C. is neither able to imagine personal uses for the rewards nor provide a rationale for selecting larger future rewards over smaller current rewards, this study demonstrates a dissociation between imagining and making decisions involving the future. Thus, although those capable of mental time travel may use it in making decisions about future rewards, these results demonstrate that it is not required for such decisions. Copyright © 2011 Wiley Periodicals, Inc.

Decision Making in Health and Medicine

NASA Astrophysics Data System (ADS)

Hunink, Myriam; Glasziou, Paul; Siegel, Joanna; Weeks, Jane; Pliskin, Joseph; Elstein, Arthur; Weinstein, Milton C.

2001-11-01

Decision making in health care means navigating through a complex and tangled web of diagnostic and therapeutic uncertainties, patient preferences and values, and costs. In addition, medical therapies may include side effects, surgery may lead to undesirable complications, and diagnostic technologies may produce inconclusive results. In many clinical and health policy decisions it is necessary to counterbalance benefits and risks, and to trade off competing objectives such as maximizing life expectancy vs optimizing quality of life vs minimizing the required resources. This textbook plots a clear course through these complex and conflicting variables. It clearly explains and illustrates tools for integrating quantitative evidence-based data and subjective outcome values in making clinical and health policy decisions. An accompanying CD-ROM features solutions to the exercises, PowerPoint® presentations of the illustrations, and sample models and tables.

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

NASA Astrophysics Data System (ADS)

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

2016-05-01

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

Sound data management as a foundation for natural resources management and science

USGS Publications Warehouse

Burley, Thomas E.

2012-01-01

Effective decision making is closely related to the quality and completeness of available data and information. Data management helps to ensure data quality in any discipline and supports decision making. Managing data as a long-term scientific asset helps to ensure that data will be usable beyond the original intended application. Emerging issues in water-resources management and climate variability require the ability to analyze change in the conditions of natural resources over time. The availability of quality, well-managed, and documented data from the past and present helps support this requirement.

The Hare and the Tortoise: Emphasizing Speed Can Change the Evidence Used to Make Decisions

ERIC Educational Resources Information Center

Rae, Babette; Heathcote, Andrew; Donkin, Chris; Averell, Lee; Brown, Scott

2014-01-01

Decision-makers effortlessly balance the need for urgency against the need for caution. Theoretical and neurophysiological accounts have explained this tradeoff solely in terms of the "quantity" of evidence required to trigger a decision (the "threshold"). This explanation has also been used as a benchmark test for evaluating…

Exploring the Decision Landscape: Integration and Display of Ecosystem Services & Indicators Using the Driver-Pressure-State-Impact-Response Framework and Dynamic Web Application

EPA Science Inventory

Making decisions to increase community or regional sustainability requires a comprehensive understanding of the linkages between environmental, social, and economic systems. We present a visualization tool that can improve decision processes by enhancing understanding of system c...

Taking a gamble or playing by the rules: Dissociable prefrontal systems implicated in probabilistic versus deterministic rule-based decisions

PubMed Central

Bhanji, Jamil P.; Beer, Jennifer S.; Bunge, Silvia A.

2014-01-01

A decision may be difficult because complex information processing is required to evaluate choices according to deterministic decision rules and/or because it is not certain which choice will lead to the best outcome in a probabilistic context. Factors that tax decision making such as decision rule complexity and low decision certainty should be disambiguated for a more complete understanding of the decision making process. Previous studies have examined the brain regions that are modulated by decision rule complexity or by decision certainty but have not examined these factors together in the context of a single task or study. In the present functional magnetic resonance imaging study, both decision rule complexity and decision certainty were varied in comparable decision tasks. Further, the level of certainty about which choice to make (choice certainty) was varied separately from certainty about the final outcome resulting from a choice (outcome certainty). Lateral prefrontal cortex, dorsal anterior cingulate cortex, and bilateral anterior insula were modulated by decision rule complexity. Anterior insula was engaged more strongly by low than high choice certainty decisions, whereas ventromedial prefrontal cortex showed the opposite pattern. These regions showed no effect of the independent manipulation of outcome certainty. The results disambiguate the influence of decision rule complexity, choice certainty, and outcome certainty on activity in diverse brain regions that have been implicated in decision making. Lateral prefrontal cortex plays a key role in implementing deterministic decision rules, ventromedial prefrontal cortex in probabilistic rules, and anterior insula in both. PMID:19781652

Heuristic and optimal policy computations in the human brain during sequential decision-making.

PubMed

Korn, Christoph W; Bach, Dominik R

2018-01-23

Optimal decisions across extended time horizons require value calculations over multiple probabilistic future states. Humans may circumvent such complex computations by resorting to easy-to-compute heuristics that approximate optimal solutions. To probe the potential interplay between heuristic and optimal computations, we develop a novel sequential decision-making task, framed as virtual foraging in which participants have to avoid virtual starvation. Rewards depend only on final outcomes over five-trial blocks, necessitating planning over five sequential decisions and probabilistic outcomes. Here, we report model comparisons demonstrating that participants primarily rely on the best available heuristic but also use the normatively optimal policy. FMRI signals in medial prefrontal cortex (MPFC) relate to heuristic and optimal policies and associated choice uncertainties. Crucially, reaction times and dorsal MPFC activity scale with discrepancies between heuristic and optimal policies. Thus, sequential decision-making in humans may emerge from integration between heuristic and optimal policies, implemented by controllers in MPFC.

Police response to domestic violence: making decisions about risk and risk management.

PubMed

Perez Trujillo, Monica; Ross, Stuart

2008-04-01

Assessing and responding to risk are key elements in how police respond to domestic violence. However, relatively little is known about the way police make judgments about the risks associated with domestic violence and how these judgments influence their actions. This study examines police decisions about risk in domestic violence incidents when using a risk assessment instrument. Based on a sample of 501 risk assessments completed by police in Australia, this study shows that a limited number of items on the risk assessment instrument are important in police officers' decisions about risk. Statistical analyses show that the victim's level of fear contributes to police officers' judgment on the level of risk and their decisions on which risk management strategy should be used. These findings suggest that research on police responses to domestic violence needs to pay greater attention to situational dynamics and the task requirements of risk-based decision making.

Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions.

PubMed

Barnes, Andrew J; Groskaufmanis, Lauren; Thomson, Norman B

2016-12-01

Lung cancer is a devastating disease, the deadliest form of cancer in the world and in the United States. As a consequence of CMS's determination to provide low-dose CT (LDCT) as a covered service for at-risk smokers, LDCT lung cancer screening is now a covered service for many at-risk patients that first requires counseling and shared clinical decision making, including discussions of the risks and benefits of LDCT screening. However, shared decision making fundamentally relies on the premise that with better information, patients will arrive at rational decisions that align with their preferences and values. Evidence from the field of behavioral economics offers many contrary viewpoints that take into account patient decision making biases and the role of the shared decision environment that can lead to flawed choices and that are particularly relevant to lung cancer screening and treatment. This article discusses some of the most relevant biases, and suggests incorporating such knowledge into screening and treatment guidelines and shared decision making best practices to increase the likelihood that such efforts will produce their desired objectives to improve survival and quality of life. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Mechanisms Underlying Decision-Making as Revealed by Deep-Brain Stimulation in Patients with Parkinson's Disease.

PubMed

Herz, Damian M; Little, Simon; Pedrosa, David J; Tinkhauser, Gerd; Cheeran, Binith; Foltynie, Tom; Bogacz, Rafal; Brown, Peter

2018-04-23

To optimally balance opposing demands of speed and accuracy during decision-making, we must flexibly adapt how much evidence we require before making a choice. Such adjustments in decision thresholds have been linked to the subthalamic nucleus (STN), and therapeutic STN deep-brain stimulation (DBS) has been shown to interfere with this function. Here, we performed continuous as well as closed-loop DBS of the STN while Parkinson's disease patients performed a perceptual decision-making task. Closed-loop STN DBS allowed temporally patterned STN stimulation and simultaneous recordings of STN activity. This revealed that DBS only affected patients' ability to adjust decision thresholds if applied in a specific temporally confined time window during deliberation. Only stimulation in that window diminished the normal slowing of response times that occurred on difficult trials when DBS was turned off. Furthermore, DBS eliminated a relative, time-specific increase in STN beta oscillations and compromised its functional relationship with trial-by-trial adjustments in decision thresholds. Together, these results provide causal evidence that the STN is involved in adjusting decision thresholds in distinct, time-limited processing windows during deliberation. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

The angular gyrus and visuospatial attention in decision-making under risk.

PubMed

Studer, Bettina; Cen, Danlu; Walsh, Vincent

2014-12-01

Recent neuroimaging studies on decision-making under risk indicate that the angular gyrus (AG) is sensitive to the probability and variance of outcomes during choice. A separate body of research has established the AG as a key area in visual attention. The current study used repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers to test whether the causal contribution of the AG to decision-making is independent of or linked to the guidance of visuospatial attention. A within-subject design compared decision making on a laboratory gambling task under three conditions: following rTMS to the AG, following rTMS to the premotor cortex (PMC, as an active control condition) and without TMS. The task presented two different trial types, 'visual' and 'auditory' trials, which entailed a high versus minimal demand for visuospatial attention, respectively. Our results showed a systematic effect of rTMS to the AG upon decision-making behavior in visual trials. Without TMS and following rTMS to the control region, decision latencies reflected the odds of winning; this relationship was disrupted by rTMS to the AG. In contrast, no significant effects of rTMS to the AG (or to the PMC) upon choice behavior in auditory trials were found. Thus, rTMS to the AG affected decision-making only in the task condition requiring visuospatial attention. The current findings suggest that the AG contributes to decision-making by guiding attention to relevant information about reward and punishment in the visual environment. Copyright © 2014. Published by Elsevier Inc.

Towards ethical decision support and knowledge management in neonatal intensive care.

PubMed

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

An Examination of Accounting Majors' Ethical Decisions before and after an Ethics Course Requirement

ERIC Educational Resources Information Center

Rogers, Violet; Smith, Aileen

2008-01-01

The increased focus on ethical decision making in the accounting profession has resulted in greater attention being paid to the education of future accountants. Texas is one of the states that requires a State Board approved university course in Accounting Ethics to be on the transcript of prospective CPA candidates. This study reports on research…

Mainstreaming Climate Change: Recent and Ongoing Efforts to Understand, Improve, and Expand Consideration of Climate Change in Federal Water Resources Planning

NASA Astrophysics Data System (ADS)

Ferguson, I. M.; McGuire, M.; Broman, D.; Gangopadhyay, S.

2017-12-01

The Bureau of Reclamation is a Federal agency tasked with developing and managing water supply and hydropower projects in the Western U.S. Climate and hydrologic variability and change significantly impact management actions and outcomes across Reclamation's programs and initiatives, including water resource planning and operations, infrastructure design and maintenance, hydropower generation, and ecosystem restoration, among others. Planning, design, and implementation of these programs therefore requires consideration of future climate and hydrologic conditions will impact program objectives. Over the past decade, Reclamation and other Federal agencies have adopted new guidelines, directives, and mandates that require consideration of climate change in water resources planning and decision making. Meanwhile, the scientific community has developed a large number of climate projections, along with an array of models, methods, and tools to facilitate consideration of climate projections in planning and decision making. However, water resources engineers, planners, and decision makers continue to face challenges regarding how best to use the available data and tools to support major decisions, including decisions regarding infrastructure investments and long-term operating criteria. This presentation will discuss recent and ongoing research towards understanding, improving, and expanding consideration of climate projections and related uncertainties in Federal water resources planning and decision making. These research efforts address a variety of challenges, including: How to choose between available climate projection datasets and related methods, models, and tools—many of which are considered experimental or research tools? How to select an appropriate decision framework when design or operating alternatives may differ between climate scenarios? How to effectively communicate results of a climate impacts analysis to decision makers? And, how to improve robustness and resilience of water resources systems in the face of significant uncertainty? Discussion will focus on the intersection between technical challenges and decision making paradigms and the need for improved scientist-decision maker engagement through the lens of this Federal water management agency.

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study.

PubMed

Jack, Susan M; Dobbins, Maureen; Sword, Wendy; Novotna, Gabriela; Brooks, Sandy; Lipman, Ellen L; Niccols, Alison

2011-11-07

Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions.

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

PubMed Central

2011-01-01

Background Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. Methods A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Results Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. Conclusions There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions. PMID:22059528

Informed consent in surgical trials.

PubMed

Etchells, E

1999-12-01

All participants must provide a valid consent to surgical clinical trials. A valid consent requires patient capacity, adequate disclosure of information, and voluntariness. Capacity is the ability to understand information relevant to making a decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision. To protect vulnerable persons, an incapable person should not be enrolled in most clinical trials. The only exception is if the study can only be conducted on incapable persons. If the willing research participant is incapable, consent must be obtained from others through a process called substitute (or proxy) consent. Disclosure refers to the provision of relevant information to the patient and its comprehension by the patient. Most surgical trials carry more than minimal risks, so the requirement for careful disclosure of these risks to potential participants is generally stringent. Voluntariness refers to the freedom of a person to make a treatment decision. In specific circumstances related to emergency research, the requirement for consent may be waived. Waiver can be justified only if the delay required to obtain consent would prevent the research from occurring and only after prior consultation with from the "community" of potential research participants.

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.

GUIDED TOUR OF A WEB-BASED ENVIRONMENTAL DECISION TOOLKIT

EPA Science Inventory

Decision-making regarding the targeting of vulnerable resources and prioritization of actions requires synthesis of data on condition, vulnerability, and feasibility of risk management alternatives. EP A's Regional Vulnerability Assessment (ReV A) Program has evaluated existing a...

High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.

PubMed

Lipstein, Ellen A; Lovell, Daniel J; Denson, Lee A; Kim, Sandra C; Spencer, Charles; Ittenbach, Richard F; Britto, Maria T

2016-12-01

The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.

Employee Participation--A Practical Guide.

ERIC Educational Resources Information Center

Wooden, Mark

1990-01-01

Despite the benefits of employee participation in decision making, it is not widespread. Making it work requires commitment, job security, training, access to information, communication channels, goal setting, flat organizational structures, and financial reinforcement. (SK)

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

PubMed Central

Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah

2004-01-01

Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making. PMID:15068484

Dissociating sensory from decision processes in human perceptual decision making.

PubMed

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

2015-12-15

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

Dissociating sensory from decision processes in human perceptual decision making

PubMed Central

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

2015-01-01

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

Risky decision-making under risk in schizophrenia: A deliberate choice?

PubMed

Pedersen, Anya; Göder, Robert; Tomczyk, Samuel; Ohrmann, Patricia

2017-09-01

Patients with schizophrenia reveal impaired decision-making strategies causing social, financial and health care problems. The extent to which deficits in decision-making reflect intentional risky choices in schizophrenia is still under debate. Based on previous studies we expected patients with schizophrenia to reveal a riskier performance on the GDT and to make more disadvantageous decisions on the IGT. In the present study, we investigated 38 patients with schizophrenia and 38 matched healthy control subjects with two competing paradigms regarding feedback: (1) The Game of Dice Task (GDT), in which the probabilities of winning or losing are stable and explicitly disclosed to the subject, to assess decision-making under risk and (2) the Iowa Gambling Task (IGT), which requires subjects to infer the probabilities of winning or losing from feedback, to investigate decision-making under ambiguity. Patients with schizophrenia revealed an overall riskier performance on the GDT; although they adjusted their strategy over the course of the GDT, they still made significantly more disadvantageous choices than controls. More positive symptoms in patients with schizophrenia indicated by higher PANSS positive scores were associated with riskier choices and less use of negative feedback. Compared to healthy controls, they were not impaired in net score but chose more disadvantageous cards than controls on the first block of the IGT. Effects of medication at the time of testing cannot be ruled out. Our findings suggest that patients with schizophrenia make riskier decisions and are less able to regulate their decision-making to implement advantageous strategies, even when the probabilities of winning or losing are explicitly disclosed. The dissociation between performance on the GDT and IGT suggests a pronounced impairment of executive functions related to the dorsolateral prefrontal cortex. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does Evidence Matter? How Middle School Students Make Decisions About Socioscientific Issues

NASA Astrophysics Data System (ADS)

Emery, Katherine Beth

People worldwide are faced with making decisions daily. While many decisions are quick (e.g., what clothes to wear), others, such as those about environmental issues (e.g., overfishing), require more thought and have less immediate outcomes. How one makes such decisions depends on how one interprets, evaluates, and uses evidence. The central objective of this thesis was to investigate environmental science literacy in general, and specifically, to understand how evidence and other factors impact decision-making. I conducted three main studies: First, I provide an example of how decision-making practices affect environmental systems and services through a descriptive case study of Atlantic bluefin tuna overfishing. I reviewed the scientific, historical and cultural factors contributing to a paradox of marine preservation in the Mediterranean and highlighted the need for education and informed decision-making about such social and ecological issues. This study motivated me to investigate how people make decisions about environmental issues. Second, I interviewed middle school students to understand how they describe and evaluate evidence hypothetically and in practice about environmental issues---a key component of environmental literacy. Students discussed how they would evaluate evidence and then were then given a packet containing multiple excerpts of information from conflicting stakeholders about an environmental issue and asked how they would make voting or purchasing decisions about these issues. Findings showed that students' ideas about evaluating evidence (e.g., by scientific and non-scientific criteria) match their practices in part. This study was unique in that it investigated how students evaluate evidence that (1) contradicts other evidence and (2), conflicts with the student's prior positions. Finally, I investigated whether middle school students used evidence when making decisions about socioscientific issues. I hypothesized that holding a strong opinion would decrease the likelihood of changing decisions when presented with additional information. Findings indicated that most students do not change their stance after reading additional evidence. Students were more likely to change their decisions about issues that they cared least about than about issues that they cared most about. Implications for science teaching and learning are discussed.

Evolutionary Algorithm Based Automated Reverse Engineering and Defect Discovery

DTIC Science & Technology

2007-09-21

a previous application of a GP as a data mining function to evolve fuzzy decision trees symbolically [3-5], the terminal set consisted of fuzzy...of input and output information is required. In the case of fuzzy decision trees, the database represented a collection of scenarios about which the...fuzzy decision tree to be evolved would make decisions . The database also had entries created by experts representing decisions about the scenarios

Practices of US health insurance companies concerning MS therapies interfere with shared decision-making and harm patients.

PubMed

Bourdette, Dennis N; Hartung, Daniel M; Whitham, Ruth H

2016-04-01

The US Food and Drug Administration has registered 13 multiple sclerosis (MS) disease-modifying therapies (DMTs). The medications are not interchangeable as they vary in route of administration, efficacy, and safety profile. Selecting the appropriate MS DMT for individual patients requires shared decision-making between patients and neurologists. To reduce costs, insurance companies acting through pharmacy benefit companies restrict access to MS DMTs through tiered coverage and other regulations. We discuss how policies established by insurance companies that limit access to MS DMTs interfere with the process of shared decision-making and harm patients. We present potential actions that neurologists can take to change how insurance companies manage MS DMTs.

Impact of a web-based prostate cancer treatment decision aid on patient-reported decision process parameters: results from the Prostate Cancer Patient Centered Care trial.

PubMed

Cuypers, Maarten; Lamers, Romy E D; Kil, Paul J M; van de Poll-Franse, Lonneke V; de Vries, Marieke

2018-05-12

To compare patients' evaluation of the treatment decision-making process in localized prostate cancer between counseling that included an online decision aid (DA) and standard counseling. Eighteen Dutch hospitals were randomized to DA counseling (n = 235) or the control group with standard counseling (n = 101) in a pragmatic, cluster randomized controlled trial. The DA was provided to patients at, or soon after diagnosis. Decisional conflict, involvement, knowledge, and satisfaction with information were assessed with a questionnaire after treatment decision-making. Anxiety and depression served as covariates. The levels of decision involvement and conflict were comparable between patients in both groups. Patients with a DA felt more knowledgeable but scored equally well on a knowledge test as patients without a DA. Small significant negative effects were found on satisfaction with information and preparation for decision-making. A preference for print over online and depression and anxiety symptoms was negatively associated with satisfaction and conflict scores in the DA group. The DA aimed to support shared decision-making, while outcomes for a majority of DA users were comparable to patients who received standard counseling. Patients, who are less comfortable with the online DA format or experience anxiety or depression symptoms, could require more guidance toward shared decision-making. To evaluate long-term DA effects, follow-up evaluation on treatment satisfaction and decisional regret will be done.

Different effects of dopaminergic medication on perceptual decision-making in Parkinson's disease as a function of task difficulty and speed-accuracy instructions.

PubMed

Huang, Yu-Ting; Georgiev, Dejan; Foltynie, Tom; Limousin, Patricia; Speekenbrink, Maarten; Jahanshahi, Marjan

2015-08-01

When choosing between two options, sufficient accumulation of information is required to favor one of the options over the other, before a decision is finally reached. To establish the effect of dopaminergic medication on the rate of accumulation of information, decision thresholds and speed-accuracy trade-offs, we tested 14 patients with Parkinson's disease (PD) on and off dopaminergic medication and 14 age-matched healthy controls on two versions of the moving-dots task. One version manipulated the level of task difficulty and hence effort required for decision-making and the other the urgency, requiring decision-making under speed vs. accuracy instructions. The drift diffusion model was fitted to the behavioral data. As expected, the reaction time data revealed an effect of task difficulty, such that the easier the perceptual decision-making task was, the faster the participants responded. PD patients not only made significantly more errors compared to healthy controls, but interestingly they also made significantly more errors ON than OFF medication. The drift diffusion model indicated that PD patients had lower drift rates when tested ON compared to OFF medication, indicating that dopamine levels influenced the quality of information derived from sensory information. On the speed-accuracy task, dopaminergic medication did not directly influence reaction times or error rates. PD patients OFF medication had slower RTs and made more errors with speed than accuracy instructions compared to the controls, whereas such differences were not observed ON medication. PD patients had lower drift rates and higher response thresholds than the healthy controls both with speed and accuracy instructions and ON and OFF medication. For the patients, only non-decision time was higher OFF than ON medication and higher with accuracy than speed instructions. The present results demonstrate that when task difficulty is manipulated, dopaminergic medication impairs perceptual decision-making and renders it more errorful in PD relative to when patients are tested OFF medication. In contrast, for the speed/accuracy task, being ON medication improved performance by eliminating the significantly higher errors and slower RTs observed for patients OFF medication compared to the HC group. There was no evidence of dopaminergic medication inducing impulsive decisions when patients were acting under speed pressure. For the speed-accuracy instructions, the sole effect of dopaminergic medication was on non-decision time, which suggests that medication primarily affected processes tightly coupled with the motor symptoms of PD. Interestingly, the current results suggest opposite effects of dopaminergic medication on the levels of difficulty and speed-accuracy versions of the moving dots task, possibly reflecting the differential effect of dopamine on modulating drift rate (levels of difficulty task) and non-decision time (speed-accuracy task) in the process of perceptual decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.

Recognition Decisions From Visual Working Memory Are Mediated by Continuous Latent Strengths.

PubMed

Ricker, Timothy J; Thiele, Jonathan E; Swagman, April R; Rouder, Jeffrey N

2017-08-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a clear pattern in favor of a continuous latent strength model of visual working memory-based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. Copyright © 2016 Cognitive Science Society, Inc.

GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey.

PubMed

Jayawickrama, Hiranya S; Amir, Lisa H; Pirotta, Marie V

2010-03-23

Many breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited. GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640). Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes. 335 (52%) GPs responded to the survey, and 253 (76%) provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%), other infections (24%) and depressive disorders (21%). The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression. GPs feel that prescribing medicines for breastfeeding women is a contentious issue. They manage the risk of prescribing by gathering information and assessing the possible effects on the breastfed infant. Without evidence-based information, they sometimes recommend cessation of breastfeeding unnecessarily.

Decomposition-Based Decision Making for Aerospace Vehicle Design

NASA Technical Reports Server (NTRS)

Borer, Nicholas K.; Mavris, DImitri N.

2005-01-01

Most practical engineering systems design problems have multiple and conflicting objectives. Furthermore, the satisfactory attainment level for each objective ( requirement ) is likely uncertain early in the design process. Systems with long design cycle times will exhibit more of this uncertainty throughout the design process. This is further complicated if the system is expected to perform for a relatively long period of time, as now it will need to grow as new requirements are identified and new technologies are introduced. These points identify a need for a systems design technique that enables decision making amongst multiple objectives in the presence of uncertainty. Traditional design techniques deal with a single objective or a small number of objectives that are often aggregates of the overarching goals sought through the generation of a new system. Other requirements, although uncertain, are viewed as static constraints to this single or multiple objective optimization problem. With either of these formulations, enabling tradeoffs between the requirements, objectives, or combinations thereof is a slow, serial process that becomes increasingly complex as more criteria are added. This research proposal outlines a technique that attempts to address these and other idiosyncrasies associated with modern aerospace systems design. The proposed formulation first recasts systems design into a multiple criteria decision making problem. The now multiple objectives are decomposed to discover the critical characteristics of the objective space. Tradeoffs between the objectives are considered amongst these critical characteristics by comparison to a probabilistic ideal tradeoff solution. The proposed formulation represents a radical departure from traditional methods. A pitfall of this technique is in the validation of the solution: in a multi-objective sense, how can a decision maker justify a choice between non-dominated alternatives? A series of examples help the reader to observe how this technique can be applied to aerospace systems design and compare the results of this so-called Decomposition-Based Decision Making to more traditional design approaches.

Thinking in Pharmacy Practice: A Study of Community Pharmacists’ Clinical Reasoning in Medication Supply Using the Think-Aloud Method

PubMed Central

Croft, Hayley; Gilligan, Conor; Rasiah, Rohan; Levett-Jones, Tracy; Schneider, Jennifer

2017-01-01

Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists’ clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply. PMID:29301223

Thinking in Pharmacy Practice: A Study of Community Pharmacists' Clinical Reasoning in Medication Supply Using the Think-Aloud Method.

PubMed

Croft, Hayley; Gilligan, Conor; Rasiah, Rohan; Levett-Jones, Tracy; Schneider, Jennifer

2017-12-31

Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists' clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply.

Health care priority setting: principles, practice and challenges

PubMed Central

Mitton, Craig; Donaldson, Cam

2004-01-01

Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated. PMID:15104792

The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region.

PubMed

Ekins, Kylie; Morphet, Julia

2015-11-01

The Australasian Triage Scale aims to ensure that the triage category allocated, reflects the urgency with which the patient needs medical assistance. This is dependent on triage nurse accuracy in decision making. The Australasian Triage Scale also aims to facilitate triage decision consistency between individuals and organisations. Various studies have explored the accuracy and consistency of triage decisions throughout Australia, yet no studies have specifically focussed on triage decision making in rural health services. Further, no standard has been identified by which accuracy or consistency should be measured. Australian emergency departments are measured against a set of standard performance indicators, including time from triage to patient review, and patient length of stay. There are currently no performance indicators for triage consistency. An online questionnaire was developed to collect demographic data and measure triage accuracy and consistency. The questionnaire utilised previously validated triage scenarios.(1) Triage decision accuracy was measured, and consistency was compared by health site type using Fleiss' kappa. Forty-six triage nurses participated in this study. The accuracy of participants' triage decision-making decreased with each less urgent triage category. Post-graduate qualifications had no bearing on triage accuracy. There was no significant difference in the consistency of decision-making between paediatric and adult scenarios. Overall inter-rater agreement using Fleiss' kappa coefficient, was 0.4. This represents a fair-to-good level of inter-rater agreement. A standard definition of accuracy and consistency in triage nurse decision making is required. Inaccurate triage decisions can result in increased morbidity and mortality. It is recommended that emergency department performance indicator thresholds be utilised as a benchmark for national triage consistency. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Making business decisions using trend information

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

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

1997-11-24

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

36 CFR 1250.26 - How quickly will NARA respond to my FOIA request?

Code of Federal Regulations, 2011 CFR

2011-07-01

... requesters of any complexity in processing their request, which may lengthen the time required to reach a final decision on the release of the records. (b) In most cases, NARA will make a decision on the...

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

PubMed

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

2018-05-01

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

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician's point of view.

PubMed

Kovshoff, Hanna; Williams, Sarah; Vrijens, May; Danckaerts, Marina; Thompson, Margaret; Yardley, Lucy; Hodgkins, Paul; Sonuga-Barke, Edmund J S

2012-02-01

Clinical decision making is influenced by a range of factors and constitutes an inherently complex task. Here we present results from the decisions regarding ADHD management (DRAMa) study in which we undertook a thematic analysis of clinicians' experiences and attitudes to assessment, diagnosis and treatment of ADHD. Fifty prescribing child psychiatrists and paediatricians from Belgium and the UK took part in semi-structured interviews about their decisions regarding the assessment, diagnosis and treatment of ADHD. Interviews were transcribed and processed using thematic analysis and the principles of grounded theory. Clinicians described the assessment and diagnostic process as inherently complicated and requiring time and experience to piece together the accounts of children made by multiple sources and through the use of varying information gathering techniques. Treatment decisions were viewed as a shared process between families, children, and the clinician. Published guidelines were viewed as vague, and few clinicians spoke about the use of symptom thresholds or specific impairment criteria. Furthermore, systematic or operationalised criteria to assess treatment outcomes were rarely used. Decision making in ADHD is regarded as a complicated, time consuming process which requires extensive use of clinical impression, and involves a partnership with parents. Clinicians want to separate biological from environmental causal factors to understand the level of impairment and the subsequent need for a diagnosis of ADHD. Clinical guidelines would benefit from revisions to take into account the real-world complexities of clinical decision making for ADHD.

Possibility expectation and its decision making algorithm

NASA Technical Reports Server (NTRS)

Keller, James M.; Yan, Bolin

1992-01-01

The fuzzy integral has been shown to be an effective tool for the aggregation of evidence in decision making. Of primary importance in the development of a fuzzy integral pattern recognition algorithm is the choice (construction) of the measure which embodies the importance of subsets of sources of evidence. Sugeno fuzzy measures have received the most attention due to the recursive nature of the fabrication of the measure on nested sequences of subsets. Possibility measures exhibit an even simpler generation capability, but usually require that one of the sources of information possess complete credibility. In real applications, such normalization may not be possible, or even desirable. In this report, both the theory and a decision making algorithm for a variation of the fuzzy integral are presented. This integral is based on a possibility measure where it is not required that the measure of the universe be unity. A training algorithm for the possibility densities in a pattern recognition application is also presented with the results demonstrated on the shuttle-earth-space training and testing images.

76 FR 28847 - Adrian & Blissfield Rail Road Company-Continuance in Control-Charlotte Southern Railroad Company...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

...) requires that the Board take environmental considerations into account in its decision making.\\6\\ Under... schedule for consideration of the application, providing for the Board's final decision to be issued on... decision is May 18, 2011. Any person who wishes to participate in this proceeding as a party of record (POR...

Training conservation practitioners to be better decision makers

USGS Publications Warehouse

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

2015-01-01

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

[How much business management does a surgeon need?].

PubMed

Bork, U; Koch, M; Büchler, M W; Weitz, J

2010-08-01

The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.

Designing Tools for Supporting User Decision-Making in e-Commerce

NASA Astrophysics Data System (ADS)

Sutcliffe, Alistair; Al-Qaed, Faisal

The paper describes a set of tools designed to support a variety of user decision-making strategies. The tools are complemented by an online advisor so they can be adapted to different domains and users can be guided to adopt appropriate tools for different choices in e-commerce, e.g. purchasing high-value products, exploring product fit to users’ needs, or selecting products which satisfy requirements. The tools range from simple recommenders to decision support by interactive querying and comparison matrices. They were evaluated in a scenario-based experiment which varied the users’ task and motivation, with and without an advisor agent. The results show the tools and advisor were effective in supporting users and agreed with the predictions of ADM (adaptive decision making) theory, on which the design of the tools was based.

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

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

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE PAGES

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu; ...

2017-10-11

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Success matters: Recasting the relationship among geophysical, biological, and behavioral scientists to support decision making on major environmental challenges

NASA Astrophysics Data System (ADS)

Knopman, Debra S.

2006-03-01

Coping with global change, providing clean water for growing populations, and disposing of nuclear waste are some of the most difficult public policy challenges of our time. Unknowns in the physical sciences are one source of the difficulty. Real difficulties in meeting these challenges also arise in the behavioral sciences. A potentially rich vein of transdisciplinary research is to integrate the psychology of decision making, known as "judgment and decision making," or JDM, with the development of technical information and decision support tools for complex, long-term environmental problems. Practitioners of JDM conduct research on how individuals and groups respond to uncertainty and ambiguity, hedge against risks, anchor decisions to the status quo, compare relative risks and rewards of alternative strategies, and cope with other classes of decisions. Practitioners use a variety of stimuli, chance devices, hypothetical and real choices involving small stakes, scenarios, and questionnaires to measure (directly and indirectly) preferences under varying conditions. These kinds of experiments can help guide choices about the level of complexity required for different types of decision-making processes, the value of new data collection efforts, and the ways in which uncertainty in model outcomes can be cast to minimize decision-making paralysis. They can also provide a scientific basis for interacting with decision makers throughout the model development process, designing better ways of eliciting and combining opinions and of communicating information relevant to public policy issues with the goal of improving the value of the scientific contribution to the social decision.

Multi-objective decision-making model based on CBM for an aircraft fleet

NASA Astrophysics Data System (ADS)

Luo, Bin; Lin, Lin

2018-04-01

Modern production management patterns, in which multi-unit (e.g., a fleet of aircrafts) are managed in a holistic manner, have brought new challenges for multi-unit maintenance decision making. To schedule a good maintenance plan, not only does the individual machine maintenance have to be considered, but also the maintenance of the other individuals have to be taken into account. Since most condition-based maintenance researches for aircraft focused on solely reducing maintenance cost or maximizing the availability of single aircraft, as well as considering that seldom researches concentrated on both the two objectives: minimizing cost and maximizing the availability of a fleet (total number of available aircraft in fleet), a multi-objective decision-making model based on condition-based maintenance concentrated both on the above two objectives is established. Furthermore, in consideration of the decision maker may prefer providing the final optimal result in the form of discrete intervals instead of a set of points (non-dominated solutions) in real decision-making problem, a novel multi-objective optimization method based on support vector regression is proposed to solve the above multi-objective decision-making model. Finally, a case study regarding a fleet is conducted, with the results proving that the approach efficiently generates outcomes that meet the schedule requirements.

Beyond evidence-based nursing: tools for practice.

PubMed

Jutel, Annemarie

2008-05-01

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

How information about other people's personal experiences can help with healthcare decision-making: a qualitative study.

PubMed

Entwistle, Vikki Ann; France, Emma F; Wyke, Sally; Jepson, Ruth; Hunt, Kate; Ziebland, Sue; Thompson, Andrew

2011-12-01

To investigate people's views of using 'general facts' and information about other people's 'personal experiences' for health-related decision-making. Sixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts. There was less discussion of 'general facts'; participants thought it obvious that good decisions required these. Participants reported having used 'personal experiences' information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use 'personal experiences' information was apparently moderated by assessments of personal relevance, the motives of information providers and the 'balance' of experiences presented. People can use 'personal experiences' information in various ways to support their decision-making, and exercise some discrimination as they do. 'Personal experiences' information may help people in a number of ways in relation to decision-making. However, 'personal experiences' information does not replace the need for 'general facts' and care should be taken when it is used in resources for patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Regret and the rationality of choices.

PubMed

Bourgeois-Gironde, Sacha

2010-01-27

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

Patient information leaflets (PILs) for UK randomised controlled trials: a feasibility study exploring whether they contain information to support decision making about trial participation.

PubMed

Gillies, Katie; Huang, Wan; Skea, Zoë; Brehaut, Jamie; Cotton, Seonaidh

2014-02-18

Informed consent is regarded as a cornerstone of ethical healthcare research and is a requirement for most clinical research studies. Guidelines suggest that prospective randomised controlled trial (RCT) participants should understand a basic amount of key information about the RCTs they are being asked to enrol in in order to provide valid informed consent. This information is usually provided to potential participants in a patient information leaflet (PIL). There is evidence that some trial participants fail to understand key components of trial processes or rationale. As such, the existing approach to information provision for potential RCT participants may not be optimal. Decision aids have been used for a variety of treatment and screening decisions to improve knowledge, but focus more on overall decision quality, and may be helpful to those making decisions about participating in an RCT. We investigated the feasibility of using a tool to identify which items recommended for good quality decision making are present in UK PILs. PILs were sampled from UK registered Clinical Trials Unit websites across a range of clinical areas. The evaluation tool, which is based on standards for supporting decision making, was applied to 20 PILs. Two researchers independently rated each PIL using the tool. In addition, word count and readability were assessed. PILs scored poorly on the evaluation tool with the majority of leaflets scoring less than 50%. Specifically, presenting probabilities, clarifying and expressing values and structured guidance in deliberation and communication sub-sections scored consistently poorly. Tool score was associated with word count (r=0.802, P <0.01); there was no association between score and readability (r=-0.372, P=0.106). The tool was feasible to use to evaluate PILs for UK RCTs. PILs did not meet current standards of information to support good quality decision making. Writers of information leaflets could use the evaluation tool as a framework during PIL development to help ensure that items are included which promote and support more informed decisions about trial participation. Further research is required to evaluate the inclusion of such information.

Factors influencing parents' decision-making when sending children with respiratory tract infections to nursery.

PubMed

Carroll, Fran E; Rooshenas, Leila; Owen-Smith, Amanda; Al-Janabi, Hareth; Hollinghurst, Sandra; Hay, Alastair D

2016-06-01

Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community. Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making. A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness. Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of New Approaches in Geothermal Exploration Decision Making: Preprint

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

Akar, S.; Young, K. R.

Geothermal exploration projects have significant amount of risk associated with uncertainties encountered in the discovery of the geothermal resource. Understanding when and how to proceed in an exploration program, and when to walk away from a site, are two of the largest challenges for increased geothermal deployment. Current methodologies for exploration decision making is left to subjective by subjective expert opinion which can be incorrectly biased by expertise (e.g. geochemistry, geophysics), geographic location of focus, and the assumed conceptual model. The aim of this project is to develop a methodology for more objective geothermal exploration decision making at a givenmore » location, including go-no-go decision points to help developers and investors decide when to give up on a location. In this scope, two different approaches are investigated: 1) value of information analysis (VOIA) which is used for evaluating and quantifying the value of a data before they are purchased, and 2) enthalpy-based exploration targeting based on reservoir size, temperature gradient estimates, and internal rate of return (IRR). The first approach, VOIA, aims to identify the value of a particular data when making decisions with an uncertain outcome. This approach targets the pre-drilling phase of exploration. These estimated VOIs are highly affected by the size of the project and still have a high degree of subjectivity in assignment of probabilities. The second approach, exploration targeting, is focused on decision making during the drilling phase. It starts with a basic geothermal project definition that includes target and minimum required production capacity and initial budgeting for exploration phases. Then, it uses average temperature gradient, reservoir temperature estimates, and production capacity to define targets and go/no-go limits. The decision analysis in this approach is based on achieving a minimum IRR at each phase of the project. This second approach was determined to be less subjective, since it requires less subjectivity in the input values.« less

Drug reimbursement decision-making in Thailand, China, and South Korea.

PubMed

Ngorsuraches, Surachat; Meng, Wei; Kim, Bo-Yeon; Kulsomboon, Vithaya

2012-01-01

To provide a comparison of national drug reimbursement decision-making, including an update of economic evaluation roles and barriers, in Thailand, China, and South Korea. Documentary reviews supplemented by experiences of policymakers. National health insurance policy in all the three countries has been developed toward coverage for all. It leads to higher health-care expenditures and requires a good reimbursement system for health-care services, including drugs. Drug reimbursement decision-making in these countries is to develop a reimbursement list with the help of various committees having different roles. Primarily, they assess the clinical and safety evidence. Economic evidence, including budget impact and pharmacoeconomic evaluation, has also been very important for their reimbursement decision-making. This evidence is sometimes used in negotiation mechanism, which allows pharmaceutical companies to lower their drug prices and leads to lower overall drug expenditures. Several common barriers, for example, human capacity and data availability, for obtaining economic evidence in all the three countries, however, still exist. Drug reimbursement decision-making in Thailand, China, and South Korea is in its transition period. It seems to run in the same direction, for example, guideline development and pharmacoeconomic evaluation agency establishment. Pharmacoeconomic evaluation plays important roles in the efficiency of drug reimbursement decision-making, even though there are several barriers to be overcome. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Reported Influences on Restaurant-Type Food Selection Decision Making in a Grocery Store Chain.

PubMed

Bachman, Jessica Lynne; Arigo, Danielle

2018-06-01

To examine food decision-making priorities for restaurant-type foods at grocery stores and determine whether adding calorie information, as required by federal menu labeling laws, affected decision-making priorities. Natural experiment: intervention and control groups with baseline and follow-up. Regional grocery store chain with 9 locations. Participants (n = 393; mean age, 54.8 ± 15.1 years) were primarily women (71%) and Caucasian (95%). Data were collected before and after calorie information was added to restaurant-type foods at 4 intervention locations. Primary influencers of food selection decision making for restaurant-type foods and frequency of use of nutrition information. Quantitative analysis examined the top 3 influencers of food selections and chi-square goodness of fit test determined whether the calorie labeling intervention changed food decision-making priorities. Qualitative data were used to describe responses. Taste, cost, and convenience were the most frequently reported influencers of restaurant-type food selections; 20% of participants rated calories as influential. Calorie labeling did not affect food selection decision making; 16% of participants in intervention stores noticed calorie labels. Qualitative explanations confirmed these findings. Menu labeling laws increase access to calorie information; however, use of this information is limited. Additional interventions are needed to encourage healthier restaurant-type food selections in grocery stores. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

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

PubMed

Brand, Paul L P; Stiggelbout, Anne M

2013-12-01

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

Judgment and decision making.

PubMed

Fischhoff, Baruch

2010-09-01

The study of judgment and decision making entails three interrelated forms of research: (1) normative analysis, identifying the best courses of action, given decision makers' values; (2) descriptive studies, examining actual behavior in terms comparable to the normative analyses; and (3) prescriptive interventions, helping individuals to make better choices, bridging the gap between the normative ideal and the descriptive reality. The research is grounded in analytical foundations shared by economics, psychology, philosophy, and management science. Those foundations provide a framework for accommodating affective and social factors that shape and complement the cognitive processes of decision making. The decision sciences have grown through applications requiring collaboration with subject matter experts, familiar with the substance of the choices and the opportunities for interventions. Over the past half century, the field has shifted its emphasis from predicting choices, which can be successful without theoretical insight, to understanding the processes shaping them. Those processes are often revealed through biases that suggest non-normative processes. The practical importance of these biases depends on the sensitivity of specific decisions and the support that individuals have in making them. As a result, the field offers no simple summary of individuals' competence as decision makers, but a suite of theories and methods suited to capturing these sensitivities. Copyright © 2010 John Wiley & Sons, Ltd. For further resources related to this article, please visit the WIREs website. Copyright © 2010 John Wiley & Sons, Ltd.

Neural Signatures of Controlled and Automatic Retrieval Processes in Memory-based Decision-making.

PubMed

Khader, Patrick H; Pachur, Thorsten; Weber, Lilian A E; Jost, Kerstin

2016-01-01

Decision-making often requires retrieval from memory. Drawing on the neural ACT-R theory [Anderson, J. R., Fincham, J. M., Qin, Y., & Stocco, A. A central circuit of the mind. Trends in Cognitive Sciences, 12, 136-143, 2008] and other neural models of memory, we delineated the neural signatures of two fundamental retrieval aspects during decision-making: automatic and controlled activation of memory representations. To disentangle these processes, we combined a paradigm developed to examine neural correlates of selective and sequential memory retrieval in decision-making with a manipulation of associative fan (i.e., the decision options were associated with one, two, or three attributes). The results show that both the automatic activation of all attributes associated with a decision option and the controlled sequential retrieval of specific attributes can be traced in material-specific brain areas. Moreover, the two facets of memory retrieval were associated with distinct activation patterns within the frontoparietal network: The dorsolateral prefrontal cortex was found to reflect increasing retrieval effort during both automatic and controlled activation of attributes. In contrast, the superior parietal cortex only responded to controlled retrieval, arguably reflecting the sequential updating of attribute information in working memory. This dissociation in activation pattern is consistent with ACT-R and constitutes an important step toward a neural model of the retrieval dynamics involved in memory-based decision-making.

Decision-making Capacity for Treatment of Psychotic Patients on Long Acting Injectable Antipsychotic Treatment.

PubMed

Nystazaki, Maria; Pikouli, Katerina; Tsapakis, Eva-Maria; Karanikola, Maria; Ploumpidis, Dimitrios; Alevizopoulos, Giorgos

2018-04-01

Providing informed, consent requires patients' Decision-Making Capacity for treatment. We evaluated the Decision Making Capacity of outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotic medication. This is a retrospective, cross-sectional, correlational study conducted at two Depot Clinics in Athens, Greece. Participants included 65 outpatients diagnosed with schizophrenia and schizoaffective disorder on treatment with Long Acting Injectable Antipsychotics. Over half of the participants showed poor understanding of the information given regarding their disease and treatment (Understanding subscale), however >70% seemed to comprehend the relevance of this information to their medical condition (Appreciation subscale). Moreover, half of the participants reported adequate reasoning ability (Reasoning subscale), whilst patients who gained >7% of their body weight scored statistically significantly higher in the subscales of Understanding and Appreciation. Our results suggest that there is a proportion of patients with significantly diminished Decision Making Capacity, hence a full assessment is recommended in order to track them down. Further research is needed to better interpret the association between antipsychotic induced weight gain and Decision Making Capacity in patients suffering from schizophrenia or schizoaffective disorder. Copyright © 2017 Elsevier Inc. All rights reserved.

Quality assessment of decision-making in colorectal cancer multidisciplinary meetings.

PubMed

Seretis, Charalampos; Mankotia, Rajnish; Goonetilleke, Kolitha; Rawstorne, Edward

2014-01-01

The quality of decision-making in the colorectal multidisciplinary team (MDT) meetings can significantly affect the quality of care delivered to patients with colorectal cancer. We performed a prospective study to assess the quality of the MDT meetings in a specialized colorectal unit using an externally observational validated tool. An externally validated observational tool, the Colorectal Multidisciplinary Team Metric for Observation of Decision-Making (cMDT-MODe), was used to assess the quality of clinical decision-making in 64 cases. Although case history information presented by the responsible surgeon was rated high (4.4/5), the quality of radiological and histopathological information regarding each patient's case which was available at the time was less adequate, scoring 3.9/5 and 3.8/5, respectively. Moreover, the precise knowledge of patients' personal views and circumstances was a field requiring further improvement. In a general overview however, the quality and extent of the available information enabled the MDT to provide a clear recommendation regarding the patients' treatment plans in 87.5% of the cases. The cMDT-MODe tool can be used to prospectively audit the quality of clinical decision-making in the colorectal MDT meetings and highlight the fields of potential improvement.

[Evidence-based Risk and Benefit Communication for Shared Decision Making].

PubMed

Nakayama, Takeo

2018-01-01

　Evidence-based medicine (EBM) can be defined as "the integration of the best research evidence with clinical expertise and a patient's unique values and circumstances". However, even with the best research evidence, many uncertainties can make clinical decisions difficult. As the social requirement of respecting patient values and preferences has been increasingly recognized, shared decision making (SDM) and consensus development between patients and clinicians have attracted attention. SDM is a process by which patients and clinicians make decisions and arrive at a consensus through interactive conversations and communications. During the process of SDM, patients and clinicians share information with each other on the goals they hope to achieve and responsibilities in meeting those goals. From the clinician's standpoint, information regarding the benefits and risks of potential treatment options based on current evidence and professional experience is provided to patients. From the patient's standpoint, information on personal values, preferences, and social roles is provided to clinicians. SDM is a sort of "wisdom" in the context of making autonomous decisions in uncertain, difficult situations through interactions and cooperation between patients and clinicians. Joint development of EBM and SDM will help facilitate patient-clinician relationships and improve the quality of healthcare.

The influence of the dorsolateral prefrontal cortex on attentional behavior and decision making. A t-DCS study on emotionally vs. functionally designed objects.

PubMed

Colombo, Barbara; Balzarotti, Stefania; Mazzucchelli, Nicla

2016-04-01

Prior research has shown that right dorsolateral prefrontal cortex may be crucial in cognitive control of affective impulses during decision making. The present study examines whether modulation of r-DLPFC with transcranial direct current stimulation influences attentional behavior and decision-making in a purchase task requiring participants to choose either emotional/attractive or functional/useful objects. 30 participants were shown sixteen pairs of emotionally or functionally designed products while their eye-movements were recorded. Participants were asked to judge aesthetics and usefulness of each object, and to decide which object of each pair they would buy. Results revealed that participants decided to buy the functionally designed objects more often regardless of condition; however, participants receiving anodal stimulation were faster in decision making. Although stimulation of r-DLPFC did not affect the actual purchasing choice and had little effect on visual exploration during decision making, it influenced perceived usefulness and attractiveness, with temporary inhibition of r-DLPFC leading to evaluate functional objects as less attractive. Finally, anodal stimulation led to judge the objects as more useful. The implications of these results are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Alternative Perspectives on Risk: Individual Differences in Problem Structuring

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Fischer, Ute; Connors, Mary M. (Technical Monitor)

1997-01-01

Team decision making involves contributions of multiple players toward a common goal. While much has been written about the importance of developing shared mental models in order for teams to work together effectively, little has been done to determine the value of alternative perspectives on problem solving and decision making. Early studies of expertise contrasted experts with novices and noted that the two groups differ in the way they structure problems and in their selection of information as salient. Little attention has been given to differences among experts who differ in their specializations. A series of experiments was conducted to determine: (1) what dimensions of flight-related problem situations pilots judge to be most important when making flight-relevant decisions; and (2) whether pilots in different crew positions differ in the way they interpret problems relating to flight decisions. A sorting task was used to identify underlying dimensions judged as salient to individual pilots. Captains, first officers, and flight engineers from two major carriers participated in the study. Twenty-two flight scenarios were developed based on ASRS reports. Pilots were required to make judgments about how they would respond in each case and to sort the scenarios on the basis of similarity of decision factors. They were also asked to provide a verbal label that described each of their sorted categories. A second study required a different group of pilots (also captains, first officers and flight engineers) to sort on predetermined bases.

Temporal dynamics of selective attention and conflict resolution during cross-dimensional Go-NoGo decisions.

PubMed

Kopp, Bruno; Tabeling, Sandra; Moschner, Carsten; Wessel, Karl

2007-08-17

Decision-making is a fundamental capacity which is crucial to many higher-order psychological functions. We recorded event-related potentials (ERPs) during a visual target-identification task that required go-nogo choices. Targets were identified on the basis of cross-dimensional conjunctions of particular colors and forms. Color discriminability was manipulated in three conditions to determine the effects of color distinctiveness on component processes of decision-making. Target identification was accompanied by the emergence of prefrontal P2a and P3b. Selection negativity (SN) revealed that target-compatible features captured attention more than target-incompatible features, suggesting that intra-dimensional attentional capture was goal-contingent. No changes of cross-dimensional selection priorities were measurable when color discriminability was altered. Peak latencies of the color-related SN provided a chronometric measure of the duration of attention-related neural processing. ERPs recorded over the frontocentral scalp (N2c, P3a) revealed that color-overlap distractors, more than form-overlap distractors, required additional late selection. The need for additional response selection induced by color-overlap distractors was severely reduced when color discriminability decreased. We propose a simple model of cross-dimensional perceptual decision-making. The temporal synchrony of separate color-related and form-related choices determines whether or not distractor processing includes post-perceptual stages. ERP measures contribute to a comprehensive explanation of the temporal dynamics of component processes of perceptual decision-making.

Feminist ethics and menopause: autonomy and decision-making in primary medical care.

PubMed

Murtagh, Madeleine J; Hepworth, Julie

2003-04-01

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners' accounts of menopause and treatment in Australia, women's 'choice', 'informed decision-making' and 'empowerment' were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of 'informed decision-making' in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an 'ethic of autonomy' and an 'offer of choice' in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Patients' views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury-A qualitative interview-based study.

PubMed

Scheel-Sailer, Anke; Post, Marcel W; Michel, Franz; Weidmann-Hügle, Tatjana; Baumann Hölzle, Ruth

2017-10-01

Involving patients in decision making is a legal requirement in many countries, associated with better rehabilitation outcomes, but not easily accomplished during initial inpatient rehabilitation after severe trauma. Providing medical treatment according to the principles of shared decision making is challenging as a point in case for persons with spinal cord injury (SCI). The aim of this study was to retrospectively explore the patients' views on their participation in decision making during their first inpatient rehabilitation after onset of SCI, in order to optimize treatment concepts. A total of 22 participants with SCI were interviewed in-depth using a semi-structured interview scheme between 6 months and 35 years post-onset. Interviews were transcribed verbatim and analysed with the Mayring method for qualitative content analysis. Participants experienced a substantially reduced ability to participate in decision making during the early phase after SCI. They perceived physical, psychological and environmental factors to have impacted upon this ability. Patients mentioned regaining their ability to make decisions was an important goal during their first rehabilitation. Receiving adequate information in an understandable and personalized way was a prerequisite to achieve this goal. Other important factors included medical and psychological condition, personal engagement, time and dialogue with peers. During the initial rehabilitation of patients with SCI, professionals need to deal with the discrepancy between the obligation to respect a patient's autonomy and their diminished ability for decision making. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

PubMed

Taylor, Janice; Sims, Jane; Haines, Terry P

2014-12-01

To explore mobility care as provided by care staff in nursing homes. Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. A focused ethnography. The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care. © 2014 John Wiley & Sons Ltd.

Neurofunctional Correlates of Ethical, Food-Related Decision-Making

PubMed Central

Cherry, J. Bradley C.; Bruce, Jared M.; Lusk, Jayson L.; Crespi, John M.; Lim, Seung-Lark; Bruce, Amanda S.

2015-01-01

For consumers today, the perceived ethicality of a food’s production method can be as important a purchasing consideration as its price. Still, few studies have examined how, neurofunctionally, consumers are making ethical, food-related decisions. We examined how consumers’ ethical concern about a food’s production method may relate to how, neurofunctionally, they make decisions whether to purchase that food. Forty-six participants completed a measure of the extent to which they took ethical concern into consideration when making food-related decisions. They then underwent a series of functional magnetic resonance imaging (fMRI) scans while performing a food-related decision-making (FRDM) task. During this task, they made 56 decisions whether to purchase a food based on either its price (i.e., high or low, the “price condition”) or production method (i.e., with or without the use of cages, the “production method condition”), but not both. For 23 randomly selected participants, we performed an exploratory, whole-brain correlation between ethical concern and differential neurofunctional activity in the price and production method conditions. Ethical concern correlated negatively and significantly with differential neurofunctional activity in the left dorsolateral prefrontal cortex (dlPFC). For the remaining 23 participants, we performed a confirmatory, region-of-interest (ROI) correlation between the same variables, using an 8-mm3 volume situated in the left dlPFC. Again, the variables correlated negatively and significantly. This suggests, when making ethical, food-related decisions, the more consumers take ethical concern into consideration, the less they may rely on neurofunctional activity in the left dlPFC, possibly because making these decisions is more routine for them, and therefore a more perfunctory process requiring fewer cognitive resources. PMID:25830288

Neurofunctional correlates of ethical, food-related decision-making.

PubMed

Cherry, J Bradley C; Bruce, Jared M; Lusk, Jayson L; Crespi, John M; Lim, Seung-Lark; Bruce, Amanda S

2015-01-01

For consumers today, the perceived ethicality of a food's production method can be as important a purchasing consideration as its price. Still, few studies have examined how, neurofunctionally, consumers are making ethical, food-related decisions. We examined how consumers' ethical concern about a food's production method may relate to how, neurofunctionally, they make decisions whether to purchase that food. Forty-six participants completed a measure of the extent to which they took ethical concern into consideration when making food-related decisions. They then underwent a series of functional magnetic resonance imaging (fMRI) scans while performing a food-related decision-making (FRDM) task. During this task, they made 56 decisions whether to purchase a food based on either its price (i.e., high or low, the "price condition") or production method (i.e., with or without the use of cages, the "production method condition"), but not both. For 23 randomly selected participants, we performed an exploratory, whole-brain correlation between ethical concern and differential neurofunctional activity in the price and production method conditions. Ethical concern correlated negatively and significantly with differential neurofunctional activity in the left dorsolateral prefrontal cortex (dlPFC). For the remaining 23 participants, we performed a confirmatory, region-of-interest (ROI) correlation between the same variables, using an 8-mm3 volume situated in the left dlPFC. Again, the variables correlated negatively and significantly. This suggests, when making ethical, food-related decisions, the more consumers take ethical concern into consideration, the less they may rely on neurofunctional activity in the left dlPFC, possibly because making these decisions is more routine for them, and therefore a more perfunctory process requiring fewer cognitive resources.

49 CFR 240.401 - Review board established.

Code of Federal Regulations, 2010 CFR

2010-10-01

... that he or she failed to meet the qualification requirements of this regulation when making the decision to deny or revoke certification, may petition the Federal Railroad Administrator to review the railroad's decision. (b) The Federal Railroad Administrator has delegated initial responsibility for...

Adverse Outcome Pathways – Organizing Toxicological Information to Improve Decision Making

EPA Science Inventory

The number of chemicals for which environmental regulatory decisions are required far exceeds the current capacity for toxicity testing. High throughput screening (HTS) commonly used for drug discovery has the potential to increase this capacity. The adverse outcome pathway (AOP)...

A Decision Support Tool for Sustainable Land Use, Transportation, Buildings/Infrastructure, and Materials Management

EPA Science Inventory

One issue for community groups, local and regional planners, and politicians, is that they require relevant information to develop programs and initiatives for incorporating sustainability principles into their physical infrastructure, operations, and decision-making processes. T...

Insect pest management decisions in food processing facilities

USDA-ARS?s Scientific Manuscript database

Pest management decision making in food processing facilities such as flour mills, rice mills, human and pet food manufacturing facilities, distribution centers and warehouses, and retail stores is a challenging undertaking. Insect pest management programs require an understanding of the food facili...

Recruiting patients to clinical trials: lessons from studies of growth hormone treatment in renal failure.

PubMed

Postlethwaite, R J; Reynolds, J M; Wood, A J; Evans, J H; Lewis, M A; Eminson, D M

1995-07-01

Issues raised by the recruitment of children to trials of growth hormone treatment for short stature in chronic renal failure are reported. Information needs of parents and children are discussed, the latter should take account of the children's developmental level and anticipated involvement in decision making. When the incidence of certain side effects is low and probably unquantifiable there are particular problems; failure to include these in information sheets may compromise informed consent but inclusion will, at least for some families, make an already difficult decision even more complicated. A process of recruitment is described which attempts to protect against bias and which balances the requirement to impart neutral information with appropriate clinical involvement in the decision to enter the study. Other functions of the recruitment process are identified. Analysis of understanding and decision making demonstrates that good understanding is neither necessary nor sufficient for ease of decision making. The recruitment process was time consuming and needs planning and funding in future studies. Many of these issues are of general importance for trials of treatment in children.

Planning effectiveness may grow on fault trees.

PubMed

Chow, C W; Haddad, K; Mannino, B

1991-10-01

The first step of a strategic planning process--identifying and analyzing threats and opportunities--requires subjective judgments. By using an analytical tool known as a fault tree, healthcare administrators can reduce the unreliability of subjective decision making by creating a logical structure for problem solving and decision making. A case study of 11 healthcare administrators showed that an analysis technique called prospective hindsight can add to a fault tree's ability to improve a strategic planning process.

Managing resources in NHS dentistry: the views of decision-makers in primary care organisations.

PubMed

Holmes, R D; Donaldson, C; Exley, C; Steele, J G

2008-09-27

To investigate priority setting and decision-making in primary care organisations and to determine how resources are managed in order to meet the oral health needs of local populations. This is a qualitative study. The purposive sample comprised twelve dental public health consultants and six senior finance representatives from contrasting care systems across the United Kingdom. Participants completed a written information sheet followed by a recorded semi-structured telephone interview. Conversations were professionally transcribed verbatim and analysed independently by two investigators using the constant comparative method. The emergent themes focused upon: the role of participants in decision-making; professional relationships; managing change; information needs; and identifying and managing priorities. There was wide interpretation with respect to participants' roles and perceived information needs for decision-making and commissioning. A unifying factor was the importance placed by participants upon trust and the influence of individuals on the success of relationships forged between primary care organisations and general dental practitioners. To facilitate decision-making in primary care organisations, commissioners and managers could engage further with practitioners and incorporate them into commissioning and resource allocation processes. Greater clarity is required regarding the role of dental public health consultants within primary care organisations and commissioning decisions.

Using Risk Assessment Methodologies to Meet Management Objectives

NASA Technical Reports Server (NTRS)

DeMott, D. L.

2015-01-01

Current decision making involves numerous possible combinations of technology elements, safety and health issues, operational aspects and process considerations to satisfy program goals. Identifying potential risk considerations as part of the management decision making process provides additional tools to make more informed management decision. Adapting and using risk assessment methodologies can generate new perspectives on various risk and safety concerns that are not immediately apparent. Safety and operational risks can be identified and final decisions can balance these considerations with cost and schedule risks. Additional assessments can also show likelihood of event occurrence and event consequence to provide a more informed basis for decision making, as well as cost effective mitigation strategies. Methodologies available to perform Risk Assessments range from qualitative identification of risk potential, to detailed assessments where quantitative probabilities are calculated. Methodology used should be based on factors that include: 1) type of industry and industry standards, 2) tasks, tools, and environment 3) type and availability of data and 4) industry views and requirements regarding risk & reliability. Risk Assessments are a tool for decision makers to understand potential consequences and be in a position to reduce, mitigate or eliminate costly mistakes or catastrophic failures.

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

Radojcic, Riko; Nowak, Matt; Nakamoto, Mark

The status of the development of a Design-for-Stress simulation flow that captures the stress effects in packaged 3D-stacked Si products like integrated circuits (ICs) using advanced via-middle Through Si Via technology is outlined. The next set of challenges required to proliferate the methodology and to deploy it for making and dispositioning real Si product decisions are described here. These include the adoption and support of a Process Design Kit (PDK) that includes the relevant material properties, the development of stress simulation methodologies that operate at higher levels of abstraction in a design flow, and the development and adoption of suitablemore » models required to make real product reliability decisions.« less

Using real options analysis to support strategic management decisions

NASA Astrophysics Data System (ADS)

Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

2013-12-01

Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

Subliminally and Supraliminally Acquired Long-Term Memories Jointly Bias Delayed Decisions.

PubMed

Ruch, Simon; Herbert, Elizabeth; Henke, Katharina

2017-01-01

Common wisdom and scientific evidence suggest that good decisions require conscious deliberation. But growing evidence demonstrates that not only conscious but also unconscious thoughts influence decision-making. Here, we hypothesize that both consciously and unconsciously acquired memories guide decisions. Our experiment measured the influence of subliminally and supraliminally presented information on delayed (30-40 min) decision-making. Participants were presented with subliminal pairs of faces and written occupations for unconscious encoding. Following a delay of 20 min, participants consciously (re-)encoded the same faces now presented supraliminally along with either the same written occupations, occupations congruous to the subliminally presented occupations (same wage-category), or incongruous occupations (opposite wage-category). To measure decision-making, participants viewed the same faces again (with occupations absent) and decided on the putative income of each person: low, low-average, high-average, or high. Participants were encouraged to decide spontaneously and intuitively. Hence, the decision task was an implicit or indirect test of relational memory. If conscious thought alone guided decisions (= H 0 ), supraliminal information should determine decision outcomes independently of the encoded subliminal information. This was, however, not the case. Instead, both unconsciously and consciously encoded memories influenced decisions: identical unconscious and conscious memories exerted the strongest bias on income decisions, while both incongruous and congruous (i.e., non-identical) subliminally and supraliminally formed memories canceled each other out leaving no bias on decisions. Importantly, the increased decision bias following the formation of identical unconscious and conscious memories and the reduced decision bias following to the formation of non-identical memories were determined relative to a control condition, where conscious memory formation alone could influence decisions. In view of the much weaker representational strength of subliminally vs. supraliminally formed memories, their long-lasting impact on decision-making is noteworthy.

Subliminally and Supraliminally Acquired Long-Term Memories Jointly Bias Delayed Decisions

PubMed Central

Ruch, Simon; Herbert, Elizabeth; Henke, Katharina

2017-01-01

Common wisdom and scientific evidence suggest that good decisions require conscious deliberation. But growing evidence demonstrates that not only conscious but also unconscious thoughts influence decision-making. Here, we hypothesize that both consciously and unconsciously acquired memories guide decisions. Our experiment measured the influence of subliminally and supraliminally presented information on delayed (30–40 min) decision-making. Participants were presented with subliminal pairs of faces and written occupations for unconscious encoding. Following a delay of 20 min, participants consciously (re-)encoded the same faces now presented supraliminally along with either the same written occupations, occupations congruous to the subliminally presented occupations (same wage-category), or incongruous occupations (opposite wage-category). To measure decision-making, participants viewed the same faces again (with occupations absent) and decided on the putative income of each person: low, low-average, high-average, or high. Participants were encouraged to decide spontaneously and intuitively. Hence, the decision task was an implicit or indirect test of relational memory. If conscious thought alone guided decisions (= H0), supraliminal information should determine decision outcomes independently of the encoded subliminal information. This was, however, not the case. Instead, both unconsciously and consciously encoded memories influenced decisions: identical unconscious and conscious memories exerted the strongest bias on income decisions, while both incongruous and congruous (i.e., non-identical) subliminally and supraliminally formed memories canceled each other out leaving no bias on decisions. Importantly, the increased decision bias following the formation of identical unconscious and conscious memories and the reduced decision bias following to the formation of non-identical memories were determined relative to a control condition, where conscious memory formation alone could influence decisions. In view of the much weaker representational strength of subliminally vs. supraliminally formed memories, their long-lasting impact on decision-making is noteworthy. PMID:28955268

Health economic evaluations in reimbursement decision making in the Netherlands: time to take it seriously?

PubMed

Franken, Margreet; Koopmanschap, Marc; Steenhoek, Adri

2014-01-01

Health technology assessment already informed Dutch policymaking in the early 1980s. Evidence of health economic evaluations is, however, only systematically used in drug reimbursement decision making. Outpatient drugs with an added therapeutic value and expensive specialist drugs require evidence from an economic evaluation. Due to many exemptions, however, the availability of evidence of health economic evaluations remains rather low. Although the Dutch reimbursement agency suggested a cost-effectiveness threshold range depending on the severity of the disease (i.e., €10,000 - 80,000 per Quality Adjusted Life Year), it was never confirmed nor endorsed by the Ministry of Health. It is highly questionable whether health economic evaluations currently play a role in actual Dutch reimbursement decision making. Although the requirements exist in policy procedures, recent cases show that Dutch policymakers experience great difficulties in putting restrictions on reimbursement based on evidence from health economic evaluations. The near future will show whether the need will increase to base decisions on societal value for money, and whether Dutch policymakers show the courage to take health economic evaluations seriously. Copyright © 2014. Published by Elsevier GmbH.

Shared decision making in designing new healthcare environments-time to begin improving quality.

PubMed

Elf, Marie; Fröst, Peter; Lindahl, Göran; Wijk, Helle

2015-03-21

Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users' perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Diverse decisions. How culture affects ethical decision making.

PubMed

Wright, F; Cohen, S; Caroselli, C

1997-03-01

Even under optimal conditions, assisting patients and families in making ethical decisions is difficult at best. Often these decisions revolve around the end-of-life issues that require acknowledgement that the patient is unlikely to survive, which may be perceived as a failure to both the family and the staff. At the very least, it can be a sad time, fraught with uncertainty and indecision. When these difficulties are coupled with ineffective communication related to cultural insensitivity or unawareness, the effects can be devastating to the decision-making process. All CCNs are expected to master the skills necessary for assisting patients and families through the harrowing experience of life-threatening illness. Whereas much of critical care focuses on managing pathophysiologic disturbances, emotional needs are equally important. It follows then that the CCN must assume responsibility for assisting patients and families in coping with the crisis of critical illness and working through ethical issues, which often include end-of-life decisions and organ donation. Culturally competent care is required when addressing patient needs holistically, but it is so much more. It is an opportunity to enrich and deepen the CCN/patient/family relationship, advocate for the patient, and broaden the opportunities for communication among staff. This article has provided some beginning steps for increasing nursing cultural awareness and has offered some initial strategies to consider when designing a plan of care. Through continuing efforts, CCNs and organizations can do much to decrease the alienation that many patients and families have traditionally encountered in the CCU, an estrangement that is exacerbated when their culture is different from the predominant culture of the unit. The effort to become more culturally aware may appear to require extraordinary effort; however, the rewards of optimizing patient care are unsurpassed.

Different profiles of decision making and physiology under varying levels of stress in trained military personnel.

PubMed

Gamble, Katherine R; Vettel, Jean M; Patton, Debra J; Eddy, Marianna D; Caroline Davis, F; Garcia, Javier O; Spangler, Derek P; Thayer, Julian F; Brooks, Justin R

2018-03-23

Decision making is one of the most vital processes we use every day, ranging from mundane decisions about what to eat to life-threatening choices such as how to avoid a car collision. Thus, the context in which our decisions are made is critical, and our physiology enables adaptive responses that account for how environmental stress influences our performance. The relationship between stress and decision making can additionally be affected by one's expertise in making decisions in high-threat environments, where experts can develop an adaptive response that mitigates the negative impacts of stress. In the present study, 26 male military personnel made friend/foe discriminations in an environment where we manipulated the level of stress. In the high-stress condition, participants received a shock when they incorrectly shot a friend or missed shooting a foe; in the low-stress condition, participants received a vibration for an incorrect decision. We characterized performance using signal detection theory to investigate whether a participant changed their decision criterion to avoid making an error. Results showed that under high-stress, participants made more false alarms, mistaking friends as foes, and this co-occurred with increased high frequency heart rate variability. Finally, we examined the relationship between decision making and physiology, and found that participants exhibited adaptive behavioral and physiological profiles under different stress levels. We interpret this adaptive profile as a marker of an expert's ingrained training that does not require top down control, suggesting a way that expert training in high-stress environments helps to buffer negative impacts of stress on performance. Published by Elsevier B.V.

Gray matter volume and rapid decision-making in major depressive disorder.

PubMed

Nakano, Masayuki; Matsuo, Koji; Nakashima, Mami; Matsubara, Toshio; Harada, Kenichiro; Egashira, Kazuteru; Masaki, Hiroaki; Takahashi, Kanji; Watanabe, Yoshifumi

2014-01-03

Reduced motivation and blunted decision-making are key features of major depressive disorder (MDD). Patients with MDD show abnormal decision-making when given negative feedback regarding a reward. The brain mechanisms underpinning this behavior remain unclear. In the present study, we examined the association between rapid decision-making with negative feedback and brain volume in MDD. Thirty-six patients with MDD and 54 age-, sex- and IQ-matched healthy subjects were studied. Subjects performed a rapid decision-making monetary task in which participants could make high- or low-risk choices. We compared between the 2 groups the probability that a high-risk choice followed negative feedback. In addition, we used voxel-based morphometry (VBM) to compare between group differences in gray matter volume, and the correlation between the probability for high-risk choices and brain volume. Compared to the healthy group, the MDD group showed significantly lower probabilities for high-risk choices following negative feedback. VBM analysis revealed that the MDD group had less gray matter volume in the right medial prefrontal cortex and orbitofrontal cortex (OFC) compared to the healthy group. The right OFC volume was negatively correlated with the probability that a high-risk choice followed negative feedback in patients with MDD. We did not observe these trends in healthy subjects. Patients with MDD show reduced motivation for monetary incentives when they were required to make rapid decisions following negative feedback. We observed a correlation between this reduced motivation and gray matter volume in the medial and ventral prefrontal cortex, which suggests that these brain regions are likely involved in the pathophysiology of aberrant decision-making in MDD. © 2013.

Evidence and Options for Informed Decision-Making to Achive Arctic Sustainability

NASA Astrophysics Data System (ADS)

Berkman, P. A.

2017-12-01

This presentation will consider the development of evidence and options for informed decision-making that will need to operate across generations to achieve Arctic sustainability (Figure). Context of these Arctic decisions is global, recognizing that we live in an interconnected civilization on a planetary scale, as revealed unambiguously with evidence from the `world' wars in the first half of the 20thcentury. First, for clarification, data and evidence are not the same. Data is generated from information and observations to answer specific questions, posed with methods from the natural and social sciences as well as indigenous knowledge. These data reveal patterns and trends in our societies and natural world, underscoring the evidence for decisions to address impacts, issues and resources within, across and beyond the boundaries of nations - recognizing that nations still are the principal jurisdictional unit. However, for this decision-support process to be effective, options (without advocacy) - which can be used or ignored explicitly - must be generated from the evidence, taking into consideration stakeholder perspectives and governance records in a manner that will contribute to informed decision-making. The resulting decisions will involve built elements that require capitalization and technology as well as governance mechanisms coming from diverse jurisdictional authorities. The innovation required is to balance economic prosperity, environmental protection and societal well-being. These three pillars of sustainability further involve stability, balancing urgencies of the moment and of future generations, recognizing that children born today will be alive in the 22nd century. Consequently, options for informed decisions must operate across a continuum of urgencies from security time scales to sustainability time scales. This decision-support process is holistic (international, interdisciplinary and inclusive), reflecting the applications of science diplomacy to balance national interests and common interests for the benefit of all on Earth.

End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life.

PubMed

Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis

2012-12-03

The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries). Nonetheless, the study revealed cases where not all legal obligations were met or where the decision was totally illegal. There is still a lot to be done through medical education and population awareness-raising to ensure that the decision-making process is compatible with current legislation, the physician's duty of care and the patient's rights.

Network-centric decision architecture for financial or 1/f data models

NASA Astrophysics Data System (ADS)

Jaenisch, Holger M.; Handley, James W.; Massey, Stoney; Case, Carl T.; Songy, Claude G.

2002-12-01

This paper presents a decision architecture algorithm for training neural equation based networks to make autonomous multi-goal oriented, multi-class decisions. These architectures make decisions based on their individual goals and draw from the same network centric feature set. Traditionally, these architectures are comprised of neural networks that offer marginal performance due to lack of convergence of the training set. We present an approach for autonomously extracting sample points as I/O exemplars for generation of multi-branch, multi-node decision architectures populated by adaptively derived neural equations. To test the robustness of this architecture, open source data sets in the form of financial time series were used, requiring a three-class decision space analogous to the lethal, non-lethal, and clutter discrimination problem. This algorithm and the results of its application are presented here.

“I’m a mother first”: The influence of mothering in the decision-making processes of battered immigrant Latino women

PubMed Central

Kelly, Ursula A.

2018-01-01

Healthcare providers (HCPs) may be perplexed by the decision-making processes of battered Latino women in situations involving intimate partner violence (IPV). In particular, decisions may appear contradictory and hazardous to the women’s children. The findings of this interpretive descriptive study reveal that the mothering role was central to battered Latina mothers’ decisions. The mothers strove to prioritize, protect, and provide for their children in every way, including managing the abuse and avoiding IPV disclosure to HCPs. Disparate understandings of the women’s decisions and mothering create a Catch-22 between battered Latina mothers and their HCPs. A trusting mother-HCP relationship is necessary for effective screening and intervention for IPV. This requires HCPs’ understanding of these mothers’ decisions and changes in clinical practice. PMID:19350663

Using cognitive task analysis to identify critical decisions in the laparoscopic environment.

PubMed

Craig, Curtis; Klein, Martina I; Griswold, John; Gaitonde, Krishnanath; McGill, Thomas; Halldorsson, Ari

2012-12-01

The aim of this study was to identify the critical decisions surgeons need to make regarding laparoscopic surgery, the information these decisions are based on, the strategies employed by surgeons to reach their objectives, and the difficulties experienced by novices. Laparoscopic training focuses on the development of technical skills. However, successful surgical outcomes are also dependent on appropriate decisions made during surgery, which are influenced by critical cues and the use of appropriate strategies. Novices might not be as adept at cue detection and strategy use. Participants were eight attending surgeons. The authors employed task-analytic techniques to identify critical decisions inherent in laparoscopy and the cues, strategies, and novice traps associated with these decisions. The authors used decision requirements tables to organize the data into the key decisions made during the preoperative, operative, and postoperative phases as well as the cues, strategies, and novice traps associated with these decisions. Key decisions identified for the preoperative phase included but were not limited to the decision of performing a laparoscopic versus open surgery, necessity to review the literature, practicing the procedure, and trocar placement. Some key decisions identified for the operative phase included converting to open surgery, performing angiograms, cutting tissue or organs, and reevaluation of the approach. Only one key decision was identified for the postoperative phrase: whether the surgeon's technique needs to be evaluated and revised. The laparoscopic environment requires complex decision making, and novices are prone to errors in their decisions. The information elicited in this study is applicable to laparoscopic training.

Moving data off the shelf and into action: an intervention to improve data-informed decision making in Côte d'Ivoire.

PubMed

Nutley, Tara; Gnassou, Léontine; Traore, Moussa; Bosso, Abitche Edwige; Mullen, Stephanie

2014-01-01

Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d'Ivoire, data were largely unused in health decision-making processes. To implement and evaluate an intervention to improve the use of data in decision making in Cote d'Ivoire. From 2008 to 2012, Cote d'Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use. From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same - 38%. The central score is not reported, because of a methodological difference in the two assessments. The intervention improved the use of data in decision making at the district level in Côte d'Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making.

Thinking like an expert: surgical decision making as a cyclical process of being aware.

PubMed

Cristancho, Sayra M; Apramian, Tavis; Vanstone, Meredith; Lingard, Lorelei; Ott, Michael; Forbes, Thomas; Novick, Richard

2016-01-01

Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the "Reconciliation Cycle" as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. The Reconciliation Cycle constituted an iterative process of "gaining" and "transforming information." The cyclical nature of surgeons' decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events. Copyright © 2016 Elsevier Inc. All rights reserved.

Situating methodology within qualitative research.

PubMed

Kramer-Kile, Marnie L

2012-01-01

Qualitative nurse researchers are required to make deliberate and sometimes complex methodological decisions about their work. Methodology in qualitative research is a comprehensive approach in which theory (ideas) and method (doing) are brought into close alignment. It can be difficult, at times, to understand the concept of methodology. The purpose of this research column is to: (1) define qualitative methodology; (2) illuminate the relationship between epistemology, ontology and methodology; (3) explicate the connection between theory and method in qualitative research design; and 4) highlight relevant examples of methodological decisions made within cardiovascular nursing research. Although there is no "one set way" to do qualitative research, all qualitative researchers should account for the choices they make throughout the research process and articulate their methodological decision-making along the way.