Future of electronic health records: implications for decision support.

PubMed

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

2012-01-01

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

Transit operations decision support systems (TODSS) : core functional requirements for identification of service disruptions and provision of service restoration options 1.0

DOT National Transportation Integrated Search

2004-03-15

The Transit Operations Decision Support System (TODSS) Project was initiated to address concerns raised by transit agencies that have implemented and are using Automated Vehicle Location (AVL) and Computer Aided Dispatch Systems (CAD). This document ...

ANFIS multi criteria decision making for overseas construction projects: a methodology

NASA Astrophysics Data System (ADS)

Utama, W. P.; Chan, A. P. C.; Zulherman; Zahoor, H.; Gao, R.; Jumas, D. Y.

2018-02-01

A critical part when a company targeting a foreign market is how to make a better decision in connection with potential project selection. Since different attributes of information are often incomplete, imprecise and ill-defined in overseas projects selection, the process of decision making by relying on the experiences and intuition is a risky attitude. This paper aims to demonstrate a decision support method in deciding overseas construction projects (OCPs). An Adaptive Neuro-Fuzzy Inference System (ANFIS), the amalgamation of Neural Network and Fuzzy Theory, was used as decision support tool to decide to go or not go on OCPs. Root mean square error (RMSE) and coefficient of correlation (R) were employed to identify the ANFIS system indicating an optimum and efficient result. The optimum result was obtained from ANFIS network with two input membership functions, Gaussian membership function (gaussmf) and hybrid optimization method. The result shows that ANFIS may help the decision-making process for go/not go decision in OCPs.

A Flight Deck Decision Support Tool for Autonomous Airborne Operations

NASA Technical Reports Server (NTRS)

Ballin, Mark G.; Sharma, Vivek; Vivona, Robert A.; Johnson, Edward J.; Ramiscal, Ermin

2002-01-01

NASA is developing a flight deck decision support tool to support research into autonomous operations in a future distributed air/ground traffic management environment. This interactive real-time decision aid, referred to as the Autonomous Operations Planner (AOP), will enable the flight crew to plan autonomously in the presence of dense traffic and complex flight management constraints. In assisting the flight crew, the AOP accounts for traffic flow management and airspace constraints, schedule requirements, weather hazards, aircraft operational limits, and crew or airline flight-planning goals. This paper describes the AOP and presents an overview of functional and implementation design considerations required for its development. Required AOP functionality is described, its application in autonomous operations research is discussed, and a prototype software architecture for the AOP is presented.

Extending BPM Environments of Your Choice with Performance Related Decision Support

NASA Astrophysics Data System (ADS)

Fritzsche, Mathias; Picht, Michael; Gilani, Wasif; Spence, Ivor; Brown, John; Kilpatrick, Peter

What-if Simulations have been identified as one solution for business performance related decision support. Such support is especially useful in cases where it can be automatically generated out of Business Process Management (BPM) Environments from the existing business process models and performance parameters monitored from the executed business process instances. Currently, some of the available BPM Environments offer basic-level performance prediction capabilities. However, these functionalities are normally too limited to be generally useful for performance related decision support at business process level. In this paper, an approach is presented which allows the non-intrusive integration of sophisticated tooling for what-if simulations, analytic performance prediction tools, process optimizations or a combination of such solutions into already existing BPM environments. The approach abstracts from process modelling techniques which enable automatic decision support spanning processes across numerous BPM Environments. For instance, this enables end-to-end decision support for composite processes modelled with the Business Process Modelling Notation (BPMN) on top of existing Enterprise Resource Planning (ERP) processes modelled with proprietary languages.

A two-stage clinical decision support system for early recognition and stratification of patients with sepsis: an observational cohort study.

PubMed

Amland, Robert C; Lyons, Jason J; Greene, Tracy L; Haley, James M

2015-10-01

To examine the diagnostic accuracy of a two-stage clinical decision support system for early recognition and stratification of patients with sepsis. Observational cohort study employing a two-stage sepsis clinical decision support to recognise and stratify patients with sepsis. The stage one component was comprised of a cloud-based clinical decision support with 24/7 surveillance to detect patients at risk of sepsis. The cloud-based clinical decision support delivered notifications to the patients' designated nurse, who then electronically contacted a provider. The second stage component comprised a sepsis screening and stratification form integrated into the patient electronic health record, essentially an evidence-based decision aid, used by providers to assess patients at bedside. Urban, 284 acute bed community hospital in the USA; 16,000 hospitalisations annually. Data on 2620 adult patients were collected retrospectively in 2014 after the clinical decision support was implemented. 'Suspected infection' was the established gold standard to assess clinical decision support clinimetric performance. A sepsis alert activated on 417 (16%) of 2620 adult patients hospitalised. Applying 'suspected infection' as standard, the patient population characteristics showed 72% sensitivity and 73% positive predictive value. A postalert screening conducted by providers at bedside of 417 patients achieved 81% sensitivity and 94% positive predictive value. Providers documented against 89% patients with an alert activated by clinical decision support and completed 75% of bedside screening and stratification of patients with sepsis within one hour from notification. A clinical decision support binary alarm system with cross-checking functionality improves early recognition and facilitates stratification of patients with sepsis.

Partially dissociable roles of OFC and ACC in stimulus-guided and action-guided decision making.

PubMed

Khani, Abbas

2014-05-01

Recently, the functional specialization of prefrontal areas of the brain, and, specifically, the functional dissociation of the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC), during decision making have become a particular focus of research. A number of neuropsychological and lesion studies have shown that the OFC and ACC have dissociable functions in various dimensions of decision making, which are supported by their different anatomical connections. A recent single-neuron study, however, described a more complex picture of the functional dissociation between these two frontal regions during decision making. Here, I discuss the results of that study and consider alternative interpretations in connection with other findings.

The Politics of Information: Building a Relational Database To Support Decision-Making at a Public University.

ERIC Educational Resources Information Center

Friedman, Debra; Hoffman, Phillip

2001-01-01

Describes creation of a relational database at the University of Washington supporting ongoing academic planning at several levels and affecting the culture of decision making. Addresses getting started; sharing the database; questions, worries, and issues; improving access to high-demand courses; the advising function; management of instructional…

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis

PubMed Central

Miller, Matthew James; McGuire, Kerry M.; Feigh, Karen M.

2016-01-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity. The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design. PMID:28491008

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis.

PubMed

Miller, Matthew James; McGuire, Kerry M; Feigh, Karen M

2017-06-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity . The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design.

A decision technology system for health care electronic commerce.

PubMed

Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Improved CLARAty Functional-Layer/Decision-Layer Interface

NASA Technical Reports Server (NTRS)

Estlin, Tara; Rabideau, Gregg; Gaines, Daniel; Johnston, Mark; Chouinard, Caroline; Nessnas, Issa; Shu, I-Hsiang

2008-01-01

Improved interface software for communication between the CLARAty Decision and Functional layers has been developed. [The Coupled Layer Architecture for Robotics Autonomy (CLARAty) was described in Coupled-Layer Robotics Architecture for Autonomy (NPO-21218), NASA Tech Briefs, Vol. 26, No. 12 (December 2002), page 48. To recapitulate: the CLARAty architecture was developed to improve the modularity of robotic software while tightening coupling between planning/execution and basic control subsystems. Whereas prior robotic software architectures typically contained three layers, the CLARAty contains two layers: a decision layer (DL) and a functional layer (FL).] Types of communication supported by the present software include sending commands from DL modules to FL modules and sending data updates from FL modules to DL modules. The present software supplants prior interface software that had little error-checking capability, supported data parameters in string form only, supported commanding at only one level of the FL, and supported only limited updates of the state of the robot. The present software offers strong error checking, and supports complex data structures and commanding at multiple levels of the FL, and relative to the prior software, offers a much wider spectrum of state-update capabilities.

Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer.

PubMed

Grimmett, Chloe; Pickett, Karen; Shepherd, Jonathan; Welch, Karen; Recio-Saucedo, Alejandra; Streit, Elke; Seers, Helen; Armstrong, Anne; Cutress, Ramsey I; Evans, D Gareth; Copson, Ellen; Meiser, Bettina; Eccles, Diana; Foster, Claire

2018-05-01

Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations. Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion. Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making. Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress. Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

Functional specifications for a radioactive waste decision support system

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

Westrom, G.B.; Kurrasch, E.R.; Carlton, R.E.

1989-09-01

It is generally recognized that decisions relative to the treatment, handling, transportation and disposal of low-level wastes produced in nuclear power plants involve a complex array of many inter-related elements or considerations. Complex decision processes can be aided through the use of computer-based expert systems which are based on the knowledge of experts and the inferencing of that knowledge to provide advice to an end-user. To determine the feasibility of developing and applying an expert system in nuclear plant low level waste operations, a Functional Specification for a Radwaste Decision Support System (RDSS) was developed. All areas of radwaste management,more » from the point of waste generation to the disposition of the waste in the final disposal location were considered for inclusion within the scope of the RDSS. 27 figs., 8 tabs.« less

48 CFR 37.114 - Special acquisition requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... attention to ensure that they do not result in performance of inherently governmental functions by the... those that involve support of government policy or decision making. During performance of service... contracting for functions that are not inherently governmental but closely support the performance of...

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

PubMed Central

Roman, Tamlyn Eslie; Cleary, Susan; McIntyre, Diane

2017-01-01

Background: The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. Methods: A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. Results: The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. Conclusion: The literature supports Bossert’s conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning. PMID:28812832

Airborne Tactical Intent-Based Conflict Resolution Capability

NASA Technical Reports Server (NTRS)

Wing, David J.; Vivona, Robert A.; Roscoe, David A.

2009-01-01

Trajectory-based operations with self-separation involve the aircraft taking the primary role in the management of its own trajectory in the presence of other traffic. In this role, the flight crew assumes the responsibility for ensuring that the aircraft remains separated from all other aircraft by at least a minimum separation standard. These operations are enabled by cooperative airborne surveillance and by airborne automation systems that provide essential monitoring and decision support functions for the flight crew. An airborne automation system developed and used by NASA for research investigations of required functionality is the Autonomous Operations Planner. It supports the flight crew in managing their trajectory when responsible for self-separation by providing monitoring and decision support functions for both strategic and tactical flight modes. The paper focuses on the latter of these modes by describing a capability for tactical intent-based conflict resolution and its role in a comprehensive suite of automation functions supporting trajectory-based operations with self-separation.

Optimal data systems: the future of clinical predictions and decision support.

PubMed

Celi, Leo A; Csete, Marie; Stone, David

2014-10-01

The purpose of the review is to describe the evolving concept and role of data as it relates to clinical predictions and decision-making. Critical care medicine is, as an especially data-rich specialty, becoming acutely cognizant not only of its historic deficits in data utilization but also of its enormous potential for capturing, mining, and leveraging such data into well-designed decision support modalities as well as the formulation of robust best practices. Modern electronic medical records create an opportunity to design complete and functional data systems that can support clinical care to a degree never seen before. Such systems are often referred to as 'data-driven,' but a better term is 'optimal data systems' (ODS). Here we discuss basic features of an ODS and its benefits, including the potential to transform clinical prediction and decision support.

An Overview of R in Health Decision Sciences.

PubMed

Jalal, Hawre; Pechlivanoglou, Petros; Krijkamp, Eline; Alarid-Escudero, Fernando; Enns, Eva; Hunink, M G Myriam

2017-10-01

As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it. These functions facilitate applications of health decision science methodology as well as the visualization and communication of results. Although R's popularity is increasing among health decision scientists, methodological extensions of R in the field of decision analysis remain isolated. The purpose of this article is to provide an overview of existing R functionality that is applicable to the various stages of decision analysis, including model design, input parameter estimation, and analysis of model outputs.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

The development of a decision support system for prioritizing forested wetland restoration areeas in the lower Yazoo River Basin, Mississippi

Treesearch

Anegla A. Davis; Barbara A. Kleiss; Charles G. O' Hara; Jennifer S. Derby

2000-01-01

The Eco-Assessor, a GIS-based decision-support system, has been developed for the lower part of the Yazoo River Basin, Mississippi, to help planners and managers determine the best locations for the restoration of wetlands based on defined ecological and geographic criteria and probability of success. To assess the functional characteristics of the potential...

Exploration of the functions of health impact assessment in real-world policymaking in the field of social health inequality: towards a conception of conceptual learning.

PubMed

Feyaerts, Gille; Deguerry, Murielle; Deboosere, Patrick; De Spiegelaere, Myriam

2017-06-01

With the implementation of health impact assessment (HIA)'s conceptual model into real-world policymaking, a number of fundamental issues arise concerning its decision-support function. Rooted in a rational vision of the decision-making process, focus regarding both conceptualisation and evaluation has been mainly on the function of instrumental policy-learning. However, in the field of social health inequalities, this function is strongly limited by the intrinsic 'wickedness' of the policy issue. Focusing almost exclusively on this instrumental function, the real influence HIA can have on policymaking in the longer term is underestimated and remains largely unexploited. Drawing insights from theoretical models developed in the field of political science and sociology, we explore the different decision-support functions HIA can fulfill and identify conceptual learning as potentially the most important. Accordingly, dominant focus on the technical engineering function, where knowledge is provided in order to 'rationalise' the policy process and to tackle 'tame' problems, should be complemented with an analysis of the conditions for conceptual learning, where knowledge introduces new information and perspectives and, as such, contributes in the longer term to a paradigm change.

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

PubMed

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

A Customized Drought Decision Support Tool for Hsinchu Science Park

NASA Astrophysics Data System (ADS)

Huang, Jung; Tien, Yu-Chuan; Lin, Hsuan-Te; Liu, Tzu-Ming; Tung, Ching-Pin

2016-04-01

Climate change creates more challenges for water resources management. Due to the lack of sufficient precipitation in Taiwan in fall of 2014, many cities and counties suffered from water shortage during early 2015. Many companies in Hsinchu Science Park were significantly influenced and realized that they need a decision support tool to help them managing water resources. Therefore, a customized computer program was developed, which is capable of predicting the future status of public water supply system and water storage of factories when the water rationing is announced by the government. This program presented in this study for drought decision support (DDSS) is a customized model for a semiconductor company in the Hsinchu Science Park. The DDSS is programmed in Java which is a platform-independent language. System requirements are any PC with the operating system above Windows XP and an installed Java SE Runtime Environment 7. The DDSS serves two main functions. First function is to predict the future storage of Baoshan Reservoir and Second Baoshan Reservoir, so to determine the time point of water use restriction in Hsinchu Science Park. Second function is to use the results to help the company to make decisions to trigger their response plans. The DDSS can conduct real-time scenario simulations calculating the possible storage of water tank for each factory with pre-implementation and post-implementation of those response plans. In addition, DDSS can create reports in Excel to help decision makers to compare results between different scenarios.

A decision support for an integrated multi-scale analysis of irrigation: DSIRR.

PubMed

Bazzani, Guido M

2005-12-01

The paper presents a decision support designed to conduct an economic-environmental assessment of the agricultural activity focusing on irrigation called 'Decision Support for IRRigated Agriculture' (DSIRR). The program describes the effect at catchment scale of choices taken at micro scale by independent actors, the farmers, by simulating their decision process. The decision support (DS) has been thought of as a support tool for participatory water policies as requested by the Water Framework Directive and it aims at analyzing alternatives in production and technology, according to different market, policy and climate conditions. The tool uses data and models, provides a graphical user interface and can incorporate the decision makers' own insights. Heterogeneity in preferences is admitted since it is assumed that irrigators try to optimize personal multi-attribute utility functions, subject to a set of constraints. Consideration of agronomic and engineering aspects allows an accurate description of irrigation. Mathematical programming techniques are applied to find solutions. The program has been applied in the river Po basin (northern Italy) to analyze the impact of a pricing policy in a context of irrigation technology innovation. Water demand functions and elasticity to water price have been estimated. Results demonstrate how different areas and systems react to the same policy in quite a different way. While in the annual cropping system pricing seems effective to save the resource at the cost of impeding Water Agencies cost recovery, the same policy has an opposite effect in the perennial fruit system which shows an inelastic response to water price. The multidimensional assessment conducted clarified the trades-off among conflicting economic-social-environmental objectives, thus generating valuable information to design a more tailored mix of measures.

Computerized Clinical Decision Support: Contributions from 2015

PubMed Central

Bouaud, J.

2016-01-01

Summary Objective To summarize recent research and select the best papers published in 2015 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Method A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry (CPOE) systems. The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the IMIA editorial team was finally conducted to conclude in the best paper selection. Results Among the 974 retrieved papers, the entire review process resulted in the selection of four best papers. One paper reports on a CDSS routinely applied in pediatrics for more than 10 years, relying on adaptations of the Arden Syntax. Another paper assessed the acceptability and feasibility of an important CPOE evaluation tool in hospitals outside the US where it was developed. The third paper is a systematic, qualitative review, concerning usability flaws of medication-related alerting functions, providing an important evidence-based, methodological contribution in the domain of CDSS design and development in general. Lastly, the fourth paper describes a study quantifying the effect of a complex, continuous-care, guideline-based CDSS on the correctness and completeness of clinicians’ decisions. Conclusions While there are notable examples of routinely used decision support systems, this 2015 review on CDSSs and CPOE systems still shows that, despite methodological contributions, theoretical frameworks, and prototype developments, these technologies are not yet widely spread (at least with their full functionalities) in routine clinical practice. Further research, testing, evaluation, and training are still needed for these tools to be adopted in clinical practice and, ultimately, illustrate the benefits that they promise. PMID:27830247

Integrating conflict analysis and consensus reaching in a decision support system for water resource management.

PubMed

Giordano, R; Passarella, G; Uricchio, V F; Vurro, M

2007-07-01

The importance of shared decision processes in water management derives from the awareness of the inadequacy of traditional--i.e. engineering--approaches in dealing with complex and ill-structured problems. It is becoming increasingly obvious that traditional problem solving and decision support techniques, based on optimisation and factual knowledge, have to be combined with stakeholder based policy design and implementation. The aim of our research is the definition of an integrated decision support system for consensus achievement (IDSS-C) able to support a participative decision-making process in all its phases: problem definition and structuring, identification of the possible alternatives, formulation of participants' judgments, and consensus achievement. Furthermore, the IDSS-C aims at structuring, i.e. systematising the knowledge which has emerged during the participative process in order to make it comprehensible for the decision-makers and functional for the decision process. Problem structuring methods (PSM) and multi-group evaluation methods (MEM) have been integrated in the IDSS-C. PSM are used to support the stakeholders in providing their perspective of the problem and to elicit their interests and preferences, while MEM are used to define not only the degree of consensus for each alternative, highlighting those where the agreement is high, but also the consensus label for each alternative and the behaviour of individuals during the participative decision-making. The IDSS-C is applied experimentally to a decision process regarding the use of treated wastewater for agricultural irrigation in the Apulia Region (southern Italy).

Fast support vector data descriptions for novelty detection.

PubMed

Liu, Yi-Hung; Liu, Yan-Chen; Chen, Yen-Jen

2010-08-01

Support vector data description (SVDD) has become a very attractive kernel method due to its good results in many novelty detection problems. However, the decision function of SVDD is expressed in terms of the kernel expansion, which results in a run-time complexity linear in the number of support vectors. For applications where fast real-time response is needed, how to speed up the decision function is crucial. This paper aims at dealing with the issue of reducing the testing time complexity of SVDD. A method called fast SVDD (F-SVDD) is proposed. Unlike the traditional methods which all try to compress a kernel expansion into one with fewer terms, the proposed F-SVDD directly finds the preimage of a feature vector, and then uses a simple relationship between this feature vector and the SVDD sphere center to re-express the center with a single vector. The decision function of F-SVDD contains only one kernel term, and thus the decision boundary of F-SVDD is only spherical in the original space. Hence, the run-time complexity of the F-SVDD decision function is no longer linear in the support vectors, but is a constant, no matter how large the training set size is. In this paper, we also propose a novel direct preimage-finding method, which is noniterative and involves no free parameters. The unique preimage can be obtained in real time by the proposed direct method without taking trial-and-error. For demonstration, several real-world data sets and a large-scale data set, the extended MIT face data set, are used in experiments. In addition, a practical industry example regarding liquid crystal display micro-defect inspection is also used to compare the applicability of SVDD and our proposed F-SVDD when faced with mass data input. The results are very encouraging.

Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

PubMed

Siminoff, L A; Sandberg, D E

2015-05-01

Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. © Georg Thieme Verlag KG Stuttgart · New York.

Working Memory and Decision-Making in a Frontoparietal Circuit Model

PubMed Central

2017-01-01

Working memory (WM) and decision-making (DM) are fundamental cognitive functions involving a distributed interacting network of brain areas, with the posterior parietal cortex (PPC) and prefrontal cortex (PFC) at the core. However, the shared and distinct roles of these areas and the nature of their coordination in cognitive function remain poorly understood. Biophysically based computational models of cortical circuits have provided insights into the mechanisms supporting these functions, yet they have primarily focused on the local microcircuit level, raising questions about the principles for distributed cognitive computation in multiregional networks. To examine these issues, we developed a distributed circuit model of two reciprocally interacting modules representing PPC and PFC circuits. The circuit architecture includes hierarchical differences in local recurrent structure and implements reciprocal long-range projections. This parsimonious model captures a range of behavioral and neuronal features of frontoparietal circuits across multiple WM and DM paradigms. In the context of WM, both areas exhibit persistent activity, but, in response to intervening distractors, PPC transiently encodes distractors while PFC filters distractors and supports WM robustness. With regard to DM, the PPC module generates graded representations of accumulated evidence supporting target selection, while the PFC module generates more categorical responses related to action or choice. These findings suggest computational principles for distributed, hierarchical processing in cortex during cognitive function and provide a framework for extension to multiregional models. SIGNIFICANCE STATEMENT Working memory and decision-making are fundamental “building blocks” of cognition, and deficits in these functions are associated with neuropsychiatric disorders such as schizophrenia. These cognitive functions engage distributed networks with prefrontal cortex (PFC) and posterior parietal cortex (PPC) at the core. It is not clear, however, what the contributions of PPC and PFC are in light of the computations that subserve working memory and decision-making. We constructed a biophysical model of a reciprocally connected frontoparietal circuit that revealed shared and distinct functions for the PFC and PPC across working memory and decision-making tasks. Our parsimonious model connects circuit-level properties to cognitive functions and suggests novel design principles beyond those of local circuits for cognitive processing in multiregional brain networks. PMID:29114071

Working Memory and Decision-Making in a Frontoparietal Circuit Model.

PubMed

Murray, John D; Jaramillo, Jorge; Wang, Xiao-Jing

2017-12-13

Working memory (WM) and decision-making (DM) are fundamental cognitive functions involving a distributed interacting network of brain areas, with the posterior parietal cortex (PPC) and prefrontal cortex (PFC) at the core. However, the shared and distinct roles of these areas and the nature of their coordination in cognitive function remain poorly understood. Biophysically based computational models of cortical circuits have provided insights into the mechanisms supporting these functions, yet they have primarily focused on the local microcircuit level, raising questions about the principles for distributed cognitive computation in multiregional networks. To examine these issues, we developed a distributed circuit model of two reciprocally interacting modules representing PPC and PFC circuits. The circuit architecture includes hierarchical differences in local recurrent structure and implements reciprocal long-range projections. This parsimonious model captures a range of behavioral and neuronal features of frontoparietal circuits across multiple WM and DM paradigms. In the context of WM, both areas exhibit persistent activity, but, in response to intervening distractors, PPC transiently encodes distractors while PFC filters distractors and supports WM robustness. With regard to DM, the PPC module generates graded representations of accumulated evidence supporting target selection, while the PFC module generates more categorical responses related to action or choice. These findings suggest computational principles for distributed, hierarchical processing in cortex during cognitive function and provide a framework for extension to multiregional models. SIGNIFICANCE STATEMENT Working memory and decision-making are fundamental "building blocks" of cognition, and deficits in these functions are associated with neuropsychiatric disorders such as schizophrenia. These cognitive functions engage distributed networks with prefrontal cortex (PFC) and posterior parietal cortex (PPC) at the core. It is not clear, however, what the contributions of PPC and PFC are in light of the computations that subserve working memory and decision-making. We constructed a biophysical model of a reciprocally connected frontoparietal circuit that revealed shared and distinct functions for the PFC and PPC across working memory and decision-making tasks. Our parsimonious model connects circuit-level properties to cognitive functions and suggests novel design principles beyond those of local circuits for cognitive processing in multiregional brain networks. Copyright © 2017 the authors 0270-6474/17/3712167-20$15.00/0.

Performing a secondary executive task with affective stimuli interferes with decision making under risk conditions.

PubMed

Gathmann, Bettina; Pawlikowski, Mirko; Schöler, Tobias; Brand, Matthias

2014-05-01

Previous studies demonstrated that executive functions are crucial for advantageous decision making under risk and that therefore decision making is disrupted when working memory capacity is demanded while working on a decision task. While some studies also showed that emotions can affect decision making under risk, it is unclear how affective processing and executive functions predict decision-making performance in interaction. The current experimental study used a between-subjects design to examine whether affective pictures (positive and negative pictures compared to neutral pictures), included in a parallel executive task (working memory 2-back task), have an impact on decision making under risk as assessed by the Game of Dice Task (GDT). Moreover, the performance GDT plus 2-back task was compared to the performance in the GDT without any additional task (GDT solely). The results show that the performance in the GDT differed between groups (positive, negative, neutral, and GDT solely). The groups with affective pictures, especially those with positive pictures in the 2-back task, showed more disadvantageous decisions in the GDT than the groups with neutral pictures and the group performing the GDT without any additional task. However, executive functions moderated the effect of the affective pictures. Regardless of affective influence, subjects with good executive functions performed advantageously in the GDT. These findings support the assumption that executive functions and emotional processing interact in predicting decision making under risk.

A multimedia electronic patient record (ePR) system to improve decision support in pre- and rehabilitation through clinical and movement analysis

NASA Astrophysics Data System (ADS)

Liu, Brent; Documet, Jorge; McNitt-Gray, Sarah; Requejo, Phil; McNitt-Gray, Jill

2011-03-01

Clinical decisions for improving motor function in patients both with disability as well as improving an athlete's performance are made through clinical and movement analysis. Currently, this analysis facilitates identifying abnormalities in a patient's motor function for a large amount of neuro-musculoskeletal pathologies. However definitively identifying the underlying cause or long-term consequences of a specific abnormality in the patient's movement pattern is difficult since this requires information from multiple sources and formats across different times and currently relies on the experience and intuition of the expert clinician. In addition, this data must be persistent for longitudinal outcomes studies. Therefore a multimedia ePR system integrating imaging informatics data could have a significant impact on decision support within this clinical workflow. We present the design and architecture of such an ePR system as well as the data types that need integration in order to develop relevant decision support tools. Specifically, we will present two data model examples: 1) A performance improvement project involving volleyball athletes and 2) Wheelchair propulsion evaluation of patients with disabilities. The end result is a new frontier area of imaging informatics research within rehabilitation engineering and biomechanics.

Dynamic Amygdala Influences on the Fronto-Striatal Brain Mechanisms Involved in Self-Control of Impulsive Desires.

PubMed

Krämer, Bernd; Gruber, Oliver

2015-01-01

Human decisions are guided by a variety of motivational factors, such as immediate rewards, long-term goals, and emotions. We used functional magnetic resonance imaging to investigate the dynamic functional interactions between the amygdala, the nucleus accumbens, and the prefrontal cortex that underlie the influences of emotions, desires, and rationality on human decisions. We found that increased functional connectivity between the amygdala and the nucleus accumbens facilitated the approach of an immediate reward in the presence of emotional information. Further, increased functional interactions of the anteroventral prefrontal cortex with the amygdala and the nucleus accumbens were associated with rational decisions in dilemma situations. These findings support previous animal studies by demonstrating that emotional signals from the amygdala and goal-oriented information from prefrontal cortices interface in the nucleus accumbens to guide human decisions and reward-directed actions. © 2015 S. Karger AG, Basel.

75 FR 9005 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-26

... functionally equivalent to previously submitted GEPS 2 contracts, and is supported by Governors' Decision No... functionally equivalent agreements to be included within the product, provided that they meet the requirements...]\\ Notice of United States Postal Service Filing of Functionally Equivalent Global Expedited Package...

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

Clinical decision support for personalized medicine: an opportunity for pharmacist-physician collaboration.

PubMed

Barlow, Jane F

2012-06-01

Pharmacogenomics has significant potential to improve the efficacy and safety of medication therapy, but it requires new expertise and adds a new layer of complexity for all healthcare professionals. Pharmacists and pharmacy management systems can play a leading role in providing clinical decision support for the use and interpretation of pharmacogenomic tests. To serve this role effectively, pharmacists will need to expand their expertise in the emerging field of clinical pharmacogenomics. Pharmacy-based clinical programs can expedite the use of pharmacogenomic testing, help physicians interpret the test results and identify future medication risks associated with the patient's phenotype. Over time, some of these functions can be embedded in clinical decision support systems as part of the broader automation of the healthcare system.

Strategic control in decision-making under uncertainty.

PubMed

Venkatraman, Vinod; Huettel, Scott A

2012-04-01

Complex economic decisions - whether investing money for retirement or purchasing some new electronic gadget - often involve uncertainty about the likely consequences of our choices. Critical for resolving that uncertainty are strategic meta-decision processes, which allow people to simplify complex decision problems, evaluate outcomes against a variety of contexts, and flexibly match behavior to changes in the environment. In recent years, substantial research has implicated the dorsomedial prefrontal cortex (dmPFC) in the flexible control of behavior. However, nearly all such evidence comes from paradigms involving executive function or response selection, not complex decision-making. Here, we review evidence that demonstrates that the dmPFC contributes to strategic control in complex decision-making. This region contains a functional topography such that the posterior dmPFC supports response-related control, whereas the anterior dmPFC supports strategic control. Activation in the anterior dmPFC signals changes in how a decision problem is represented, which in turn can shape computational processes elsewhere in the brain. Based on these findings, we argue for both generalized contributions of the dmPFC to cognitive control, and specific computational roles for its subregions depending upon the task demands and context. We also contend that these strategic considerations are likely to be critical for decision-making in other domains, including interpersonal interactions in social settings. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Strategic Control in Decision Making under Uncertainty

PubMed Central

Venkatraman, Vinod; Huettel, Scott

2012-01-01

Complex economic decisions – whether investing money for retirement or purchasing some new electronic gadget – often involve uncertainty about the likely consequences of our choices. Critical for resolving that uncertainty are strategic meta-decision processes, which allow people to simplify complex decision problems, to evaluate outcomes against a variety of contexts, and to flexibly match behavior to changes in the environment. In recent years, substantial research implicates the dorsomedial prefrontal cortex (dmPFC) in the flexible control of behavior. However, nearly all such evidence comes from paradigms involving executive function or response selection, not complex decision making. Here, we review evidence that demonstrates that the dmPFC contributes to strategic control in complex decision making. This region contains a functional topography such that the posterior dmPFC supports response-related control while the anterior dmPFC supports strategic control. Activation in the anterior dmPFC signals changes in how a decision problem is represented, which in turn can shape computational processes elsewhere in the brain. Based on these findings, we argue both for generalized contributions of the dmPFC to cognitive control, and for specific computational roles for its subregions depending upon the task demands and context. We also contend that these strategic considerations are also likely to be critical for decision making in other domains, including interpersonal interactions in social settings. PMID:22487037

Will Anything Useful Come Out of Virtual Reality? Examination of a Naval Application

DTIC Science & Technology

1993-05-01

The term virtual reality can encompass varying meanings, but some generally accepted attributes of a virtual environment are that it is immersive...technology, but at present there are few practical applications which are utilizing the broad range of virtual reality technology. This paper will discuss an...Operability, operator functions, Virtual reality , Man-machine interface, Decision aids/decision making, Decision support. ASW.

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature.

PubMed

Roman, Tamlyn Eslie; Cleary, Susan; McIntyre, Diane

2017-02-27

The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. The literature supports Bossert's conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING IN TWO WESTERN U.S. WATERSHEDS

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions ...

Habitat modeling for biodiversity conservation.

Treesearch

Bruce G. Marcot

2006-01-01

Habitat models address only 1 component of biodiversity but can be useful in addressing and managing single or multiple species and ecosystem functions, for projecting disturbance regimes, and in supporting decisions. I review categories and examples of habitat models, their utility for biodiversity conservation, and their roles in making conservation decisions. I...

Computational Support for Technology- Investment Decisions

NASA Technical Reports Server (NTRS)

Adumitroaie, Virgil; Hua, Hook; Lincoln, William; Block, Gary; Mrozinski, Joseph; Shelton, Kacie; Weisbin, Charles; Elfes, Alberto; Smith, Jeffrey

2007-01-01

Strategic Assessment of Risk and Technology (START) is a user-friendly computer program that assists human managers in making decisions regarding research-and-development investment portfolios in the presence of uncertainties and of non-technological constraints that include budgetary and time limits, restrictions related to infrastructure, and programmatic and institutional priorities. START facilitates quantitative analysis of technologies, capabilities, missions, scenarios and programs, and thereby enables the selection and scheduling of value-optimal development efforts. START incorporates features that, variously, perform or support a unique combination of functions, most of which are not systematically performed or supported by prior decision- support software. These functions include the following: Optimal portfolio selection using an expected-utility-based assessment of capabilities and technologies; Temporal investment recommendations; Distinctions between enhancing and enabling capabilities; Analysis of partial funding for enhancing capabilities; and Sensitivity and uncertainty analysis. START can run on almost any computing hardware, within Linux and related operating systems that include Mac OS X versions 10.3 and later, and can run in Windows under the Cygwin environment. START can be distributed in binary code form. START calls, as external libraries, several open-source software packages. Output is in Excel (.xls) file format.

Namibia Dashboard Enhancements

NASA Technical Reports Server (NTRS)

Mandl, Daniel; Handy, Matthew

2014-01-01

The purpose of this presentation is for a Technical Interchange Meeting with the Namibia Hydrological Services (NHS) in Namibia. The meeting serves as a capacity building exercise. This presentation goes over existing software functionality developed in collaboration with NHS over the past five years called the Namibia Flood Dashboard. Furthermore, it outlines new functionality developed over the past year and future functionality that will be developed. The main purpose of the Dashboard is to assist in decision support for flood warning. The Namibia Flood Dashboard already exists online in a cloud environment and has been used in prototype mode for the past few years.Functionality in the Dashboard includes river gauge hydrographs, TRMM estimate rainfall, EO-1 flood maps, infrastructure maps and other related functions. Future functionality includes attempting to integrate interoperability standards and crowd-sourcing capability. To this end, we are adding OpenStreetMap compatibility and an Applications Program Interface (API) called a GeoSocial API to enable discovery and sharing of data products useful for decision support via social media.

Decision making generalized by a cumulative probability weighting function

NASA Astrophysics Data System (ADS)

dos Santos, Lindomar Soares; Destefano, Natália; Martinez, Alexandre Souto

2018-01-01

Typical examples of intertemporal decision making involve situations in which individuals must choose between a smaller reward, but more immediate, and a larger one, delivered later. Analogously, probabilistic decision making involves choices between options whose consequences differ in relation to their probability of receiving. In Economics, the expected utility theory (EUT) and the discounted utility theory (DUT) are traditionally accepted normative models for describing, respectively, probabilistic and intertemporal decision making. A large number of experiments confirmed that the linearity assumed by the EUT does not explain some observed behaviors, as nonlinear preference, risk-seeking and loss aversion. That observation led to the development of new theoretical models, called non-expected utility theories (NEUT), which include a nonlinear transformation of the probability scale. An essential feature of the so-called preference function of these theories is that the probabilities are transformed by decision weights by means of a (cumulative) probability weighting function, w(p) . We obtain in this article a generalized function for the probabilistic discount process. This function has as particular cases mathematical forms already consecrated in the literature, including discount models that consider effects of psychophysical perception. We also propose a new generalized function for the functional form of w. The limiting cases of this function encompass some parametric forms already proposed in the literature. Far beyond a mere generalization, our function allows the interpretation of probabilistic decision making theories based on the assumption that individuals behave similarly in the face of probabilities and delays and is supported by phenomenological models.

An Application of Multidimensional Scaling to the Prioritization of Decision Aids in the S-3A.

DTIC Science & Technology

1980-09-01

subjects at once and recent research by Burton (1975] suggests that most people can do a single sorting of sixty(60) stimuli in fifteen to thirty...implicit ordering of areas in which TACCOs think decision aids would be useful. a. Gain Attack Criteria The Gain Attack Criteria decision function was...will provide you with better, more intelligent support from machines and will give you time to do what you do best - think and make decision. The whole

The EVOTION Decision Support System: Utilizing It for Public Health Policy-Making in Hearing Loss.

PubMed

Katrakazas, Panagiotis; Trenkova, Lyubov; Milas, Josip; Brdaric, Dario; Koutsouris, Dimitris

2017-01-01

As Decision Support Systems start to play a significant role in decision making, especially in the field of public-health policy making, we present an initial attempt to formulate such a system in the concept of public health policy making for hearing loss related problems. Justification for the system's conceptual architecture and its key functionalities are presented. The introduction of the EVOTION DSS sets a key innovation and a basis for paradigm shift in policymaking, by incorporating relevant models, big data analytics and generic demographic data. Expected outcomes for this joint effort are discussed from a public-health point of view.

A Semantic Approach with Decision Support for Safety Service in Smart Home Management

PubMed Central

Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

2016-01-01

Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate. PMID:27527170

A Semantic Approach with Decision Support for Safety Service in Smart Home Management.

PubMed

Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

2016-08-03

Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate.

A knowledge-based patient assessment system: conceptual and technical design.

PubMed Central

Reilly, C. A.; Zielstorff, R. D.; Fox, R. L.; O'Connell, E. M.; Carroll, D. L.; Conley, K. A.; Fitzgerald, P.; Eng, T. K.; Martin, A.; Zidik, C. M.; Segal, M.

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring. PMID:11079970

A knowledge-based patient assessment system: conceptual and technical design.

PubMed

Reilly, C A; Zielstorff, R D; Fox, R L; O'Connell, E M; Carroll, D L; Conley, K A; Fitzgerald, P; Eng, T K; Martin, A; Zidik, C M; Segal, M

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

On implementing clinical decision support: achieving scalability and maintainability by combining business rules and ontologies.

PubMed

Kashyap, Vipul; Morales, Alfredo; Hongsermeier, Tonya

2006-01-01

We present an approach and architecture for implementing scalable and maintainable clinical decision support at the Partners HealthCare System. The architecture integrates a business rules engine that executes declarative if-then rules stored in a rule-base referencing objects and methods in a business object model. The rules engine executes object methods by invoking services implemented on the clinical data repository. Specialized inferences that support classification of data and instances into classes are identified and an approach to implement these inferences using an OWL based ontology engine is presented. Alternative representations of these specialized inferences as if-then rules or OWL axioms are explored and their impact on the scalability and maintenance of the system is presented. Architectural alternatives for integration of clinical decision support functionality with the invoking application and the underlying clinical data repository; and their associated trade-offs are discussed and presented.

Demand driven decision support for efficient water resources allocation in irrigated agriculture

NASA Astrophysics Data System (ADS)

Schuetze, Niels; Grießbach, Ulrike Ulrike; Röhm, Patric; Stange, Peter; Wagner, Michael; Seidel, Sabine; Werisch, Stefan; Barfus, Klemens

2014-05-01

Due to climate change, extreme weather conditions, such as longer dry spells in the summer months, may have an increasing impact on the agriculture in Saxony (Eastern Germany). For this reason, and, additionally, declining amounts of rainfall during the growing season the use of irrigation will be more important in future in Eastern Germany. To cope with this higher demand of water, a new decision support framework is developed which focuses on an integrated management of both irrigation water supply and demand. For modeling the regional water demand, local (and site-specific) water demand functions are used which are derived from the optimized agronomic response at farms scale. To account for climate variability the agronomic response is represented by stochastic crop water production functions (SCWPF) which provide the estimated yield subject to the minimum amount of irrigation water. These functions take into account the different soil types, crops and stochastically generated climate scenarios. By applying mathematical interpolation and optimization techniques, the SCWPF's are used to compute the water demand considering different constraints, for instance variable and fix costs or the producer price. This generic approach enables the computation for both multiple crops at farm scale as well as of the aggregated response to water pricing at a regional scale for full and deficit irrigation systems. Within the SAPHIR (SAxonian Platform for High Performance Irrigation) project a prototype of a decision support system is developed which helps to evaluate combined water supply and demand management policies for an effective and efficient utilization of water in order to meet future demands. The prototype is implemented as a web-based decision support system and it is based on a service-oriented geo-database architecture.

Assisting Public Organizations in Their Outsourcing Endeavors: A Decision Support Mode

NASA Technical Reports Server (NTRS)

Kremic, TIbor; Tukel, Oya

2006-01-01

There has been a tremendous growth in outsourcing practices in recent years. The public organizations in the United States have outsourced some functions and are now being compelled to outsource additional ones. While there are numerous studies that document and analyze outsourcing practices, there is limited research to guide public or governmental organizations in determining what functions to outsource. This study fills this gap by developing a decision support model for a typical public organization in determining what to outsource and how. A set of outsourcing decision factors is identified that can be used as parameters in the three integer programming formulations developed. These formulations are used as solution engines in the model. The first formulation identifies which functions are the best candidates for outsourcing given the organization's priorities. The other formulations place the functions into recommended contracts and re-assign displaced employees. Data from NASA Glenn Research Center in Ohio is used to test and analyze the model. Analysis indicates that cost and skills-related factors are the most sensitive parameters for the data tested. The model and the formulations are a relatively comprehensive package and may help guide outsourcing decisionmakers and policymakers in public organizations.

Developing an electronic health record (EHR) for methadone treatment recording and decision support

PubMed Central

2011-01-01

Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. PMID:21284849

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING WITH THE AUTOMATED GEOSPATIAL WATERSHED ASSESSMENT (AGWA) TOOL

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions...

Putting Bandits into Context: How Function Learning Supports Decision Making

ERIC Educational Resources Information Center

Schulz, Eric; Konstantinidis, Emmanouil; Speekenbrink, Maarten

2018-01-01

The authors introduce the contextual multi-armed bandit task as a framework to investigate learning and decision making in uncertain environments. In this novel paradigm, participants repeatedly choose between multiple options in order to maximize their rewards. The options are described by a number of contextual features which are predictive of…

Managing the University Campus: Exploring Models for the Future and Supporting Today's Decisions

ERIC Educational Resources Information Center

den Heijer, Alexandra

2012-01-01

Managing contemporary campuses and taking decisions that will impact on those of tomorrow is a complex task for universities worldwide. It involves strategic, financial, functional and physical aspects as well as multiple stakeholders. This article summarises the conclusions of a comprehensive PhD research project which was enriched with lessons…

Scenario Analysis: Evaluating Biodiversity Response to Forecasted Land-Use Change in the San Pedro River Basin (U.S.-Mexico)

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions...

Implement the medical group revenue function. Create competitive advantage.

PubMed

Colucci, C

1998-01-01

This article shows medical groups how they can employ new financial management and information technology techniques to safeguard their revenue and income streams. These managerial techniques stem from the application of the medical group revenue function, which is defined herein. This article also describes how the medical group revenue function can be used to create value by employing a database and a decision support system. Finally, the article describes how the decision support system can be used to create competitive advantage. Through the wise use of internally generated information, medical groups can negotiate better contract terms, improve their operations, cut their costs, embark on capital investment programs and improve market share. As medical groups gain market power by improving in these areas, they will be more attractive to potential strategic allies, payers and investment bankers.

Functional compensation in the ventromedial prefrontal cortex improves memory-dependent decisions in older adults.

PubMed

Lighthall, Nichole R; Huettel, Scott A; Cabeza, Roberto

2014-11-19

Everyday consumer choices frequently involve memory, as when we retrieve information about consumer products when making purchasing decisions. In this context, poor memory may affect decision quality, particularly in individuals with memory decline, such as older adults. However, age differences in choice behavior may be reduced if older adults can recruit additional neural resources that support task performance. Although such functional compensation is well documented in other cognitive domains, it is presently unclear whether it can support memory-guided decision making and, if so, which brain regions play a role in compensation. The current study engaged younger and older humans in a memory-dependent choice task in which pairs of consumer products from a popular online-shopping site were evaluated with different delays between the first and second product. Using functional imaging (fMRI), we found that the ventromedial prefrontal cortex (vmPFC) supports compensation as defined by three a priori criteria: (1) increased vmPFC activation was observed in older versus younger adults; (2) age-related increases in vmPFC activity were associated with increased retrieval demands; and (3) increased vmPFC activity was positively associated with performance in older adults-evidence of successful compensation. Extending these results, we observed evidence for compensation in connectivity between vmPFC and the dorsolateral PFC during memory-dependent choice. In contrast, we found no evidence for age differences in value-related processing or age-related compensation for choices without delayed retrieval. Together, these results converge on the conclusion that age-related decline in memory-dependent choice performance can be minimized via functional compensation in vmPFC. Copyright © 2014 the authors 0270-6474/14/3415648-10$15.00/0.

Functional Compensation in the Ventromedial Prefrontal Cortex Improves Memory-Dependent Decisions in Older Adults

PubMed Central

Huettel, Scott A.; Cabeza, Roberto

2014-01-01

Everyday consumer choices frequently involve memory, as when we retrieve information about consumer products when making purchasing decisions. In this context, poor memory may affect decision quality, particularly in individuals with memory decline, such as older adults. However, age differences in choice behavior may be reduced if older adults can recruit additional neural resources that support task performance. Although such functional compensation is well documented in other cognitive domains, it is presently unclear whether it can support memory-guided decision making and, if so, which brain regions play a role in compensation. The current study engaged younger and older humans in a memory-dependent choice task in which pairs of consumer products from a popular online-shopping site were evaluated with different delays between the first and second product. Using functional imaging (fMRI), we found that the ventromedial prefrontal cortex (vmPFC) supports compensation as defined by three a priori criteria: (1) increased vmPFC activation was observed in older versus younger adults; (2) age-related increases in vmPFC activity were associated with increased retrieval demands; and (3) increased vmPFC activity was positively associated with performance in older adults—evidence of successful compensation. Extending these results, we observed evidence for compensation in connectivity between vmPFC and the dorsolateral PFC during memory-dependent choice. In contrast, we found no evidence for age differences in value-related processing or age-related compensation for choices without delayed retrieval. Together, these results converge on the conclusion that age-related decline in memory-dependent choice performance can be minimized via functional compensation in vmPFC. PMID:25411493

Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems

PubMed Central

Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford

2011-01-01

Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065

Employment Status, Psychological Well-Being, Social Support, and Physical Discipline Practices of Single Black Mothers.

ERIC Educational Resources Information Center

Jackson, Aurora P.; Gyamfi, Phyllis; Brooks-Gunn, Jeanne; Blake, Mandy

1998-01-01

Investigates the effects of depressive symptomatology, parental stress, and instrumental support on maternal spanking. Results show that employment has a moderating effect on the relationship between mothers' psychological functioning and their decision to use spanking. The availability of instrumental support seems to increase the frequency of…

Content-specific evidence accumulation in inferior temporal cortex during perceptual decision-making

PubMed Central

Tremel, Joshua J.; Wheeler, Mark E.

2015-01-01

During a perceptual decision, neuronal activity can change as a function of time-integrated evidence. Such neurons may serve as decision variables, signaling a choice when activity reaches a boundary. Because the signals occur on a millisecond timescale, translating to human decision-making using functional neuroimaging has been challenging. Previous neuroimaging work in humans has identified patterns of neural activity consistent with an accumulation account. However, the degree to which the accumulating neuroimaging signals reflect specific sources of perceptual evidence is unknown. Using an extended face/house discrimination task in conjunction with cognitive modeling, we tested whether accumulation signals, as measured using functional magnetic resonance imaging (fMRI), are stimulus-specific. Accumulation signals were defined as a change in the slope of the rising edge of activation corresponding with response time (RT), with higher slopes associated with faster RTs. Consistent with an accumulation account, fMRI activity in face- and house-selective regions in the inferior temporal cortex increased at a rate proportional to decision time in favor of the preferred stimulus. This finding indicates that stimulus-specific regions perform an evidence integrative function during goal-directed behavior and that different sources of evidence accumulate separately. We also assessed the decision-related function of other regions throughout the brain and found that several regions were consistent with classifications from prior work, suggesting a degree of domain generality in decision processing. Taken together, these results provide support for an integration-to-boundary decision mechanism and highlight possible roles of both domain-specific and domain-general regions in decision evidence evaluation. PMID:25562821

Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study

PubMed Central

McClelland, Gary M.; Weiner, Dana A.; Jordan, Neil; Lyons, John S.

2015-01-01

After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed. PMID:24677172

Probability and Statistics in Sensor Performance Modeling

DTIC Science & Technology

2010-12-01

language software program is called Environmental Awareness for Sensor and Emitter Employment. Some important numerical issues in the implementation...3 Statistical analysis for measuring sensor performance...complementary cumulative distribution function cdf cumulative distribution function DST decision-support tool EASEE Environmental Awareness of

The process of decision-making in home-care case management: implications for the introduction of universal assessment and information technology.

PubMed

Egan, Mary; Wells, Jennie; Byrne, Kerry; Jaglal, Susan; Stolee, Paul; Chesworth, Bert M; Hillier, Loretta M

2009-07-01

Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers' decisional process was one of a clinician-broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making.

Uncertainty indication in soil function maps - transparent and easy-to-use information to support sustainable use of soil resources

NASA Astrophysics Data System (ADS)

Greiner, Lucie; Nussbaum, Madlene; Papritz, Andreas; Zimmermann, Stephan; Gubler, Andreas; Grêt-Regamey, Adrienne; Keller, Armin

2018-05-01

Spatial information on soil function fulfillment (SFF) is increasingly being used to inform decision-making in spatial planning programs to support sustainable use of soil resources. Soil function maps visualize soils abilities to fulfill their functions, e.g., regulating water and nutrient flows, providing habitats, and supporting biomass production based on soil properties. Such information must be reliable for informed and transparent decision-making in spatial planning programs. In this study, we add to the transparency of soil function maps by (1) indicating uncertainties arising from the prediction of soil properties generated by digital soil mapping (DSM) that are used for soil function assessment (SFA) and (2) showing the response of different SFA methods to the propagation of uncertainties through the assessment. For a study area of 170 km2 in the Swiss Plateau, we map 10 static soil sub-functions for agricultural soils for a spatial resolution of 20 × 20 m together with their uncertainties. Mapping the 10 soil sub-functions using simple ordinal assessment scales reveals pronounced spatial patterns with a high variability of SFF scores across the region, linked to the inherent properties of the soils and terrain attributes and climate conditions. Uncertainties in soil properties propagated through SFA methods generally lead to substantial uncertainty in the mapped soil sub-functions. We propose two types of uncertainty maps that can be readily understood by stakeholders. Cumulative distribution functions of SFF scores indicate that SFA methods respond differently to the propagated uncertainty of soil properties. Even where methods are comparable on the level of complexity and assessment scale, their comparability in view of uncertainty propagation might be different. We conclude that comparable uncertainty indications in soil function maps are relevant to enable informed and transparent decisions on the sustainable use of soil resources.

Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

NASA Astrophysics Data System (ADS)

Spahr, K.; Hogue, T. S.

2016-12-01

Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

Technosocial Predictive Analytics in Support of Naturalistic Decision Making

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

Sanfilippo, Antonio P.; Cowell, Andrew J.; Malone, Elizabeth L.

2009-06-23

A main challenge we face in fostering sustainable growth is to anticipate outcomes through predictive and proactive across domains as diverse as energy, security, the environment, health and finance in order to maximize opportunities, influence outcomes and counter adversities. The goal of this paper is to present new methods for anticipatory analytical thinking which address this challenge through the development of a multi-perspective approach to predictive modeling as a core to a creative decision making process. This approach is uniquely multidisciplinary in that it strives to create decision advantage through the integration of human and physical models, and leverages knowledgemore » management and visual analytics to support creative thinking by facilitating the achievement of interoperable knowledge inputs and enhancing the user’s cognitive access. We describe a prototype system which implements this approach and exemplify its functionality with reference to a use case in which predictive modeling is paired with analytic gaming to support collaborative decision-making in the domain of agricultural land management.« less

Design and implementation of the standards-based personal intelligent self-management system (PICS).

PubMed

von Bargen, Tobias; Gietzelt, Matthias; Britten, Matthias; Song, Bianying; Wolf, Klaus-Hendrik; Kohlmann, Martin; Marschollek, Michael; Haux, Reinhold

2013-01-01

Against the background of demographic change and a diminishing care workforce there is a growing need for personalized decision support. The aim of this paper is to describe the design and implementation of the standards-based personal intelligent care systems (PICS). PICS makes consistent use of internationally accepted standards such as the Health Level 7 (HL7) Arden syntax for the representation of the decision logic, HL7 Clinical Document Architecture for information representation and is based on a open-source service-oriented architecture framework and a business process management system. Its functionality is exemplified for the application scenario of a patient suffering from congestive heart failure. Several vital signs sensors provide data for the decision support system, and a number of flexible communication channels are available for interaction with patient or caregiver. PICS is a standards-based, open and flexible system enabling personalized decision support. Further development will include the implementation of components on small computers and sensor nodes.

A study of diverse clinical decision support rule authoring environments and requirements for integration

PubMed Central

2012-01-01

Background Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules. Methods The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools. Results While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users. Conclusions A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting. PMID:23145874

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

PubMed

Velickovski, Filip; Ceccaroni, Luigi; Roca, Josep; Burgos, Felip; Galdiz, Juan B; Marina, Nuria; Lluch-Ariet, Magí

2014-11-28

The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

PubMed Central

2014-01-01

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems. PMID:25471545

Defense Agencies Initiative Increment 2 (DAI Inc 2)

DTIC Science & Technology

2016-03-01

2016 Major Automated Information System Annual Report Defense Agencies Initiative Increment 2 (DAI Inc 2) Defense Acquisition Management...Automated Information System MAIS OE - MAIS Original Estimate MAR – MAIS Annual Report MDA - Milestone Decision Authority MDD - Materiel Development...management systems supporting diverse operational functions and the warfighter in decision making and financial reporting . These disparate, non

A novel clinical decision support system using improved adaptive genetic algorithm for the assessment of fetal well-being.

PubMed

Ravindran, Sindhu; Jambek, Asral Bahari; Muthusamy, Hariharan; Neoh, Siew-Chin

2015-01-01

A novel clinical decision support system is proposed in this paper for evaluating the fetal well-being from the cardiotocogram (CTG) dataset through an Improved Adaptive Genetic Algorithm (IAGA) and Extreme Learning Machine (ELM). IAGA employs a new scaling technique (called sigma scaling) to avoid premature convergence and applies adaptive crossover and mutation techniques with masking concepts to enhance population diversity. Also, this search algorithm utilizes three different fitness functions (two single objective fitness functions and multi-objective fitness function) to assess its performance. The classification results unfold that promising classification accuracy of 94% is obtained with an optimal feature subset using IAGA. Also, the classification results are compared with those of other Feature Reduction techniques to substantiate its exhaustive search towards the global optimum. Besides, five other benchmark datasets are used to gauge the strength of the proposed IAGA algorithm.

Concept of Operations for Integrated Intelligent Flight Deck Displays and Decision Support Technologies

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Prinzel, Lawrence J.; Kramer, Lynda J.; Young, Steve D.

2011-01-01

The document describes a Concept of Operations for Flight Deck Display and Decision Support technologies which may help enable emerging Next Generation Air Transportation System capabilities while also maintaining, or improving upon, flight safety. This concept of operations is used as the driving function within a spiral program of research, development, test, and evaluation for the Integrated Intelligent Flight Deck (IIFD) project. As such, the concept will be updated at each cycle within the spiral to reflect the latest research results and emerging developments

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

An Ontology-Based, Mobile-Optimized System for Pharmacogenomic Decision Support at the Point-of-Care

PubMed Central

Miñarro-Giménez, Jose Antonio; Blagec, Kathrin; Boyce, Richard D.; Adlassnig, Klaus-Peter; Samwald, Matthias

2014-01-01

Background The development of genotyping and genetic sequencing techniques and their evolution towards low costs and quick turnaround have encouraged a wide range of applications. One of the most promising applications is pharmacogenomics, where genetic profiles are used to predict the most suitable drugs and drug dosages for the individual patient. This approach aims to ensure appropriate medical treatment and avoid, or properly manage, undesired side effects. Results We developed the Medicine Safety Code (MSC) service, a novel pharmacogenomics decision support system, to provide physicians and patients with the ability to represent pharmacogenomic data in computable form and to provide pharmacogenomic guidance at the point-of-care. Pharmacogenomic data of individual patients are encoded as Quick Response (QR) codes and can be decoded and interpreted with common mobile devices without requiring a centralized repository for storing genetic patient data. In this paper, we present the first fully functional release of this system and describe its architecture, which utilizes Web Ontology Language 2 (OWL 2) ontologies to formalize pharmacogenomic knowledge and to provide clinical decision support functionalities. Conclusions The MSC system provides a novel approach for enabling the implementation of personalized medicine in clinical routine. PMID:24787444

An ontology-based, mobile-optimized system for pharmacogenomic decision support at the point-of-care.

PubMed

Miñarro-Giménez, Jose Antonio; Blagec, Kathrin; Boyce, Richard D; Adlassnig, Klaus-Peter; Samwald, Matthias

2014-01-01

The development of genotyping and genetic sequencing techniques and their evolution towards low costs and quick turnaround have encouraged a wide range of applications. One of the most promising applications is pharmacogenomics, where genetic profiles are used to predict the most suitable drugs and drug dosages for the individual patient. This approach aims to ensure appropriate medical treatment and avoid, or properly manage, undesired side effects. We developed the Medicine Safety Code (MSC) service, a novel pharmacogenomics decision support system, to provide physicians and patients with the ability to represent pharmacogenomic data in computable form and to provide pharmacogenomic guidance at the point-of-care. Pharmacogenomic data of individual patients are encoded as Quick Response (QR) codes and can be decoded and interpreted with common mobile devices without requiring a centralized repository for storing genetic patient data. In this paper, we present the first fully functional release of this system and describe its architecture, which utilizes Web Ontology Language 2 (OWL 2) ontologies to formalize pharmacogenomic knowledge and to provide clinical decision support functionalities. The MSC system provides a novel approach for enabling the implementation of personalized medicine in clinical routine.

Functional Genetic Variation in Dopamine Signaling Moderates Prefrontal Cortical Activity During Risky Decision Making.

PubMed

Kohno, Milky; Nurmi, Erika L; Laughlin, Christopher P; Morales, Angelica M; Gail, Emma H; Hellemann, Gerhard S; London, Edythe D

2016-02-01

Brain imaging has revealed links between prefrontal activity during risky decision-making and striatal dopamine receptors. Specifically, striatal dopamine D2-like receptor availability is correlated with risk-taking behavior and sensitivity of prefrontal activation to risk in the Balloon Analogue Risk Task (BART). The extent to which these associations, involving a single neurochemical measure, reflect more general effects of dopaminergic functioning on risky decision making, however, is unknown. Here, 65 healthy participants provided genotypes and performed the BART during functional magnetic resonance imaging. For each participant, dopamine function was assessed using a gene composite score combining known functional variation across five genes involved in dopaminergic signaling: DRD2, DRD3, DRD4, DAT1, and COMT. The gene composite score was negatively related to dorsolateral prefrontal cortical function during risky decision making, and nonlinearly related to earnings on the task. Iterative permutations of all possible allelic variations (7777 allelic combinations) was tested on brain function in an independently defined region of the prefrontal cortex and confirmed empirical validity of the composite score, which yielded stronger association than 95% of all other possible combinations. The gene composite score also accounted for a greater proportion of variability in neural and behavioral measures than the independent effects of each gene variant, indicating that the combined effects of functional dopamine pathway genes can provide a robust assessment, presumably reflecting the cumulative and potentially interactive effects on brain function. Our findings support the view that the links between dopaminergic signaling, prefrontal function, and decision making vary as a function of dopamine signaling capacity.

Sex-related functional asymmetry of the amygdala: preliminary evidence using a case-matched lesion approach.

PubMed

Tranel, Daniel; Bechara, Antoine

2009-06-01

We have reported previously that there appears to be an intriguing sex-related functional asymmetry of the prefrontal cortices, especially the ventromedial sector, in regard to social conduct, emotional processing, and decision-making, whereby the right-sided sector is important in men but not women and the left-sided sector is important in women but not men. The amygdala is another structure that has been widely implicated in emotion processing and social decision-making, and the question arises as to whether the amygdala, in a manner akin to what has been observed for the prefrontal cortex, might have sex-related functional asymmetry in regard to social and emotional functions. A preliminary test of this question was carried out in the current study, where we used a case-matched lesion approach and contrasted a pair of men cases and a pair of women cases, where in each pair one patient had left amygdala damage and the other had right amygdala damage. We investigated the domains of social conduct, emotional processing and personality, and decision-making. The results provide support for the notion that there is sex-related functional asymmetry of the amygdala in regard to these functions - in the male pair, the patient with right-sided amygdala damage was impaired in these functions, and the patient with left-sided amygdala damage was not, whereas in the female pair, the opposite pattern obtained, with the left-sided woman being impaired and the right-sided woman being unimpaired. These data provide preliminary support for the notion that sex-related functional asymmetry of the amygdala may entail functions such as social conduct, emotional processing, and decision-making, a finding that in turn could reflect (as either a cause or effect) differences in the manner in which men and women apprehend, process, and execute emotion-related information.

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

Decision support systems for clinical radiological practice — towards the next generation

PubMed Central

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-01-01

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully. PMID:20965900

Reasoning, learning, and creativity: frontal lobe function and human decision-making.

PubMed

Collins, Anne; Koechlin, Etienne

2012-01-01

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

Reasoning, Learning, and Creativity: Frontal Lobe Function and Human Decision-Making

PubMed Central

Collins, Anne; Koechlin, Etienne

2012-01-01

The frontal lobes subserve decision-making and executive control—that is, the selection and coordination of goal-directed behaviors. Current models of frontal executive function, however, do not explain human decision-making in everyday environments featuring uncertain, changing, and especially open-ended situations. Here, we propose a computational model of human executive function that clarifies this issue. Using behavioral experiments, we show that unlike others, the proposed model predicts human decisions and their variations across individuals in naturalistic situations. The model reveals that for driving action, the human frontal function monitors up to three/four concurrent behavioral strategies and infers online their ability to predict action outcomes: whenever one appears more reliable than unreliable, this strategy is chosen to guide the selection and learning of actions that maximize rewards. Otherwise, a new behavioral strategy is tentatively formed, partly from those stored in long-term memory, then probed, and if competitive confirmed to subsequently drive action. Thus, the human executive function has a monitoring capacity limited to three or four behavioral strategies. This limitation is compensated by the binary structure of executive control that in ambiguous and unknown situations promotes the exploration and creation of new behavioral strategies. The results support a model of human frontal function that integrates reasoning, learning, and creative abilities in the service of decision-making and adaptive behavior. PMID:22479152

Knowledge-based geographic information systems on the Macintosh computer: a component of the GypsES project

Treesearch

Gregory Elmes; Thomas Millette; Charles B. Yuill

1991-01-01

GypsES, a decision-support and expert system for the management of Gypsy Moth addresses five related research problems in a modular, computer-based project. The modules are hazard rating, monitoring, prediction, treatment decision and treatment implementation. One common component is a geographic information system designed to function intelligently. We refer to this...

Post Cold War transformation of the medical function in support of the deployed soldier.

PubMed

Vekerdi, Zoltan

2013-12-01

This article summarises the changes that resulted in, and still act towards, final implementation of a separate medical function in operational medical support. This article is not intended to represent an historical account, but to provide concise supplemental material for decision makers to position medical under the commander, which enables medical staff to support and care for the troops and which can be used in the best possible way as an image forming factor for the force. The aim of this article is to clearly articulate the necessity for independence of the medical and logistic functions, while recognising the need for continued close coordination.

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.

Software tool for data mining and its applications

NASA Astrophysics Data System (ADS)

Yang, Jie; Ye, Chenzhou; Chen, Nianyi

2002-03-01

A software tool for data mining is introduced, which integrates pattern recognition (PCA, Fisher, clustering, hyperenvelop, regression), artificial intelligence (knowledge representation, decision trees), statistical learning (rough set, support vector machine), computational intelligence (neural network, genetic algorithm, fuzzy systems). It consists of nine function models: pattern recognition, decision trees, association rule, fuzzy rule, neural network, genetic algorithm, Hyper Envelop, support vector machine, visualization. The principle and knowledge representation of some function models of data mining are described. The software tool of data mining is realized by Visual C++ under Windows 2000. Nonmonotony in data mining is dealt with by concept hierarchy and layered mining. The software tool of data mining has satisfactorily applied in the prediction of regularities of the formation of ternary intermetallic compounds in alloy systems, and diagnosis of brain glioma.

Impaired decision making under ambiguity but not under risk in individuals with pathological buying-behavioral and psychophysiological evidence.

PubMed

Trotzke, Patrick; Starcke, Katrin; Pedersen, Anya; Müller, Astrid; Brand, Matthias

2015-09-30

Pathological buying (PB) is described as dysfunctional buying behavior, associated with harmful consequences. It is discussed whether decision-making deficits are related to PB, because affected individuals often choose the short-term rewarding option of buying despite persistent negative long-term consequences. We investigated 30 patients suffering from PB and 30 matched control participants with two different decision-making tasks: the Iowa Gambling Task (IGT) measures decisions under ambiguity and involves emotional feedback processing, whereas the Game of Dice Task (GDT) measures decisions under risk and can be solved strategically. Potential emotional and cognitive correlates of decision making were investigated by assessing skin conductance response (SCR) and executive functioning. In comparison to the control participants, the patients showed more disadvantageous decisions under ambiguity in the IGT. These data were supported by the SCR results: patients failed to generate SCRs that usually occur before disadvantageous decisions. The physiological and behavioral performance on decisions under risk and executive functioning did not differ between groups. Thus, deficits in emotional feedback processing might be one potential factor in etiology and pathogenesis of PB and should be considered in theory and treatment. Copyright © 2015. Published by Elsevier Ireland Ltd.

Decision Making Under Objective Risk Conditions-a Review of Cognitive and Emotional Correlates, Strategies, Feedback Processing, and External Influences.

PubMed

Schiebener, Johannes; Brand, Matthias

2015-06-01

While making decisions under objective risk conditions, the probabilities of the consequences of the available options are either provided or calculable. Brand et al. (Neural Networks 19:1266-1276, 2006) introduced a model describing the neuro-cognitive processes involved in such decisions. In this model, executive functions associated with activity in the fronto-striatal loop are important for developing and applying decision-making strategies, and for verifying, adapting, or revising strategies according to feedback. Emotional rewards and punishments learned from such feedback accompany these processes. In this literature review, we found support for the role of executive functions, but also found evidence for the importance of further cognitive abilities in decision making. Moreover, in addition to reflective processing (driven by cognition), decisions can be guided by impulsive processing (driven by anticipation of emotional reward and punishment). Reflective and impulsive processing may interact during decision making, affecting the evaluation of available options, as both processes are affected by feedback. Decision-making processes are furthermore modulated by individual attributes (e.g., age), and external influences (e.g., stressors). Accordingly, we suggest a revised model of decision making under objective risk conditions.

Individual differences in decision making competence revealed by multivariate fMRI.

PubMed

Talukdar, Tanveer; Román, Francisco J; Operskalski, Joachim T; Zwilling, Christopher E; Barbey, Aron K

2018-06-01

While an extensive literature in decision neuroscience has elucidated the neurobiological foundations of decision making, prior research has focused primarily on group-level effects in a sample population. Due to the presence of inherent differences between individuals' cognitive abilities, it is also important to examine the neural correlates of decision making that explain interindividual variability in cognitive performance. This study therefore investigated how individual differences in decision making competence, as measured by the Adult Decision Making Competence (A-DMC) battery, are related to functional brain connectivity patterns derived from resting-state fMRI data in a sample of 304 healthy participants. We examined connectome-wide associations, identifying regions within frontal, parietal, temporal, and occipital cortex that demonstrated significant associations with decision making competence. We then assessed whether the functional interactions between brain regions sensitive to decision making competence and seven intrinsic connectivity networks (ICNs) were predictive of specific facets of decision making assessed by subtests of the A-DMC battery. Our findings suggest that individual differences in specific facets of decision making competence are mediated by ICNs that support executive, social, and perceptual processes, and motivate an integrative framework for understanding the neural basis of individual differences in decision making competence. © 2018 Wiley Periodicals, Inc.

E-DECIDER Decision Support Gateway For Earthquake Disaster Response

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Stough, T. M.; Parker, J. W.; Burl, M. C.; Donnellan, A.; Blom, R. G.; Pierce, M. E.; Wang, J.; Ma, Y.; Rundle, J. B.; Yoder, M. R.

2013-12-01

Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing capabilities for decision-making utilizing remote sensing data and modeling software in order to provide decision support for earthquake disaster management and response. E-DECIDER incorporates earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project in order to produce standards-compliant map data products to aid in decision-making following an earthquake. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools, help provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). E-DECIDER utilizes a service-based GIS model for its cyber-infrastructure in order to produce standards-compliant products for different user types with multiple service protocols (such as KML, WMS, WFS, and WCS). The goal is to make complex GIS processing and domain-specific analysis tools more accessible to general users through software services as well as provide system sustainability through infrastructure services. The system comprises several components, which include: a GeoServer for thematic mapping and data distribution, a geospatial database for storage and spatial analysis, web service APIs, including simple-to-use REST APIs for complex GIS functionalities, and geoprocessing tools including python scripts to produce standards-compliant data products. These are then served to the E-DECIDER decision support gateway (http://e-decider.org), the E-DECIDER mobile interface, and to the Department of Homeland Security decision support middleware UICDS (Unified Incident Command and Decision Support). The E-DECIDER decision support gateway features a web interface that delivers map data products including deformation modeling results (slope change and strain magnitude) and aftershock forecasts, with remote sensing change detection results under development. These products are event triggered (from the USGS earthquake feed) and will be posted to event feeds on the E-DECIDER webpage and accessible via the mobile interface and UICDS. E-DECIDER also features a KML service that provides infrastructure information from the FEMA HAZUS database through UICDS and the mobile interface. The back-end GIS service architecture and front-end gateway components form a decision support system that is designed for ease-of-use and extensibility for end-users.

An architecture for a continuous, user-driven, and data-driven application of clinical guidelines and its evaluation.

PubMed

Shalom, Erez; Shahar, Yuval; Lunenfeld, Eitan

2016-02-01

Design, implement, and evaluate a new architecture for realistic continuous guideline (GL)-based decision support, based on a series of requirements that we have identified, such as support for continuous care, for multiple task types, and for data-driven and user-driven modes. We designed and implemented a new continuous GL-based support architecture, PICARD, which accesses a temporal reasoning engine, and provides several different types of application interfaces. We present the new architecture in detail in the current paper. To evaluate the architecture, we first performed a technical evaluation of the PICARD architecture, using 19 simulated scenarios in the preeclampsia/toxemia domain. We then performed a functional evaluation with the help of two domain experts, by generating patient records that simulate 60 decision points from six clinical guideline-based scenarios, lasting from two days to four weeks. Finally, 36 clinicians made manual decisions in half of the scenarios, and had access to the automated GL-based support in the other half. The measures used in all three experiments were correctness and completeness of the decisions relative to the GL. Mean correctness and completeness in the technical evaluation were 1±0.0 and 0.96±0.03 respectively. The functional evaluation produced only several minor comments from the two experts, mostly regarding the output's style; otherwise the system's recommendations were validated. In the clinically oriented evaluation, the 36 clinicians applied manually approximately 41% of the GL's recommended actions. Completeness increased to approximately 93% when using PICARD. Manual correctness was approximately 94.5%, and remained similar when using PICARD; but while 68% of the manual decisions included correct but redundant actions, only 3% of the actions included in decisions made when using PICARD were redundant. The PICARD architecture is technically feasible and is functionally valid, and addresses the realistic continuous GL-based application requirements that we have defined; in particular, the requirement for care over significant time frames. The use of the PICARD architecture in the domain we examined resulted in enhanced completeness and in reduction of redundancies, and is potentially beneficial for general GL-based management of chronic patients. Copyright © 2015 Elsevier Inc. All rights reserved.

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

NASA Technical Reports Server (NTRS)

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

1997-01-01

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

Development of decision support tools to assess pedestrian and bicycle safety : development of safety performance functions : final report.

DOT National Transportation Integrated Search

2016-11-15

While a number of studies have developed Safety Performance Functions (SPFs) for : motorized traffic, there has been a very limited focus on developing SPFs for non-motorized : traffic. Lack of exposure measures for pedestrians and bicyclists has bee...

Comparison of risk-based decision-support systems for brownfield site rehabilitation: DESYRE and SADA applied to a Romanian case study.

PubMed

Stezar, I C; Pizzol, L; Critto, A; Ozunu, A; Marcomini, A

2013-12-15

Brownfield rehabilitation is an essential step for sustainable land-use planning and management in the European Union. In brownfield regeneration processes, the legacy contamination plays a significant role, firstly because of the persistent contaminants in soil or groundwater which extends the existing hazards and risks well into the future; and secondly, problems from historical contamination are often more difficult to manage than contamination caused by new activities. Due to the complexity associated with the management of brownfield site rehabilitation, Decision Support Systems (DSSs) have been developed to support problem holders and stakeholders in the decision-making process encompassing all phases of the rehabilitation. This paper presents a comparative study between two DSSs, namely SADA (Spatial Analysis and Decision Assistance) and DESYRE (Decision Support System for the Requalification of Contaminated Sites), with the main objective of showing the benefits of using DSSs to introduce and process data and then to disseminate results to different stakeholders involved in the decision-making process. For this purpose, a former car manufacturing plant located in the Brasov area, Central Romania, contaminated chiefly by heavy metals and total petroleum hydrocarbons, has been selected as a case study to apply the two examined DSSs. Major results presented here concern the analysis of the functionalities of the two DSSs in order to identify similarities, differences and complementarities and, thus, to provide an indication of the most suitable integration options. Copyright © 2013 Elsevier Ltd. All rights reserved.

The need for sustainability and alignment of future support for National Immunization Technical Advisory Groups (NITAGs) in low and middle-income countries.

PubMed

Howard, Natasha; Bell, Sadie; Walls, Helen; Blanchard, Laurence; Brenzel, Logan; Jit, Mark; Mounier-Jack, Sandra

2018-02-22

National Immunisation Technical Advisory Groups (NITAGs) provide independent guidance to health ministries to support evidence-based and nationally relevant immunisation decisions. We examined NITAGs' value, sustainability, and need for support in low and middle-income countries, drawing from a mixed-methods study including 130 global and national-level key informant interviews. NITAGs were particularly valued for providing independent and nationally owned evidence-based decision-making (EBDM), but needed to be integrated within national processes to effectively balance independence and influence. Participants agreed that most NITAGs, being relatively new, would need developmental and strengthening support for at least a decade. While national governments could support NITAG functioning, external support is likely needed for requisite capacity building. This might come from Gavi mechanisms and WHO, but would require alignment among stakeholders to be effective.

Exploring patient involvement in healthcare decision making across different education and functional health literacy groups.

PubMed

Smith, Sian K; Dixon, Ann; Trevena, Lyndal; Nutbeam, Don; McCaffery, Kirsten J

2009-12-01

Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. Participants were recruited from a community sample with lower educational attainment, plus an educated sample of University of Sydney alumni. The transcripts were analysed using the 'Framework' approach, a matrix-based method of thematic analysis. We found that participants with different education conceptualised their involvement in decision making in diverse ways. Participants with higher education appeared to conceive their involvement as sharing the responsibility with the doctor throughout the decision-making process. This entailed verifying the credibility of the information and exploring options beyond those presented in the consultation. They also viewed themselves as helping others in their health decisions and acting as information resources. In contrast, participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by the doctor, and having responsibility for the ultimate decision, to agree or disagree with the recommendation. They also described how relatives and friends sought information on their behalf and played a key role in their decisions. Both education groups described how aspects of the patient-practitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.

Data Teams for School Improvement

ERIC Educational Resources Information Center

Schildkamp, Kim; Poortman, Cindy L.; Handelzalts, Adam

2016-01-01

The use of data for educational decision making has never been more prevalent. However, teachers and school leaders need support in data use. Support can be provided by means of professional development in the form of "data teams". This study followed the functioning of 4 data teams over a period of 2 years, applying a qualitative case…

Decision support methodology to establish priorities on the inspection of structures

NASA Astrophysics Data System (ADS)

Cortes, V. Juliette; Sterlacchini, Simone; Bogaard, Thom; Frigerio, Simone; Schenato, Luca; Pasuto, Alessandro

2014-05-01

For hydro-meteorological hazards in mountain areas, the regular inspection of check dams and bridges is important due to the effect of their functional status on water-sediment processes. Moreover, the inspection of these structures is time consuming for organizations due to their extensive number in many regions. However, trained citizen-volunteers can support civil protection and technical services in the frequency, timeliness and coverage of monitoring the functional status of hydraulic structures. Technicians should evaluate and validate these reports to get an index for the status of the structure. Thus, preventive actions could initiate such as the cleaning of obstructions or to pre-screen potential problems for a second level inspection. This study proposes a decision support methodology that technicians can use to assess an index for three parameters representing the functional status of the structure: a) condition of the structure at the opening of the stream flow, b) level of obstruction at the structure and c) the level of erosion in the stream bank. The calculation of the index for each parameter is based upon fuzzy logic theory to handle ranges in precision of the reports and to convert the linguistic rating scales into numbers representing the structure's status. A weighting method and multi-criteria method (Analytic Hierarchy Process- AHP and TOPSIS), can be used by technicians to combine the different ratings according to the component elements of the structure and the completeness of the reports. Finally, technicians can set decision rules based on the worst rating and a threshold for the functional indexes. The methodology was implemented as a prototype web-based tool to be tested with technicians of the Civil Protection in the Fella basin, Northern Italy. Results at this stage comprise the design and implementation of the web-based tool with GIS interaction to evaluate available reports and to set priorities on the inspection of structures. Keywords Decision-making, Multi-criteria methods, Torrent control structures, Web-based tools.

Does the cost function matter in Bayes decision rule?

PubMed

Schlü ter, Ralf; Nussbaum-Thom, Markus; Ney, Hermann

2012-02-01

In many tasks in pattern recognition, such as automatic speech recognition (ASR), optical character recognition (OCR), part-of-speech (POS) tagging, and other string recognition tasks, we are faced with a well-known inconsistency: The Bayes decision rule is usually used to minimize string (symbol sequence) error, whereas, in practice, we want to minimize symbol (word, character, tag, etc.) error. When comparing different recognition systems, we do indeed use symbol error rate as an evaluation measure. The topic of this work is to analyze the relation between string (i.e., 0-1) and symbol error (i.e., metric, integer valued) cost functions in the Bayes decision rule, for which fundamental analytic results are derived. Simple conditions are derived for which the Bayes decision rule with integer-valued metric cost function and with 0-1 cost gives the same decisions or leads to classes with limited cost. The corresponding conditions can be tested with complexity linear in the number of classes. The results obtained do not make any assumption w.r.t. the structure of the underlying distributions or the classification problem. Nevertheless, the general analytic results are analyzed via simulations of string recognition problems with Levenshtein (edit) distance cost function. The results support earlier findings that considerable improvements are to be expected when initial error rates are high.

Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

PubMed

Leong, T Y; Kaiser, K; Miksch, S

2007-01-01

Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

Conceptual and Empirical Approaches to Financial Decision-making by Older Adults: Results from a Financial Decision-making Rating Scale.

PubMed

Lichtenberg, Peter A; Ocepek-Welikson, Katja; Ficker, Lisa J; Gross, Evan; Rahman-Filipiak, Analise; Teresi, Jeanne A

2018-01-01

The objectives of this study were threefold: (1) to empirically test the conceptual model proposed by the Lichtenberg Financial Decision-making Rating Scale (LFDRS); (2) to examine the psychometric properties of the LFDRS contextual factors in financial decision-making by investigating both the reliability and convergent validity of the subscales and total scale, and (3) extending previous work on the scale through the collection of normative data on financial decision-making. A convenience sample of 200 independent function and community dwelling older adults underwent cognitive and financial management testing and were interviewed using the LFDRS. Confirmatory factor analysis, internal consistency measures, and hierarchical regression were used in a sample of 200 community-dwelling older adults, all of whom were making or had recently made a significant financial decision. Results confirmed the scale's reliability and supported the conceptual model. Convergent validity analyses indicate that as hypothesized, cognition is a significant predictor of risk scores. Financial management scores, however, were not predictive of decision-making risk scores. The psychometric properties of the LFDRS support the scale's use as it was proposed. The LFDRS instructions and scale are provided for clinicians to use in financial capacity assessments.

Are electronic health records ready for genomic medicine?

PubMed

Scheuner, Maren T; de Vries, Han; Kim, Benjamin; Meili, Robin C; Olmstead, Sarah H; Teleki, Stephanie

2009-07-01

The goal of this project was to assess genetic/genomic content in electronic health records. Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records. There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years. Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.

[The Role and Function of Informatics Nurses in Information Technology Decision-Making].

PubMed

Lee, Tso-Ying

2017-08-01

The medical environment has changed greatly with the coming of the information age, and, increasingly, the operating procedures for medical services have been altered in keeping with the trend toward mobile, paperless services. Informatization has the potential to improve the working efficiency of medical personnel, enhance patient care safety, and give medical organizations a positive image. Informatics nurses play an important role in the decision-making processes that accompany informatization. As one of the decision-making links in the information technology lifecycle, this role affects the success of the development and operation of information systems. The present paper examines the functions and professional knowledge that informatics nurses must possess during the technology lifecycle, the four stages of which include: planning, analysis, design/development/revision, and implementation/assessment/support/maintenance. The present paper further examines the decision-making shortcomings and errors that an informatics nurses may make during the decision-making process. We hope that this paper will serve as an effective and useful reference for informatics nurses during the informatization decision-making process.

Improving medical diagnosis reliability using Boosted C5.0 decision tree empowered by Particle Swarm Optimization.

PubMed

Pashaei, Elnaz; Ozen, Mustafa; Aydin, Nizamettin

2015-08-01

Improving accuracy of supervised classification algorithms in biomedical applications is one of active area of research. In this study, we improve the performance of Particle Swarm Optimization (PSO) combined with C4.5 decision tree (PSO+C4.5) classifier by applying Boosted C5.0 decision tree as the fitness function. To evaluate the effectiveness of our proposed method, it is implemented on 1 microarray dataset and 5 different medical data sets obtained from UCI machine learning databases. Moreover, the results of PSO + Boosted C5.0 implementation are compared to eight well-known benchmark classification methods (PSO+C4.5, support vector machine under the kernel of Radial Basis Function, Classification And Regression Tree (CART), C4.5 decision tree, C5.0 decision tree, Boosted C5.0 decision tree, Naive Bayes and Weighted K-Nearest neighbor). Repeated five-fold cross-validation method was used to justify the performance of classifiers. Experimental results show that our proposed method not only improve the performance of PSO+C4.5 but also obtains higher classification accuracy compared to the other classification methods.

Decision making as a window on cognition.

PubMed

Shadlen, Michael N; Kiani, Roozbeh

2013-10-30

A decision is a commitment to a proposition or plan of action based on information and values associated with the possible outcomes. The process operates in a flexible timeframe that is free from the immediacy of evidence acquisition and the real time demands of action itself. Thus, it involves deliberation, planning, and strategizing. This Perspective focuses on perceptual decision making in nonhuman primates and the discovery of neural mechanisms that support accuracy, speed, and confidence in a decision. We suggest that these mechanisms expose principles of cognitive function in general, and we speculate about the challenges and directions before the field. Copyright © 2013 Elsevier Inc. All rights reserved.

Preserving the Finger Lakes for the Future: A Prototype Decision Support System for Water Resource Management, Open Space, and Agricultural Protection

NASA Technical Reports Server (NTRS)

Brower, Robert

2003-01-01

As described herein, this project has progressed well, with the initiation or completion of a number of program facets at programmatic, technical, and inter-agency levels. The concept of the Virtual Management Operations Center has taken shape, grown, and has been well received by parties from a wide variety of agencies and organizations in the Finger Lakes region and beyond. As it has evolved in design and functionality, and to better illustrate its current focus for this project, it has been given the expanded name of Watershed Virtual Management Operations Center (W-VMOC). It offers the advanced, compelling functionality of interactive 3D visualization interfaced with 2D mapping, all accessed via Internet or virtually any kind of distributed computer network. This strong foundation will allow the development of a Decision Support System (DSS) with anticipated enhanced functionality to be applied to the myriad issues involved in the wise management of the Finger Lakes region.

A work-centered cognitively based architecture for decision support: the work-centered infomediary layer (WIL) model

NASA Astrophysics Data System (ADS)

Zachary, Wayne; Eggleston, Robert; Donmoyer, Jason; Schremmer, Serge

2003-09-01

Decision-making is strongly shaped and influenced by the work context in which decisions are embedded. This suggests that decision support needs to be anchored by a model (implicit or explicit) of the work process, in contrast to traditional approaches that anchor decision support to either context free decision models (e.g., utility theory) or to detailed models of the external (e.g., battlespace) environment. An architecture for cognitively-based, work centered decision support called the Work-centered Informediary Layer (WIL) is presented. WIL separates decision support into three overall processes that build and dynamically maintain an explicit context model, use the context model to identify opportunities for decision support and tailor generic decision-support strategies to the current context and offer them to the system-user/decision-maker. The generic decision support strategies include such things as activity/attention aiding, decision process structuring, work performance support (selective, contextual automation), explanation/ elaboration, infosphere data retrieval, and what if/action-projection and visualization. A WIL-based application is a work-centered decision support layer that provides active support without intent inferencing, and that is cognitively based without requiring classical cognitive task analyses. Example WIL applications are detailed and discussed.

Overcoming barriers to cancer-helpline professionals providing decision support for callers: an implementation study.

PubMed

Stacey, Dawn; Chambers, Suzanne K; Jacobsen, Mary Jane; Dunn, Jeff

2008-11-01

To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions. A pre- and post-test study guided by the Ottawa Model of Research Use. Australian statewide cancer call center that provides public access to information and supportive cancer services. 34 nurses, psychologists, and other allied healthcare professionals at the cancer call center. Participants completed baseline measures and, subsequently, were exposed to an intervention that included a decision support tutorial, coaching protocol, and skill-building workshop. Strategies were implemented to address organizational barriers. Perceived barriers and facilitators influencing provision of decision support, decision support knowledge, quality of decision support provided to standardized callers, and call length. Postintervention participants felt more prepared, confident in providing decision support, and aware of decision support resources. They had a stronger belief that providing decision support was within their role. Participants significantly improved their knowledge and provided higher-quality decision support to standardized callers without changing call length. The implementation intervention overcame several identified barriers that influenced call center professionals when providing decision support. Nurses and other helpline professionals have the potential to provide decision support designed to help callers understand cancer information, clarify their values associated with their options, and reduce decisional conflict. However, they require targeted education and organizational interventions to reduce their perceived barriers to providing decision support.

How to Collaborate through Teams

ERIC Educational Resources Information Center

Conderman, Greg

2016-01-01

Teachers are spending more of their time and making more decisions within teams. Effective teacher-based teams provide academic and behavioral support for students as well as professional development for teachers. Learn how the best teams function.

The Automated Logistics Element Planning System (ALEPS)

NASA Technical Reports Server (NTRS)

Schwaab, Douglas G.

1991-01-01

The design and functions of ALEPS (Automated Logistics Element Planning System) is a computer system that will automate planning and decision support for Space Station Freedom Logistical Elements (LEs) resupply and return operations. ALEPS provides data management, planning, analysis, monitoring, interfacing, and flight certification for support of LE flight load planning activities. The prototype ALEPS algorithm development is described.

A decision support system using analytical hierarchy process (AHP) for the optimal environmental reclamation of an open-pit mine

NASA Astrophysics Data System (ADS)

Bascetin, A.

2007-04-01

The selection of an optimal reclamation method is one of the most important factors in open-pit design and production planning. It also affects economic considerations in open-pit design as a function of plan location and depth. Furthermore, the selection is a complex multi-person, multi-criteria decision problem. The group decision-making process can be improved by applying a systematic and logical approach to assess the priorities based on the inputs of several specialists from different functional areas within the mine company. The analytical hierarchy process (AHP) can be very useful in involving several decision makers with different conflicting objectives to arrive at a consensus decision. In this paper, the selection of an optimal reclamation method using an AHP-based model was evaluated for coal production in an open-pit coal mine located at Seyitomer region in Turkey. The use of the proposed model indicates that it can be applied to improve the group decision making in selecting a reclamation method that satisfies optimal specifications. Also, it is found that the decision process is systematic and using the proposed model can reduce the time taken to select a optimal method.

Biomedical Ontologies in Action: Role in Knowledge Management, Data Integration and Decision Support

PubMed Central

Bodenreider, O.

2008-01-01

Summary Objectives To provide typical examples of biomedical ontologies in action, emphasizing the role played by biomedical ontologies in knowledge management, data integration and decision support. Methods Biomedical ontologies selected for their practical impact are examined from a functional perspective. Examples of applications are taken from operational systems and the biomedical literature, with a bias towards recent journal articles. Results The ontologies under investigation in this survey include SNOMED CT, the Logical Observation Identifiers, Names, and Codes (LOINC), the Foundational Model of Anatomy, the Gene Ontology, RxNorm, the National Cancer Institute Thesaurus, the International Classification of Diseases, the Medical Subject Headings (MeSH) and the Unified Medical Language System (UMLS). The roles played by biomedical ontologies are classified into three major categories: knowledge management (indexing and retrieval of data and information, access to information, mapping among ontologies); data integration, exchange and semantic interoperability; and decision support and reasoning (data selection and aggregation, decision support, natural language processing applications, knowledge discovery). Conclusions Ontologies play an important role in biomedical research through a variety of applications. While ontologies are used primarily as a source of vocabulary for standardization and integration purposes, many applications also use them as a source of computable knowledge. Barriers to the use of ontologies in biomedical applications are discussed. PMID:18660879

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

PubMed

Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

2012-01-01

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Social interactions elicit rapid shifts in functional connectivity in the social decision-making network of zebrafish

PubMed Central

Teles, Magda C.; Almeida, Olinda; Lopes, João S.; Oliveira, Rui F.

2015-01-01

According to the social decision-making (SDM) network hypothesis, SDM is encoded in a network of forebrain and midbrain structures in a distributed and dynamic fashion, such that the expression of a given social behaviour is better reflected by the overall profile of activation across the different loci rather than by the activity of a single node. This proposal has the implicit assumption that SDM relies on integration across brain regions, rather than on regional specialization. Here we tested the occurrence of functional localization and of functional connectivity in the SDM network. For this purpose we used zebrafish to map different social behaviour states into patterns of neuronal activity, as indicated by the expression of the immediate early genes c-fos and egr-1, across the SDM network. The results did not support functional localization, as some loci had similar patterns of activity associated with different social behaviour states, and showed socially driven changes in functional connectivity. Thus, this study provides functional support to the SDM network hypothesis and suggests that the neural context in which a given node of the network is operating (i.e. the state of its interconnected areas) is central to its functional relevance. PMID:26423839

Social interactions elicit rapid shifts in functional connectivity in the social decision-making network of zebrafish.

PubMed

Teles, Magda C; Almeida, Olinda; Lopes, João S; Oliveira, Rui F

2015-10-07

According to the social decision-making (SDM) network hypothesis, SDM is encoded in a network of forebrain and midbrain structures in a distributed and dynamic fashion, such that the expression of a given social behaviour is better reflected by the overall profile of activation across the different loci rather than by the activity of a single node. This proposal has the implicit assumption that SDM relies on integration across brain regions, rather than on regional specialization. Here we tested the occurrence of functional localization and of functional connectivity in the SDM network. For this purpose we used zebrafish to map different social behaviour states into patterns of neuronal activity, as indicated by the expression of the immediate early genes c-fos and egr-1, across the SDM network. The results did not support functional localization, as some loci had similar patterns of activity associated with different social behaviour states, and showed socially driven changes in functional connectivity. Thus, this study provides functional support to the SDM network hypothesis and suggests that the neural context in which a given node of the network is operating (i.e. the state of its interconnected areas) is central to its functional relevance. © 2015 The Author(s).

A-7E Software Module Guide.

DTIC Science & Technology

1981-12-08

o 14 A& B:2.1 Function Driver Module.. ..... .... 14’ ’: B:2.2 Shared Services Module . . . o o . 0 -15 M’ 5:3 Software Decision Module...2.1.13 Weapon Release Functions... ........24 C:2.l.14 Ground Test Functions .. ........... 24 C:2.2 Shared Services Module Decomposition. ........24 C...Driver (FD) Module supported by a Shared Services (SS) Module. B:2.1 FUNCTION DRIVER MODULE The Function Driver Module consists of a set of individual

Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

PubMed

Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

2016-01-01

Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

Functional neuroimaging of the Iowa Gambling Task in older adults.

PubMed

Halfmann, Kameko; Hedgcock, William; Bechara, Antoine; Denburg, Natalie L

2014-11-01

The neural systems most susceptible to age-related decline mirror the systems linked to decision making. Yet, the neural processes underlying decision-making disparities among older adults are not well understood. We sought to identify neural response patterns that distinguish 2 groups of older adults who exhibit divergent decision-making patterns. Participants were 31 healthy older adults (ages 59-88, 53% female), defined as advantageous or disadvantageous decision-makers based on Iowa Gambling Task (IGT) performance, who completed an alternate version of the IGT while undergoing functional MRI. The groups were indistinguishable on neuropsychological testing. We contrasted the BOLD signal between groups during 3 phases of the decision-making process: Prechoice (preselection), Prefeedback (postselection), and Feedback (receipt of gains/losses). We further examined whether BOLD signal varied as a function of age in each group. We observed greater activation among the IGT-Disadvantageous relative to -Advantageous older adults in the prefrontal cortex during the early phases of the decision-making process (Prechoice), and in posterior brain regions (e.g., the precuneus) during the later phases (Prefeedback and Feedback). We also found that with increasing age, IGT-Advantageous older adults showed increasing activation in the prefrontal cortex during all phases and increasing activation in the posterior cingulate during earlier phases of the decision process. By contrast, the IGT-Disadvantageous older adults exhibited a reduced or reversed trend. These functional differences may be a consequence of altered reward processing or differing compensatory strategies between IGT-Disadvantageous and -Advantageous older adults. This supports the notion that divergent neurobiological aging trajectories underlie disparate decision-making patterns. PsycINFO Database Record (c) 2014 APA, all rights reserved.

A Prototype Symbolic Model of Canonical Functional Neuroanatomy of the Motor System

PubMed Central

Rubin, Daniel L.; Halle, Michael; Musen, Mark; Kikinis, Ron

2008-01-01

Recent advances in bioinformatics have opened entire new avenues for organizing, integrating and retrieving neuroscientific data, in a digital, machine-processable format, which can be at the same time understood by humans, using ontological, symbolic data representations. Declarative information stored in ontological format can be perused and maintained by domain experts, interpreted by machines, and serve as basis for a multitude of decision-support, computerized simulation, data mining, and teaching applications. We have developed a prototype symbolic model of canonical neuroanatomy of the motor system. Our symbolic model is intended to support symbolic lookup, logical inference and mathematical modeling by integrating descriptive, qualitative and quantitative functional neuroanatomical knowledge. Furthermore, we show how our approach can be extended to modeling impaired brain connectivity in disease states, such as common movement disorders. In developing our ontology, we adopted a disciplined modeling approach, relying on a set of declared principles, a high-level schema, Aristotelian definitions, and a frame-based authoring system. These features, along with the use of the Unified Medical Language System (UMLS) vocabulary, enable the alignment of our functional ontology with an existing comprehensive ontology of human anatomy, and thus allow for combining the structural and functional views of neuroanatomy for clinical decision support and neuroanatomy teaching applications. Although the scope of our current prototype ontology is limited to a particular functional system in the brain, it may be possible to adapt this approach for modeling other brain functional systems as well. PMID:18164666

TIUPAM: A Framework for Trustworthiness-Centric Information Sharing

NASA Astrophysics Data System (ADS)

Xu, Shouhuai; Sandhu, Ravi; Bertino, Elisa

Information is essential to decision making. Nowadays, decision makers are often overwhelmed with large volumes of information, some of which may be inaccurate, incorrect, inappropriate, misleading, or maliciously introduced. With the advocated shift of information sharing paradigm from “need to know” to “need to share” this problem will be further compounded. This poses the challenge of achieving assured information sharing so that decision makers can always get and utilize the up-to-date information for making the right decisions, despite the existence of malicious attacks and without breaching privacy of honest participants. As a first step towards answering this challenge this paper proposes a systematic framework we call TIUPAM, which stands for “Trustworthiness-centric Identity, Usage, Provenance, and Attack Management.” The framework is centered at the need of trustworthiness and risk management for decision makers, and supported by four key components: identity management, usage management, provenance management and attack management. We explore the characterization of both the core functions and the supporting components in the TIUPAM framework, which may guide the design and realization of concrete schemes in the future.

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

PubMed Central

2010-01-01

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

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

PubMed

McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

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

Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

PubMed

Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight

2007-01-01

Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.

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

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

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

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

Clinical, information and business process modeling to promote development of safe and flexible software.

PubMed

Liaw, Siaw-Teng; Deveny, Elizabeth; Morrison, Iain; Lewis, Bryn

2006-09-01

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

Examining Practices of Staff Recruitment and Retention in Four High-Functioning Afterschool Programs: Extended Study from the National Afterschool Partnership Report. CRESST Report 769

ERIC Educational Resources Information Center

Huang, Denise; Cho, Jamie; Nam, Hannah H.; La Torre, Deborah; Oh, Christine; Harven, Aletha; Huber, Lindsay Perez; Rudo, Zena; Caverly, Sarah

2010-01-01

This study describes how staff qualifications, decisions on staffing procedures, and professional development opportunities support the recruitment and retention of quality staff members. Four high-functioning programs were identified. Qualitative procedures and instruments were designed to capture staff and parents' academic perspectives about…

Intraoperative Clinical Decision Support for Anesthesia: A Narrative Review of Available Systems.

PubMed

Nair, Bala G; Gabel, Eilon; Hofer, Ira; Schwid, Howard A; Cannesson, Maxime

2017-02-01

With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care. Real-time CDS holds the most promise because real-time alerts and guidance can drive provider behavior toward evidence-based standardized care during the ongoing case. In this review, we describe the different types of intraoperative CDS systems with specific emphasis on real-time systems. The technical considerations in developing and implementing real-time CDS are systematically covered. This includes the functional modules of a CDS system, development and execution of decision rules, and modalities to alert anesthesia providers concerning clinical issues. We also describe the regulatory aspects that affect development, implementation, and use of intraoperative CDS. Methods and measures to assess the effectiveness of intraoperative CDS are discussed. Last, we outline areas of future development of intraoperative CDS, particularly the possibility of providing predictive and prescriptive decision support.

A dedicated software application for treatment verification with off-line PET/CT imaging at the Heidelberg Ion Beam Therapy Center

NASA Astrophysics Data System (ADS)

Chen, W.; Bauer, J.; Kurz, C.; Tessonnier, T.; Handrack, J.; Haberer, T.; Debus, J.; Parodi, K.

2017-01-01

We present the workflow of the offline-PET based range verification method used at the Heidelberg Ion Beam Therapy Center, detailing the functionalities of an in-house developed software application, SimInterface14, with which range analysis is performed. Moreover, we introduce the design of a decision support system assessing uncertainties and facilitating physicians in decisions making for plan adaptation.

The Operational Movement Planning System: A Prototype for the Strategic Command Function

DTIC Science & Technology

1993-06-01

environment. The White Paper identifies "computer based systems to support the decision making of operational and higher level commanders" as an important...exist and objective decisions can be made. When extending the application of computers into the upper levels of an organisation higher productivity...thCtaspot. aiinssetstnttt dtrm In his magstepatecapsables tran lsptort O assets o ahie umr r dniid eemnn capabilty is avery coplex prcess . Cpabilit reuie

Conceptual and Empirical Approaches to Financial Decision-making by Older Adults: Results from a Financial Decision-Making Rating Scale

PubMed Central

Lichtenberg, Peter A.; Ocepek-Welikson, Katja; Ficker, Lisa J.; Gross, Evan; Rahman-Filipiak, Analise; Teresi, Jeanne A.

2017-01-01

Objectives The objectives of this study were threefold: (1) to empirically test the conceptual model proposed by the Lichtenberg Financial Decision Rating Scale (LFDRS); (2) to examine the psychometric properties of the LFDRS contextual factors in financial decision-making by investigating both the reliability and convergent validity of the subscales and total scale, and (3) extending previous work on the scale through the collection of normative data on financial decision-making. Methods A convenience sample of 200 independent function and community dwelling older adults underwent cognitive and financial management testing and were interviewed using the LFDRS. Confirmatory factor analysis, internal consistency measures, and hierarchical regression were used in a sample of 200 community-dwelling older adults, all of whom were making or had recently made a significant financial decision. Results Results confirmed the scale’s reliability and supported the conceptual model. Convergent validity analyses indicate that as hypothesized, cognition is a significant predictor of risk scores. Financial management scores, however, were not predictive of decision-making risk scores. Conclusions The psychometric properties of the LFDRS support the scale’s use as it was proposed in Lichtenberg et al., 2015. Clinical Implications The LFDRS instructions and scale are provided for clinicians to use in financial capacity assessments. PMID:29077531

Decision Support | Solar Research | NREL

Science.gov Websites

informed solar decision making with credible, objective, accessible, and timely resources. Solar Energy Decision Support Decision Support NREL provides technical and analytical support to support provide unbiased information on solar policies and issues for state and local government decision makers

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.

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

PubMed

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

2014-01-01

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

Space Station overall management approach for operations

NASA Technical Reports Server (NTRS)

Paules, G.

1986-01-01

An Operations Management Concept developed by NASA for its Space Station Program is discussed. The operational goals, themes, and design principles established during program development are summarized. The major operations functions are described, including: space systems operations, user support operations, prelaunch/postlanding operations, logistics support operations, market research, and cost/financial management. Strategic, tactical, and execution levels of operational decision-making are defined.

Neuro-Oncology Branch patient emotional support services | Center for Cancer Research

Cancer.gov

Emotional Support Services The diagnosis of a brain tumor elicits many different and sometimes difficult emotions, not only for the patient, but also for their family members. Patients may encounter changes in cognitive functioning and language, a diminished ability to focus or make decisions, or short-term memory loss, all of which can greatly affect their personal and

A knowledge infrastructure for occupational safety and health.

PubMed

van Dijk, Frank J H; Verbeek, Jos H; Hoving, Jan L; Hulshof, Carel T J

2010-12-01

Occupational Safety and Health (OSH) professionals should use scientific evidence to support their decisions in policy and practice. Although examples from practice show that progress has been made in evidence-based decision making, there is a challenge to improve and extend the facilities that support knowledge translation in practice. A knowledge infrastructure that supports OSH practice should include scientific research, systematic reviews, practice guidelines, and other tools for professionals such as well accessible virtual libraries and databases providing knowledge, quality tools, and good learning materials. A good infrastructure connects facilities with each other and with practice. Training and education is needed for OSH professionals in the use of evidence to improve effectiveness and efficiency. New initiatives show that occupational health can profit from intensified international collaboration to establish a good functioning knowledge infrastructure.

Patient decision making among older individuals with cancer.

PubMed

Strohschein, Fay J; Bergman, Howard; Carnevale, Franco A; Loiselle, Carmen G

2011-07-01

Patient decision making is an area of increasing inquiry. For older individuals experiencing cancer, variations in health and functional status, physiologic aspects of aging, and tension between quality and quantity of life present unique challenges to treatment-related decision making. We used the pragmatic utility method to analyze the concept of patient decision making in the context of older individuals with cancer. We first evaluated its maturity in existing literature and then posed analytical questions to clarify aspects found to be only partially mature. In this context, we found patient decision making to be an ongoing process, changing with time, reflecting individual and relational components, as well as analytical and emotional ones. Assumptions frequently associated with patient decision making were not consistent with the empirical literature. Careful attention to the multifaceted components of patient decision making among older individuals with cancer provides guidance for research, supportive interventions, and targeted follow-up care.

Functional requirements regarding medical registries--preliminary results.

PubMed

Oberbichler, Stefan; Hörbst, Alexander

2013-01-01

The term medical registry is used to reference tools and processes to support clinical or epidemiologic research or provide a data basis for decisions regarding health care policies. In spite of this wide range of applications the term registry and the functional requirements which a registry should support are not clearly defined. This work presents preliminary results of a literature review to discover functional requirements which form a registry. To extract these requirements a set of peer reviewed articles was collected. These set of articles was screened by using methods from qualitative research. Up to now most discovered functional requirements focus on data quality (e. g. prevent transcription error by conducting automatic domain checks).

Neurocognitive Development of Risk Aversion from Early Childhood to Adulthood

PubMed Central

Paulsen, David J.; Carter, R. McKell; Platt, Michael L.; Huettel, Scott A.; Brannon, Elizabeth M.

2012-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes. PMID:22291627

Neurocognitive development of risk aversion from early childhood to adulthood.

PubMed

Paulsen, David J; Carter, R McKell; Platt, Michael L; Huettel, Scott A; Brannon, Elizabeth M

2011-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes.

The contribution of the human posterior parietal cortex to episodic memory.

PubMed

Sestieri, Carlo; Shulman, Gordon L; Corbetta, Maurizio

2017-02-17

The posterior parietal cortex (PPC) is traditionally associated with attention, perceptual decision making and sensorimotor transformations, but more recent human neuroimaging studies support an additional role in episodic memory retrieval. In this Opinion article, we present a functional-anatomical model of the involvement of the PPC in memory retrieval. Parietal regions involved in perceptual attention and episodic memory are largely segregated and often show a push-pull relationship, potentially mediated by prefrontal regions. Moreover, different PPC regions carry out specific functions during retrieval - for example, representing retrieved information, recoding this information based on task demands, or accumulating evidence for memory decisions.

Remote Sensing Decision Support System for Optimal Access Restoration in Post Disaster Environments

DOT National Transportation Integrated Search

2017-01-01

Access restoration is an extremely important part of disaster response. Without access to the site, critically important emergency functions like search and rescue, emergency evacuation, and relief distribution, cannot commence. Frequently, roads are...

An external logic architecture for implementing traffic signal system control strategies.

DOT National Transportation Integrated Search

2011-09-01

The built-in logic functions in traffic controllers have very limited capability to store information, to analyze input data, to estimate performance measures, and to adopt control strategy decisions. These capabilities are imperative to support traf...

A Simplified Decision Support Approach for Evaluating Wetlands Ecosystem Services NABS11

EPA Science Inventory

State-level managers and environmental advocates often must justify their restoration actions in terms of tangible beneficial outcomes. Wetlands functional assessment tools (e.g, Wetland Evaluation Technique (WET), Habitat Evaluation Procedures (HEP), Hydrogeomorphic Method (HGM)...

Clinical decision support for whole genome sequence information leveraging a service-oriented architecture: a prototype.

PubMed

Welch, Brandon M; Rodriguez-Loya, Salvador; Eilbeck, Karen; Kawamoto, Kensaku

2014-01-01

Whole genome sequence (WGS) information could soon be routinely available to clinicians to support the personalized care of their patients. At such time, clinical decision support (CDS) integrated into the clinical workflow will likely be necessary to support genome-guided clinical care. Nevertheless, developing CDS capabilities for WGS information presents many unique challenges that need to be overcome for such approaches to be effective. In this manuscript, we describe the development of a prototype CDS system that is capable of providing genome-guided CDS at the point of care and within the clinical workflow. To demonstrate the functionality of this prototype, we implemented a clinical scenario of a hypothetical patient at high risk for Lynch Syndrome based on his genomic information. We demonstrate that this system can effectively use service-oriented architecture principles and standards-based components to deliver point of care CDS for WGS information in real-time.

Cognitive and behavioural dispositions in offspring at high risk for alcoholism.

PubMed

Kumar, Rajesh; Kumar, Keshav Janakiprasad; Benegal, Vivek

2018-06-01

Offspring with family history of alcoholism are considered to be at high risk for alcoholism. The present study sought to expand our understanding of cognitive and behavioural dispositions associated with executive control and self-regulation in alcohol naïve offspring with and without family history of alcoholism. Sample comprised of alcohol naive offspring in two groups: (i) at high risk (n = 34) and (ii) at low risk for alcoholism (n = 34). Both groups were matched on age (+/-1 year), education (+/-1 year) and gender. Measures used were: Mini-International Neuropsychiatric Interview, Family Interview for Genetic Studies, Socio-demographic Data Sheet, Annett's Handedness Questionnaire, Barratt's Impulsiveness Scale-version 11, Digit Span Test, Spatial Span Test, Tower of London, Wisconsin Card Sorting Test, Iowa Gambling Task (IGT) and Game of Dice Task (GDT). Results showed that alcohol naive offspring at high risk for alcoholism reported significantly high impulsivity and demonstrated significant differences on executive functions and decision making tasks. Correlation analysis revealed that high impulsivity was significantly associated with poor performance on explicit decision making task (GDT) and executive function task (WCST). There was no significant correlation between two decision making tasks (IGT and GDT) in both groups and performance on IGT was not significantly associated with impulsivity and executive functions. The present study indicates cognitive and behavioural dispositions in alcohol naive offspring at high risk for alcoholism and support the sub-optimal balance between reflective and impulsive system responsible for addiction. Furthermore, present study supports separability between two different types of decision making tasks. Copyright © 2018 Elsevier B.V. All rights reserved.

Fuzzy Integration of Support Vector Regression Models for Anticipatory Control of Complex Energy Systems

DOE PAGES

Alamaniotis, Miltiadis; Agarwal, Vivek

2014-04-01

Anticipatory control systems are a class of systems whose decisions are based on predictions for the future state of the system under monitoring. Anticipation denotes intelligence and is an inherent property of humans that make decisions by projecting in future. Likewise, artificially intelligent systems equipped with predictive functions may be utilized for anticipating future states of complex systems, and therefore facilitate automated control decisions. Anticipatory control of complex energy systems is paramount to their normal and safe operation. In this paper a new intelligent methodology integrating fuzzy inference with support vector regression is introduced. Our proposed methodology implements an anticipatorymore » system aiming at controlling energy systems in a robust way. Initially a set of support vector regressors is adopted for making predictions over critical system parameters. Furthermore, the predicted values are fed into a two stage fuzzy inference system that makes decisions regarding the state of the energy system. The inference system integrates the individual predictions into a single one at its first stage, and outputs a decision together with a certainty factor computed at its second stage. The certainty factor is an index of the significance of the decision. The proposed anticipatory control system is tested on a real world set of data obtained from a complex energy system, describing the degradation of a turbine. Results exhibit the robustness of the proposed system in controlling complex energy systems.« less

Command and Compensation in a Neuromodulatory Decision Network

PubMed Central

Luan, Haojiang; Diao, Fengqiu; Peabody, Nathan C.; White, Benjamin H.

2012-01-01

The neural circuits that mediate behavioral choices must not only weigh internal demands and environmental circumstances, but also select and implement specific actions, including associated visceral or neuroendocrine functions. Coordinating these multiple processes suggests considerable complexity. As a consequence, even circuits that support simple behavioral decisions remain poorly understood. Here we show that the environmentally-sensitive wing expansion decision of adult fruit flies is coordinated by a single pair of neuromodulatory neurons with command-like function. Targeted suppression of these neurons using the Split Gal4 system abrogates the fly's ability to expand its wings in the face of environmental challenges, while stimulating them forces expansion by coordinately activating both motor and neuroendocrine outputs. The arbitration and implementation of the wing expansion decision by this neuronal pair may illustrate a general strategy by which neuromodulatory neurons orchestrate behavior. Interestingly, the decision network shows a behavioral plasticity that is unmasked under conducive environmental conditions in flies lacking the function of the command-like neuromodulatory neurons. Such flies can often expand their wings using a motor program distinct from that of wildtype animals and controls. This compensatory program may be the vestige of an ancestral, environmentally-insensitive program used for wing expansion that existed prior to the evolution of the environmentally-adaptive program currently used by Drosophila and other cyclorrhaphan flies. PMID:22262886

Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

PubMed

Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

2009-04-01

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

Patient Acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) Booklet: A Prospective Non-Randomized Comparison Study Across 6 Predialysis Services.

PubMed

Winterbottom, Anna E; Gavaruzzi, Teresa; Mooney, Andrew; Wilkie, Martin; Davies, Simon J; Crane, Dennis; Tupling, Ken; Baxter, Paul D; Meads, David M; Mathers, Nigel; Bekker, Hilary L

2016-01-01

♦ Patients are satisfied with their kidney care but want more support in making dialysis choices. Predialysis leaflets vary across services, with few being sufficient to enable patients' informed decision making. We describe the acceptability of a patient decision aid and feasibility of evaluating its effectiveness within usual predialysis practice. ♦ Prospective non-randomized comparison design, Usual Care or Usual Care Plus Yorkshire Dialysis Decision Aid Booklet (+YoDDA), in 6 referral centers (Yorkshire-Humber, UK) for patients with sustained deterioration of kidney function. Consenting (C) patients completed questionnaires after predialysis consultation (T1), and 6 weeks later (T2). Measures assessed YoDDA's utility to support patients' decisions and integration within usual care. ♦ Usual Care (n = 105) and +YoDDA (n = 84) participant characteristics were similar: male (62%), white (94%), age (mean = 62.6; standard deviation [SD] 14.4), kidney disease severity (glomerular filtration rate [eGFR] mean = 14.7; SD 3.7); decisional conflict was < 25; choice-preference for home versus hospital dialysis approximately 50:50. Patients valued receiving YoDDA, reading it on their own (96%), and sharing it with family (72%). The +YoDDA participants had higher scores for understanding kidney disease, reasoning about options, feeling in control, sharing their decision with family. Study engagement varied by center (estimated range 14 - 49%; mean 45%); participants varied in completion of decision quality measures. ♦ Receiving YoDDA as part of predialysis education was valued and useful to patients with worsening kidney disease. Integrating YoDDA actively within predialysis programs will meet clinical guidelines and patient need to support dialysis decision making in the context of patients' lifestyle. Copyright © 2016 International Society for Peritoneal Dialysis.

Midlevel Maternity Providers' Preferences of a Childbirth Monitoring Tool in Low-Income Health Units in Uganda.

PubMed

Balikuddembe, Michael S; Wakholi, Peter K; Tumwesigye, Nazarius M; Tylleskär, Thorkild

2018-01-01

A third of women in childbirth are inadequately monitored, partly due to the tools used. Some stakeholders assert that the current labour monitoring tools are not efficient and need improvement to become more relevant to childbirth attendants. The study objective was to explore the expectations of maternity service providers for a mobile childbirth monitoring tool in maternity facilities in a low-income country like Uganda. Semi-structured interviews of purposively selected midwives and doctors in rural-urban childbirth facilities in Uganda were conducted before thematic data analysis. The childbirth providers expected a tool that enabled fast and secure childbirth record storage and sharing. They desired a tool that would automatically and conveniently register patient clinical findings, and actively provide interactive clinical decision support on a busy ward. The tool ought to support agreed upon standards for good pregnancy outcomes but also adaptable to the patient and their difficult working conditions. The tool functionality should include clinical data management and real-time decision support to the midwives, while the non-functional attributes include versatility and security.

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

A Review of Consequences of Poverty on Economic Decision-Making: A Hypothesized Model of a Cognitive Mechanism.

PubMed

Adamkovič, Matúš; Martončik, Marcel

2017-01-01

This review focuses on the issue of poverty affecting economic decision-making. By critically evaluating existing studies, the authors propose a structural model detailing the cognitive mechanism involved in how poverty negatively impacts economic decision-making, and explores evidence supporting the basis for the formation of this model. The suggested mechanism consists of a relationship between poverty and four other factors: (1) cognitive load (e.g., experiencing negative affect and stress); (2) executive functions (e.g., attention, working memory, and self-control); (3) intuition/deliberation in decision-making; and (4) economic decision-making (e.g., time-discounting and risk preference), with a final addition of financial literacy as a covariate. This paper focuses on shortfalls in published research, and delves further into the proposed model.

Mixture-based gatekeeping procedures in adaptive clinical trials.

PubMed

Kordzakhia, George; Dmitrienko, Alex; Ishida, Eiji

2018-01-01

Clinical trials with data-driven decision rules often pursue multiple clinical objectives such as the evaluation of several endpoints or several doses of an experimental treatment. These complex analysis strategies give rise to "multivariate" multiplicity problems with several components or sources of multiplicity. A general framework for defining gatekeeping procedures in clinical trials with adaptive multistage designs is proposed in this paper. The mixture method is applied to build a gatekeeping procedure at each stage and inferences at each decision point (interim or final analysis) are performed using the combination function approach. An advantage of utilizing the mixture method is that it enables powerful gatekeeping procedures applicable to a broad class of settings with complex logical relationships among the hypotheses of interest. Further, the combination function approach supports flexible data-driven decisions such as a decision to increase the sample size or remove a treatment arm. The paper concludes with a clinical trial example that illustrates the methodology by applying it to develop an adaptive two-stage design with a mixture-based gatekeeping procedure.

The neural system of metacognition accompanying decision-making in the prefrontal cortex

PubMed Central

Qiu, Lirong; Su, Jie; Ni, Yinmei; Bai, Yang; Zhang, Xuesong; Li, Xiaoli

2018-01-01

Decision-making is usually accompanied by metacognition, through which a decision maker monitors uncertainty regarding a decision and may then consequently revise the decision. These metacognitive processes can occur prior to or in the absence of feedback. However, the neural mechanisms of metacognition remain controversial. One theory proposes an independent neural system for metacognition in the prefrontal cortex (PFC); the other, that metacognitive processes coincide and overlap with the systems used for the decision-making process per se. In this study, we devised a novel “decision–redecision” paradigm to investigate the neural metacognitive processes involved in redecision as compared to the initial decision-making process. The participants underwent a perceptual decision-making task and a rule-based decision-making task during functional magnetic resonance imaging (fMRI). We found that the anterior PFC, including the dorsal anterior cingulate cortex (dACC) and lateral frontopolar cortex (lFPC), were more extensively activated after the initial decision. The dACC activity in redecision positively scaled with decision uncertainty and correlated with individual metacognitive uncertainty monitoring abilities—commonly occurring in both tasks—indicating that the dACC was specifically involved in decision uncertainty monitoring. In contrast, the lFPC activity seen in redecision processing was scaled with decision uncertainty reduction and correlated with individual accuracy changes—positively in the rule-based decision-making task and negatively in the perceptual decision-making task. Our results show that the lFPC was specifically involved in metacognitive control of decision adjustment and was subject to different control demands of the tasks. Therefore, our findings support that a separate neural system in the PFC is essentially involved in metacognition and further, that functions of the PFC in metacognition are dissociable. PMID:29684004

Interval-parameter semi-infinite fuzzy-stochastic mixed-integer programming approach for environmental management under multiple uncertainties.

PubMed

Guo, P; Huang, G H

2010-03-01

In this study, an interval-parameter semi-infinite fuzzy-chance-constrained mixed-integer linear programming (ISIFCIP) approach is developed for supporting long-term planning of waste-management systems under multiple uncertainties in the City of Regina, Canada. The method improves upon the existing interval-parameter semi-infinite programming (ISIP) and fuzzy-chance-constrained programming (FCCP) by incorporating uncertainties expressed as dual uncertainties of functional intervals and multiple uncertainties of distributions with fuzzy-interval admissible probability of violating constraint within a general optimization framework. The binary-variable solutions represent the decisions of waste-management-facility expansion, and the continuous ones are related to decisions of waste-flow allocation. The interval solutions can help decision-makers to obtain multiple decision alternatives, as well as provide bases for further analyses of tradeoffs between waste-management cost and system-failure risk. In the application to the City of Regina, Canada, two scenarios are considered. In Scenario 1, the City's waste-management practices would be based on the existing policy over the next 25 years. The total diversion rate for the residential waste would be approximately 14%. Scenario 2 is associated with a policy for waste minimization and diversion, where 35% diversion of residential waste should be achieved within 15 years, and 50% diversion over 25 years. In this scenario, not only landfill would be expanded, but also CF and MRF would be expanded. Through the scenario analyses, useful decision support for the City's solid-waste managers and decision-makers has been generated. Three special characteristics of the proposed method make it unique compared with other optimization techniques that deal with uncertainties. Firstly, it is useful for tackling multiple uncertainties expressed as intervals, functional intervals, probability distributions, fuzzy sets, and their combinations; secondly, it has capability in addressing the temporal variations of the functional intervals; thirdly, it can facilitate dynamic analysis for decisions of facility-expansion planning and waste-flow allocation within a multi-facility, multi-period and multi-option context. Copyright 2009 Elsevier Ltd. All rights reserved.

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

PubMed

Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

2003-09-01

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

Design Requirements for a Decision Support System for the Dynamic Retasking of Electronic Combat Assets.

DTIC Science & Technology

1988-03-01

primary mission was not pursued. The question of the *t employment and retasking of EC assets is basically a question of command and control, though...The] primary function of command is deploying and maneuvering forces or other sources of potential power to be in the best possible position to...unstructured, and multivariable problem. Research Objective The primary objective of this research is to develop an initial set requirements for a decision

Enhanced subgenual cingulate response to altruistic decisions in remitted major depressive disorder

PubMed Central

Pulcu, Erdem; Zahn, Roland; Moll, Jorge; Trotter, Paula D.; Thomas, Emma J.; Juhasz, Gabriella; Deakin, J.F.William; Anderson, Ian M.; Sahakian, Barbara J.; Elliott, Rebecca

2014-01-01

Background Major depressive disorder (MDD) is associated with functional abnormalities in fronto-meso-limbic networks contributing to decision-making, affective and reward processing impairments. Such functional disturbances may underlie a tendency for enhanced altruism driven by empathy-based guilt observed in some patients. However, despite the relevance of altruistic decisions to understanding vulnerability, as well as everyday psychosocial functioning, in MDD, their functional neuroanatomy is unknown. Methods Using a charitable donations experiment with fMRI, we compared 14 medication-free participants with fully remitted MDD and 15 demographically-matched control participants without MDD. Results Compared with the control group, the remitted MDD group exhibited enhanced BOLD response in a septal/subgenual cingulate cortex (sgACC) region for charitable donation relative to receiving simple rewards and higher striatum activation for both charitable donation and simple reward relative to a low level baseline. The groups did not differ in demographics, frequency of donations or response times, demonstrating only a difference in neural architecture. Conclusions We showed that altruistic decisions probe residual sgACC hypersensitivity in MDD even after symptoms are fully remitted. The sgACC has previously been shown to be associated with guilt which promotes altruistic decisions. In contrast, the striatum showed common activation to both simple and altruistic rewards and could be involved in the so-called “warm glow” of donation. Enhanced neural response in the depression group, in areas previously linked to altruistic decisions, supports the hypothesis of a possible association between hyper-altruism and depression vulnerability, as shown by recent epidemiological studies. PMID:24936421

Decision-Making in the Ventral Premotor Cortex Harbinger of Action

PubMed Central

Pardo-Vazquez, Jose L.; Padron, Isabel; Fernandez-Rey, Jose; Acuña, Carlos

2011-01-01

Although the premotor (PM) cortex was once viewed as the substrate of pure motor functions, soon it was realized that it was involved in higher brain functions. By this it is meant that the PM cortex functions would better be explained as motor set, preparation for limb movement, or sensory guidance of movement rather than solely by a fixed link to motor performance. These findings, together with a better knowledge of the PM cortex histology and hodology in human and non-human primates prompted quantitative studies of this area combining behavioral tasks with electrophysiological recordings. In addition, the exploration of the PM cortex neurons with qualitative methods also suggested its participation in higher functions. Behavioral choices frequently depend on temporal cues, which together with knowledge of previous outcomes and expectancies are combined to decide and choose a behavioral action. In decision-making the knowledge about the consequences of decisions, either correct or incorrect, is fundamental because they can be used to adapt future behavior. The neuronal correlates of a decision process have been described in several cortical areas of primates. Among them, there is evidence that the monkey ventral premotor (PMv) cortex, an anatomical and physiological well-differentiated area of the PM cortex, supports both perceptual decisions and performance monitoring. Here we review the evidence that the steps in a decision-making process are encoded in the firing rate of the PMv neurons. This provides compelling evidence suggesting that the PMv is involved in the use of recent and long-term sensory memory to decide, execute, and evaluate the outcomes of the subjects’ choices. PMID:21991249

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Beri, A. C.; Doll, C. E.

1990-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process is activated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

Automation of orbit determination functions for National Aeronautics and Space Administration (NASA)-supported satellite missions

NASA Technical Reports Server (NTRS)

Mardirossian, H.; Heuerman, K.; Beri, A.; Samii, M. V.; Doll, C. E.

1989-01-01

The Flight Dynamics Facility (FDF) at Goddard Space Flight Center (GSFC) provides spacecraft trajectory determination for a wide variety of National Aeronautics and Space Administration (NASA)-supported satellite missions, using the Tracking Data Relay Satellite System (TDRSS) and Ground Spaceflight and Tracking Data Network (GSTDN). To take advantage of computerized decision making processes that can be used in spacecraft navigation, the Orbit Determination Automation System (ODAS) was designed, developed, and implemented as a prototype system to automate orbit determination (OD) and orbit quality assurance (QA) functions performed by orbit operations. Based on a machine-resident generic schedule and predetermined mission-dependent QA criteria, ODAS autonomously activates an interface with the existing trajectory determination system using a batch least-squares differential correction algorithm to perform the basic OD functions. The computational parameters determined during the OD are processed to make computerized decisions regarding QA, and a controlled recovery process isactivated when the criteria are not satisfied. The complete cycle is autonomous and continuous. ODAS was extensively tested for performance under conditions resembling actual operational conditions and found to be effective and reliable for extended autonomous OD. Details of the system structure and function are discussed, and test results are presented.

Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents1

PubMed Central

Silva, Kenya de Lima; Évora, Yolanda Dora Martinez; Cintra, Camila Santana Justo

2015-01-01

Objective: to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba. Method: a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development. Result: the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan. Conclusion: the development of this tool used to document the nursing actions will contribute to decision-making and quality of care. PMID:26487144

Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents.

PubMed

Silva, Kenya de Lima; Évora, Yolanda Dora Martinez; Cintra, Camila Santana Justo

2015-01-01

to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba. a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development. the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan. the development of this tool used to document the nursing actions will contribute to decision-making and quality of care.

Design and evaluation of a web-based decision support tool for district-level disease surveillance in a low-resource setting

PubMed Central

Pore, Meenal; Sengeh, David M.; Mugambi, Purity; Purswani, Nuri V.; Sesay, Tom; Arnold, Anna Lena; Tran, Anh-Minh A.; Myers, Ralph

2017-01-01

During the 2014 West African Ebola Virus outbreak it became apparent that the initial response to the outbreak was hampered by limitations in the collection, aggregation, analysis and use of data for intervention planning. As part of the post-Ebola recovery phase, IBM Research Africa partnered with the Port Loko District Health Management Team (DHMT) in Sierra Leone and GOAL Global, to design, implement and deploy a web-based decision support tool for district-level disease surveillance. This paper discusses the design process and the functionality of the first version of the system. The paper presents evaluation results prior to a pilot deployment and identifies features for future iterations. A qualitative assessment of the tool prior to pilot deployment indicates that it improves the timeliness and ease of using data for making decisions at the DHMT level. PMID:29854209

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

Methods Clinical guideline adherence for diagnostic imaging (DI) and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 DI orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. Results Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their DI order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their work flow, which dropped to 16% as physicians gained experience with the software. Conclusions Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine work flow. PMID:21486884

Warfighter Associate: Decision Aiding and Metrics for Mission Command

DTIC Science & Technology

2012-01-23

Distributions: highlights the Pareto Principle -- the top 20% of the mission-command staff is heavily involved in collaborations. • Our...developing “Command Web”, a web service to support thin- client functionality (Intelligent Presentation Services enables this) Thank you

An exploration of function analysis and function allocation in the commercial flight domain

NASA Technical Reports Server (NTRS)

Mcguire, James C.; Zich, John A.; Goins, Richard T.; Erickson, Jeffery B.; Dwyer, John P.; Cody, William J.; Rouse, William B.

1991-01-01

The applicability is explored of functional analysis methods to support cockpit design. Specifically, alternative techniques are studied for ensuring an effective division of responsibility between the flight crew and automation. A functional decomposition is performed of the commercial flight domain to provide the information necessary to support allocation decisions and demonstrate methodology for allocating functions to flight crew or to automation. The function analysis employed 'bottom up' and 'top down' analyses and demonstrated the comparability of identified functions, using the 'lift off' segment of the 'take off' phase as a test case. The normal flight mission and selected contingencies were addressed. Two alternative methods for using the functional description in the allocation of functions between man and machine were investigated. The two methods were compared in order to ascertain their relative strengths and weaknesses. Finally, conclusions were drawn regarding the practical utility of function analysis methods.

Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability.

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life. All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference. Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life. © 2017 John Wiley & Sons Ltd.

Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.

PubMed

Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra

2017-04-01

Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.

Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients

DTIC Science & Technology

2014-10-01

physical functioning, role- physical, role- emotional , bodily pain, pretreatment vitality, mental health, social functioning and general Downloaded from...SF-36 Scores:1 Physical functioning 55.2 ± 31 Role-physical 35.5 ± 44 Role- emotional 57.4 ±46 Bodily pain...on dual processing theory, which takes into account analytical as well as emotional , intuitive processes (see Appendix). Palliative Care versus

Why bother with the brain? A role for decision neuroscience in understanding strategic variability.

PubMed

Venkatraman, Vinod

2013-01-01

Neuroscience, by its nature, seems to hold considerable promise for understanding the fundamental mechanisms of decision making. In recent years, several studies in the domain of "neuroeconomics" or "decision neuroscience" have provided important insights into brain function. Yet, the apparent success and value of each of these domains are frequently called into question by researchers in economics and behavioral decision making. Critics often charge that knowledge about the brain is unnecessary for understanding decision preferences. In this chapter, I contend that knowledge about underlying brain mechanisms helps in the development of biologically plausible models of behavior, which can then help elucidate the mechanisms underlying individual choice biases and strategic preferences. Using a novel risky choice paradigm, I will demonstrate that people vary in whether they adopt compensatory or noncompensatory rules in economic decision making. Importantly, neuroimaging studies using functional magnetic resonance imaging reveal that distinct neural mechanisms support variability in choices and variability in strategic preferences. Converging evidence from a study involving decisions between hypothetical stocks illustrates how knowledge about the underlying mechanisms can help inform neuroanatomical models of cognitive control. Last, I will demonstrate how knowledge about these underlying neural mechanisms can provide novel insights into the effects of decision states like sleep deprivation on decision preferences. Together, these findings suggest that neuroscience can play a critical role in creating robust and flexible models of real-world decision behavior. Copyright © 2013 Elsevier B.V. All rights reserved.

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.

PubMed

Müller, M L; Ganslandt, T; Eich, H P; Lang, K; Ohmann, C; Prokosch, H U

2001-12-01

Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data. An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library. Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.

Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice.

PubMed

Trivedi, Madhukar H; Daly, Ella J

2007-05-01

Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the "next best" treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses.

Measurement-Based Care for Refractory Depression: A Clinical Decision Support Model for Clinical Research and Practice

PubMed Central

Trivedi, Madhukar H.; Daly, Ella J.

2009-01-01

Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the “next best” treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses. PMID:17320312

A functional difference in information processing between orbitofrontal cortex and ventral striatum during decision-making behaviour.

PubMed

Stott, Jeffrey J; Redish, A David

2014-11-05

Both orbitofrontal cortex (OFC) and ventral striatum (vStr) have been identified as key structures that represent information about value in decision-making tasks. However, the dynamics of how this information is processed are not yet understood. We recorded ensembles of cells from OFC and vStr in rats engaged in the spatial adjusting delay-discounting task, a decision-making task that involves a trade-off between delay to and magnitude of reward. Ventral striatal neural activity signalled information about reward before the rat's decision, whereas such reward-related signals were absent in OFC until after the animal had committed to its decision. These data support models in which vStr is directly involved in action selection, but OFC processes decision-related information afterwards that can be used to compare the predicted and actual consequences of behaviour. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Decision-making in geriatric oncology: systemic treatment considerations for older adults with colon cancer.

PubMed

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

2016-12-01

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

A Medical Decision Support System for the Space Station Health Maintenance Facility

PubMed Central

Ostler, David V.; Gardner, Reed M.; Logan, James S.

1988-01-01

NASA is developing a Health Maintenance Facility (HMF) to provide the equipment and supplies necessary to deliver medical care in the Space Station. An essential part of the Health Maintenance Facility is a computerized Medical Decision Support System (MDSS) that will enhance the ability of the medical officer (“paramedic” or “physician”) to maintain the crew's health, and to provide emergency medical care. The computer system has four major functions: 1) collect and integrate medical information into an electronic medical record from Space Station medical officers, HMF instrumentation, and exercise equipment; 2) provide an integrated medical record and medical reference information management system; 3) manage inventory for logistical support of supplies and secure pharmaceuticals; 4) supply audio and electronic mail communications between the medical officer and ground based flight surgeons. ImagesFigure 1

Facial attractiveness: evolutionary based research.

PubMed

Little, Anthony C; Jones, Benedict C; DeBruine, Lisa M

2011-06-12

Face preferences affect a diverse range of critical social outcomes, from mate choices and decisions about platonic relationships to hiring decisions and decisions about social exchange. Firstly, we review the facial characteristics that influence attractiveness judgements of faces (e.g. symmetry, sexually dimorphic shape cues, averageness, skin colour/texture and cues to personality) and then review several important sources of individual differences in face preferences (e.g. hormone levels and fertility, own attractiveness and personality, visual experience, familiarity and imprinting, social learning). The research relating to these issues highlights flexible, sophisticated systems that support and promote adaptive responses to faces that appear to function to maximize the benefits of both our mate choices and more general decisions about other types of social partners.

Facial attractiveness: evolutionary based research

PubMed Central

Little, Anthony C.; Jones, Benedict C.; DeBruine, Lisa M.

2011-01-01

Face preferences affect a diverse range of critical social outcomes, from mate choices and decisions about platonic relationships to hiring decisions and decisions about social exchange. Firstly, we review the facial characteristics that influence attractiveness judgements of faces (e.g. symmetry, sexually dimorphic shape cues, averageness, skin colour/texture and cues to personality) and then review several important sources of individual differences in face preferences (e.g. hormone levels and fertility, own attractiveness and personality, visual experience, familiarity and imprinting, social learning). The research relating to these issues highlights flexible, sophisticated systems that support and promote adaptive responses to faces that appear to function to maximize the benefits of both our mate choices and more general decisions about other types of social partners. PMID:21536551

A study on building data warehouse of hospital information system.

PubMed

Li, Ping; Wu, Tao; Chen, Mu; Zhou, Bin; Xu, Wei-guo

2011-08-01

Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system. To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information. Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making. This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.

SEA ARCHER Distributed Aviation Platform

DTIC Science & Technology

2001-12-01

manual processes, but should also improve decision support functions through advanced modeling and simulation. SEA ARCHER’s information architecture...this payload model was the SH-60 for which accurate weights were attained. Weights for the Marine STOVL version of the JSF were also attained, and

Older people. Rising SAP.

PubMed

Wilson, Keith

2003-07-10

Single assessment is a complex process involving a variety of agencies, professions and functions. A key decision will be about the development or purchase of a standard assessment tool. A single assessment process lead needs to be appointed with support from senior management in all relevant organisations.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

PubMed Central

Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-01-01

Objectives Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Design Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Setting Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Participants Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12). Results Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Conclusions Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. PMID:29654025

Towards a Decision Support Tool for 3d Visualisation: Application to Selectivity Purpose of Single Object in a 3d City Scene

NASA Astrophysics Data System (ADS)

Neuville, R.; Pouliot, J.; Poux, F.; Hallot, P.; De Rudder, L.; Billen, R.

2017-10-01

This paper deals with the establishment of a comprehensive methodological framework that defines 3D visualisation rules and its application in a decision support tool. Whilst the use of 3D models grows in many application fields, their visualisation remains challenging from the point of view of mapping and rendering aspects to be applied to suitability support the decision making process. Indeed, there exists a great number of 3D visualisation techniques but as far as we know, a decision support tool that facilitates the production of an efficient 3D visualisation is still missing. This is why a comprehensive methodological framework is proposed in order to build decision tables for specific data, tasks and contexts. Based on the second-order logic formalism, we define a set of functions and propositions among and between two collections of entities: on one hand static retinal variables (hue, size, shape…) and 3D environment parameters (directional lighting, shadow, haze…) and on the other hand their effect(s) regarding specific visual tasks. It enables to define 3D visualisation rules according to four categories: consequence, compatibility, potential incompatibility and incompatibility. In this paper, the application of the methodological framework is demonstrated for an urban visualisation at high density considering a specific set of entities. On the basis of our analysis and the results of many studies conducted in the 3D semiotics, which refers to the study of symbols and how they relay information, the truth values of propositions are determined. 3D visualisation rules are then extracted for the considered context and set of entities and are presented into a decision table with a colour coding. Finally, the decision table is implemented into a plugin developed with three.js, a cross-browser JavaScript library. The plugin consists of a sidebar and warning windows that help the designer in the use of a set of static retinal variables and 3D environment parameters.

Neural network modeling for surgical decisions on traumatic brain injury patients.

PubMed

Li, Y C; Liu, L; Chiu, W T; Jian, W S

2000-01-01

Computerized medical decision support systems have been a major research topic in recent years. Intelligent computer programs were implemented to aid physicians and other medical professionals in making difficult medical decisions. This report compares three different mathematical models for building a traumatic brain injury (TBI) medical decision support system (MDSS). These models were developed based on a large TBI patient database. This MDSS accepts a set of patient data such as the types of skull fracture, Glasgow Coma Scale (GCS), episode of convulsion and return the chance that a neurosurgeon would recommend an open-skull surgery for this patient. The three mathematical models described in this report including a logistic regression model, a multi-layer perceptron (MLP) neural network and a radial-basis-function (RBF) neural network. From the 12,640 patients selected from the database. A randomly drawn 9480 cases were used as the training group to develop/train our models. The other 3160 cases were in the validation group which we used to evaluate the performance of these models. We used sensitivity, specificity, areas under receiver-operating characteristics (ROC) curve and calibration curves as the indicator of how accurate these models are in predicting a neurosurgeon's decision on open-skull surgery. The results showed that, assuming equal importance of sensitivity and specificity, the logistic regression model had a (sensitivity, specificity) of (73%, 68%), compared to (80%, 80%) from the RBF model and (88%, 80%) from the MLP model. The resultant areas under ROC curve for logistic regression, RBF and MLP neural networks are 0.761, 0.880 and 0.897, respectively (P < 0.05). Among these models, the logistic regression has noticeably poorer calibration. This study demonstrated the feasibility of applying neural networks as the mechanism for TBI decision support systems based on clinical databases. The results also suggest that neural networks may be a better solution for complex, non-linear medical decision support systems than conventional statistical techniques such as logistic regression.

Design of a radiator shade for testing in a simulated lunar environment

NASA Technical Reports Server (NTRS)

Huff, Jaimi; Remington, Randy; Tang, Toan

1992-01-01

The National Aeronautics and Space Administration (NASA) and The Universities Space Research Association (USRA) have chosen the parabolic/catenary concept from their sponsored Fall 1991 lunar radiation shade project for further testing and development. NASA asked the design team to build a shading device and support structure for testing in a vacuum chamber. Besides the support structure for the catenary shading device, the design team was asked to develop a system for varying the shade shape so that the device can be tested at different focal lengths. The design team developed concept variants and combined the concept variants to form overall designs. Using a decision matrix, an overall design was selected by the team from several overall design alternatives. Concept variants were developed for three primary functions. The three functions were structural support, shape adjustments, and end shielding. The shade adjustment function was divided into two sub-functions, arc length adjustment, and width adjustment.

Challenges in building intelligent systems for space mission operations

NASA Technical Reports Server (NTRS)

Hartman, Wayne

1991-01-01

The purpose here is to provide a top-level look at the stewardship functions performed in space operations, and to identify the major issues and challenges that must be addressed to build intelligent systems that can realistically support operations functions. The focus is on decision support activities involving monitoring, state assessment, goal generation, plan generation, and plan execution. The bottom line is that problem solving in the space operations domain is a very complex process. A variety of knowledge constructs, representations, and reasoning processes are necessary to support effective human problem solving. Emulating these kinds of capabilities in intelligent systems offers major technical challenges that the artificial intelligence community is only beginning to address.

Development of the Supported Decision Making Inventory System.

PubMed

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support

PubMed Central

2010-01-01

Background Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. Method This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. Results EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. Discussion This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research. PMID:20920289

Integrating clinicians, knowledge and data: expert-based cooperative analysis in healthcare decision support.

PubMed

Gibert, Karina; García-Alonso, Carlos; Salvador-Carulla, Luis

2010-09-30

Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research.

A GIS-based generic real-time risk assessment framework and decision tools for chemical spills in the river basin.

PubMed

Jiang, Jiping; Wang, Peng; Lung, Wu-seng; Guo, Liang; Li, Mei

2012-08-15

This paper presents a generic framework and decision tools of real-time risk assessment on Emergency Environmental Decision Support System for response to chemical spills in river basin. The generic "4-step-3-model" framework is able to delineate the warning area and the impact on vulnerable receptors considering four types of hazards referring to functional area, societal impact, and human health and ecology system. Decision tools including the stand-alone system and software components were implemented on GIS platform. A detailed case study on the Songhua River nitrobenzene spill illustrated the goodness of the framework and tool Spill first responders and decision makers of catchment management will benefit from the rich, visual and dynamic hazard information output from the software. Copyright © 2012 Elsevier B.V. All rights reserved.

A Review of Consequences of Poverty on Economic Decision-Making: A Hypothesized Model of a Cognitive Mechanism

PubMed Central

Adamkovič, Matúš; Martončik, Marcel

2017-01-01

This review focuses on the issue of poverty affecting economic decision-making. By critically evaluating existing studies, the authors propose a structural model detailing the cognitive mechanism involved in how poverty negatively impacts economic decision-making, and explores evidence supporting the basis for the formation of this model. The suggested mechanism consists of a relationship between poverty and four other factors: (1) cognitive load (e.g., experiencing negative affect and stress); (2) executive functions (e.g., attention, working memory, and self-control); (3) intuition/deliberation in decision-making; and (4) economic decision-making (e.g., time-discounting and risk preference), with a final addition of financial literacy as a covariate. This paper focuses on shortfalls in published research, and delves further into the proposed model. PMID:29075221

A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function: design, development and proof of concept.

PubMed

Shemeikka, Tero; Bastholm-Rahmner, Pia; Elinder, Carl-Gustaf; Vég, Anikó; Törnqvist, Elisabeth; Cornelius, Birgitta; Korkmaz, Seher

2015-06-01

To develop and verify proof of concept for a clinical decision support system (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care. A pilot study in one geriatric clinic, one internal medicine admission ward and two outpatient healthcare centers was evaluated with a questionnaire focusing on the usefulness of the CDSS. The usage of the system was followed in a log. The CDSS is considered to increase the attention on patients with impaired renal function, provides a better understanding of dosing and is time saving. The calculated glomerular filtration rate (eGFR) and the dosing recommendation classification were perceived useful while the recommendation texts and background had been used to a lesser extent. Few previous systems are used in primary care and cover this number of drugs. The global assessment of the CDSS scored high but some elements were used to a limited extent possibly due to accessibility or that texts were considered difficult to absorb. Choosing a formula for the calculation of eGFR in a CDSS may be problematic. A real-time CDSS to support kidney-related drug prescribing in both hospital and outpatient settings is valuable to the physicians. It has the potential to improve quality of drug prescribing by increasing the attention on patients with renal insufficiency and the knowledge of their drug dosing. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A multicriteria decision analysis of augmentative treatment of upper limbs in persons with tetraplegia.

PubMed

Hummel, J M Marjan; Snoek, Govert J; van Til, Janine A; van Rossum, Wouter; Ijzerman, Maarten J

2005-01-01

This study supported the evaluation by a rehabilitation team of the performance of two treatment options that improve the arm-hand function in subjects with sixth cervical vertebra (C6) level Motor Group 2 tetraplegia. The analytic hierarchy process, a technique for multicriteria decision analysis, was used by a rehabilitation team and potential recipients to quantitatively compare a new technology, Functional Elec trical Stimulation (FES), with conventional surgery. Perform-ance was measured by functional improvement, treatment load, risks, user-friendliness, and social outcomes. Functional improvement after FES was considered better than that after conventional surgery. However, the rehabilitation team's overall rating for conventional surgery was slightly higher than that for FES (57% vs 44%). Compared with the rehabilitation team, potential recipients gave greater weight to burden of treatment and less weight to functional improvement. This study shows that evaluation of new technology must be more comprehensive than the evaluation of functional improvement alone, and that patient preferences may differ from those of the rehabilitation team.

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

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

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

Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

Qualitative study of patients’ decision-making when accepting second-line treatment after failure of first-line chemotherapy

PubMed Central

Roch, Benoît; Roth, Caroline; Mérel, Jean-Pierre

2018-01-01

Objective Treatment failures in advanced lung cancer are frequent events affecting patients during or after first-line chemotherapy. International guidelines recommend second-line chemotherapy. However, around one half of patients who experience disease progression enter a systemic second-line therapy. In the herein qualitative study, we investigated patients' thoughts and attitudes determining the decision to undergo a second-line chemotherapy. Methods Thirty-three purposively selected patients who recently accepted second-line or palliative chemotherapy were invited to participate in this survey consisting of semi-structured in-depth interviews. Grounded theory was applied to investigate participants’ perceptions of the context that have surrounded their decision to undergo palliative chemotherapy. Results For most patients, tumor burden and reduced quality of life in relation with lung cancer itself were major drivers of the decision-making process. There was a balance between two different attitudes: making a decision to undergo a new line of chemotherapy or starting a psychological process in order to accept end of life. Choosing between these two attitudes allowed the patient to keep the matter of palliative care at a distance. Even in case of low chance of success, many patients who worried about their life partner's future would accept a new chemotherapy line. Some patients experienced ambivalent thoughts regarding social network, particularly about their family as daily function impairment required an increased need for relative's support. The initial "Worrying about others" thoughts left place to in an increasing self-need of care as those provided by relatives; this phenomenon might increase patients' self- perception of being a burden for others. Confidence previously established with formal caregiver support was another major decision driver: some patients with sustained confidence in their medical staff may have privileged this formal support rather than family support when the latter was perceived as weak, insufficient or intrusive. Conclusion This study identified three domains involved into a complex interplay for lung cancer patients’ decision regarding second-line palliative chemotherapy: (i) perception of the definitive loss of health, (ii) interactions between idiosyncrasy (hope, disease burden) and environment (healthcare and social network support), and (iii) patient's subjective evaluation of chemotherapy benefit–risk. PMID:29799879

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

PubMed

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

1997-01-01

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

Future perspectives toward the early definition of a multivariate decision-support scheme employed in clinical decision making for senior citizens.

PubMed

Frantzidis, Christos A; Gilou, Sotiria; Billis, Antonis; Karagianni, Maria; Bratsas, Charalampos D; Bamidis, Panagiotis

2016-03-01

Recent neuroscientific studies focused on the identification of pathological neurophysiological patterns (emotions, geriatric depression, memory impairment and sleep disturbances) through computerised clinical decision-support systems. Almost all these research attempts employed either resting-state condition (e.g. eyes-closed) or event-related potentials extracted during a cognitive task known to be affected by the disease under consideration. This Letter reviews existing data mining techniques and aims to enhance their robustness by proposing a holistic decision framework dealing with comorbidities and early symptoms' identification, while it could be applied in realistic occasions. Multivariate features are elicited and fused in order to be compared with average activities characteristic of each neuropathology group. A proposed model of the specific cognitive function which may be based on previous findings (a priori information) and/or validated by current experimental data should be then formed. So, the proposed scheme facilitates the early identification and prevention of neurodegenerative phenomena. Neurophysiological semantic annotation is hypothesised to enhance the importance of the proposed framework in facilitating the personalised healthcare of the information society and medical informatics research community.

Identification of Relevant Costs in the Decision to Consolidate or Maintain Two Marine Corps Recruit Training Depots

DTIC Science & Technology

2015-06-01

Martial Arts Program MCRD Marine Corps Recruit Depot PCO Property Control Office PSC permanent change of station PSE personnel support...office supplies and materials required for the operations office to function. The Property Control Office ( PCO ) is another cost under the base...operations subcategory. PCO supports the Marines with non-deployable equipment. PCO Garrison Property, PSE, collateral equipment (CE) and food preparation

Current Capabilities, Issues, and Trends in LMSs and Authoring Tools

DTIC Science & Technology

2009-08-18

architecture  Embedded best-practice design principles  Support for immersive learning technologies  Support for social media 8 LMSs LMS Functionality is... Learning System Multimedia content Application demos VOIP Real-time Collaboration technologies from Adobe Connect Pro, WebEx, LiveMeeting, & Centra...ORGANIZATION NAME(S) AND ADDRESS(ES) Advanced Decision Learning (ADL),ADL Co-Lab,1901 N. Beauregard Street Suite 600,Alexandria,VA,22311 8

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS: PUBLISHED REPORT

EPA Science Inventory

NRMRL-CIN-1351A Hofstetter**, P., and Hammitt, J. K. Human Health Metrics for Environmental Decision Support Tools: Lessons from Health Economics and Decision Analysis. EPA/600/R-01/104 (NTIS PB2002-102119). Decision makers using environmental decision support tools are often ...

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

PubMed

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

Research Program Overview

Science.gov Websites

coordinates research in support of the PEER mission in performance-based earthquake engineering. The broad system dynamic response; assessment of the performance of the structural and nonstructural systems ; consequences in terms of casualties, capital costs, and post-earthquake functionality; and decision-making to

A Simplified Decision Support Approach for Evaluating Wetlands Ecosystem Services

EPA Science Inventory

We will be presenting a simplified approach to evaluating ecosystem services provided by freshwater wetlands restoration. Our approach is based on an existing functional assessment approach developed by Golet and Miller for the State of Rhode Island, and modified by Miller for ap...

Municipal Solid Waste - Sustainable Materials Management

EPA Science Inventory

The MSW DST was initially developed in the 1990s and has evolved over the years to better account for changes in waste management practices, waste composition, and improvements in decision support tool design and functionality. The most recent version of the tool is publicly ava...

Technological innovations in the development of cardiovascular clinical information systems.

PubMed

Hsieh, Nan-Chen; Chang, Chung-Yi; Lee, Kuo-Chen; Chen, Jeen-Chen; Chan, Chien-Hui

2012-04-01

Recent studies have shown that computerized clinical case management and decision support systems can be used to assist surgeons in the diagnosis of disease, optimize surgical operation, aid in drug therapy and decrease the cost of medical treatment. Therefore, medical informatics has become an extensive field of research and many of these approaches have demonstrated potential value for improving medical quality. The aim of this study was to develop a web-based cardiovascular clinical information system (CIS) based on innovative techniques, such as electronic medical records, electronic registries and automatic feature surveillance schemes, to provide effective tools and support for clinical care, decision-making, biomedical research and training activities. The CIS developed for this study contained monitoring, surveillance and model construction functions. The monitoring layer function provided a visual user interface. At the surveillance and model construction layers, we explored the application of model construction and intelligent prognosis to aid in making preoperative and postoperative predictions. With the use of the CIS, surgeons can provide reasonable conclusions and explanations in uncertain environments.

Thalamocortical and corticothalamic pathways differentially contribute to goal-directed behaviors in the rat

PubMed Central

Alcaraz, Fabien; Fresno, Virginie; Marchand, Alain R; Kremer, Eric J; Coutureau, Etienne

2018-01-01

Highly distributed neural circuits are thought to support adaptive decision-making in volatile and complex environments. Notably, the functional interactions between prefrontal and reciprocally connected thalamic nuclei areas may be important when choices are guided by current goal value or action-outcome contingency. We examined the functional involvement of selected thalamocortical and corticothalamic pathways connecting the dorsomedial prefrontal cortex (dmPFC) and the mediodorsal thalamus (MD) in the behaving rat. Using a chemogenetic approach to inhibit projection-defined dmPFC and MD neurons during an instrumental learning task, we show that thalamocortical and corticothalamic pathways differentially support goal attributes. Both pathways participate in adaptation to the current goal value, but only thalamocortical neurons are required to integrate current causal relationships. These data indicate that antiparallel flow of information within thalamocortical circuits may convey qualitatively distinct aspects of adaptive decision-making and highlight the importance of the direction of information flow within neural circuits. PMID:29405119

A usability study of CPOE's medication administration functions: impact on physician-nurse cooperation.

PubMed

Beuscart-Zéphir, Marie Catherine; Pelayo, Sylvia; Degoulet, Patrice; Anceaux, Françoise; Guerlinger, Sandra; Meaux, Jean-Jacques

2004-01-01

Implementation of CPOE systems in Healthcare Institutions has proven efficient in reducing medication errors but it also induces hidden side-effects on Doctor-Nurse cooperation. We propose a usability engineering approach to this problem. An extensive activity analysis of the medication ordering and administration process was performed in several departments of 3 different hospitals. Two of these hospitals are still using paper-based orders, while the 3rd one is in the roll-out phase of medication functions of its CPOE system. We performed a usability assessment of this CPOE system. The usability assessment uncovered usability problems for the entry of medication administration time scheduling by the physician and revealed that the information can be ambiguous for the nurse. The comparison of cooperation models in both situation shows that users tend to adopt a distributed decision making paradigm in the paper-based situation, while the CPOE system supports a centralized decision making process. This analysis can support recommendation for the re-engineering of the Human-Computer Interface.

Preserving the Finger Lakes for the Future: A Prototype Decision Support System for Water Resource Management, Open Space, and Agricultural Protection

NASA Technical Reports Server (NTRS)

Brower, Robert

2004-01-01

This report summarizes the activity conducted under NASA Grant NAG13-02059 entitled "Preserving the Finger Lakes for the Future" A Prototype Decision Support System for Water Resources Management, Open Space and Agricultural Protection, for the period of September 26, 2003 to September 25, 2004. The RACNE continues to utilize the services of its affiliate, the Institute for the Application of Geospatial Technology at Cayuga Community College, Inc. (IAGT), for the purposes of this project under its permanent operating agreement with IAGT. IAGT is a 501(c)(3) not-for-profit Corporation created by the RACNE for the purpose of carrying out its programmatic and administrative mission. The "Preserving the Finger Lakes for the Future" project has progressed and evolved as planned, with the continuation or initiation of a number of program facets at programmatic, technical, and inter-agency levels. The project has grown, starting with the well received core concept of the Virtual Management Operations Center (VMOC), to the functional Watershed Virtual Management Operations Center (W-VMOC) prototype, to the more advanced Finger Lakes Decision Support System (FLDSS) prototype, deployed for evaluation and assessment to a wide variety of agencies and organizations in the Finger Lakes region and beyond. This suite of tools offers the advanced, compelling functionality of interactive 3D visualization interfaced with 2D mapping, all accessed via Internet or virtually any kind of distributed computer network.

On the design of computer-based models for integrated environmental science.

PubMed

McIntosh, Brian S; Jeffrey, Paul; Lemon, Mark; Winder, Nick

2005-06-01

The current research agenda in environmental science is dominated by calls to integrate science and policy to better understand and manage links between social (human) and natural (nonhuman) processes. Freshwater resource management is one area where such calls can be heard. Designing computer-based models for integrated environmental science poses special challenges to the research community. At present it is not clear whether such tools, or their outputs, receive much practical policy or planning application. It is argued that this is a result of (1) a lack of appreciation within the research modeling community of the characteristics of different decision-making processes including policy, planning, and (2) participation, (3) a lack of appreciation of the characteristics of different decision-making contexts, (4) the technical difficulties in implementing the necessary support tool functionality, and (5) the socio-technical demands of designing tools to be of practical use. This article presents a critical synthesis of ideas from each of these areas and interprets them in terms of design requirements for computer-based models being developed to provide scientific information support for policy and planning. Illustrative examples are given from the field of freshwater resources management. Although computer-based diagramming and modeling tools can facilitate processes of dialogue, they lack adequate simulation capabilities. Component-based models and modeling frameworks provide such functionality and may be suited to supporting problematic or messy decision contexts. However, significant technical (implementation) and socio-technical (use) challenges need to be addressed before such ambition can be realized.

Predictive models for subtypes of autism spectrum disorder based on single-nucleotide polymorphisms and magnetic resonance imaging.

PubMed

Jiao, Y; Chen, R; Ke, X; Cheng, L; Chu, K; Lu, Z; Herskovits, E H

2011-01-01

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, of which Asperger syndrome and high-functioning autism are subtypes. Our goal is: 1) to determine whether a diagnostic model based on single-nucleotide polymorphisms (SNPs), brain regional thickness measurements, or brain regional volume measurements can distinguish Asperger syndrome from high-functioning autism; and 2) to compare the SNP, thickness, and volume-based diagnostic models. Our study included 18 children with ASD: 13 subjects with high-functioning autism and 5 subjects with Asperger syndrome. For each child, we obtained 25 SNPs for 8 ASD-related genes; we also computed regional cortical thicknesses and volumes for 66 brain structures, based on structural magnetic resonance (MR) examination. To generate diagnostic models, we employed five machine-learning techniques: decision stump, alternating decision trees, multi-class alternating decision trees, logistic model trees, and support vector machines. For SNP-based classification, three decision-tree-based models performed better than the other two machine-learning models. The performance metrics for three decision-tree-based models were similar: decision stump was modestly better than the other two methods, with accuracy = 90%, sensitivity = 0.95 and specificity = 0.75. All thickness and volume-based diagnostic models performed poorly. The SNP-based diagnostic models were superior to those based on thickness and volume. For SNP-based classification, rs878960 in GABRB3 (gamma-aminobutyric acid A receptor, beta 3) was selected by all tree-based models. Our analysis demonstrated that SNP-based classification was more accurate than morphometry-based classification in ASD subtype classification. Also, we found that one SNP--rs878960 in GABRB3--distinguishes Asperger syndrome from high-functioning autism.

The modulatory influence of the functional COMT Val158Met polymorphism on lexical decisions and semantic priming.

PubMed

Reuter, Martin; Montag, Christian; Peters, Kristina; Kocher, Anne; Kiefer, Markus

2009-01-01

The role of the prefrontal Cortex (PFC) in higher cognitive functions - including working memory, conflict resolution, set shifting and semantic processing - has been demonstrated unequivocally. Despite the great heterogeneity among tasks measuring these phenotypes, due in part to the different cognitive sub-processes implied and the specificity of the stimulus material used, there is agreement that all of these tasks recruit an executive control system located in the PFC. On a biochemical level it is known that the dopaminergic system plays an important role in executive control functions. Evidence comes from molecular genetics relating the functional COMT Val158Met polymorphism to working memory and set shifting. In order determine whether this pattern of findings generalises to linguistic and semantic processing, we investigated the effects of the COMT Val158Met polymorphism in lexical decision making using masked and unmasked versions of the semantic priming paradigm on N = 104 healthy subjects. Although we observed strong priming effects in all conditions (masked priming, unmasked priming with short/long stimulus asynchronies (SOAs), direct and indirect priming), COMT was not significantly related to priming, suggesting no reliable influence on semantic processing. However, COMT Val158Met was strongly associated with lexical decision latencies in all priming conditions if considered separately, explaining between 9 and 14.5% of the variance. Therefore, the findings indicate that COMT mainly influences more general executive control functions in the PFC supporting the speed of lexical decisions.

IDESSA: An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas

NASA Astrophysics Data System (ADS)

Meyer, Hanna; Authmann, Christian; Dreber, Niels; Hess, Bastian; Kellner, Klaus; Morgenthal, Theunis; Nauss, Thomas; Seeger, Bernhard; Tsvuura, Zivanai; Wiegand, Kerstin

2017-04-01

Bush encroachment is a syndrome of land degradation that occurs in many savannas including those of southern Africa. The increase in density, cover or biomass of woody vegetation often has negative effects on a range of ecosystem functions and services, which are hardly reversible. However, despite its importance, neither the causes of bush encroachment, nor the consequences of different resource management strategies to combat or mitigate related shifts in savanna states are fully understood. The project "IDESSA" (An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas) aims to improve the understanding of the complex interplays between land use, climate patterns and vegetation dynamics and to implement an integrative monitoring and decision-support system for the sustainable management of different savanna types. For this purpose, IDESSA follows an innovative approach that integrates local knowledge, botanical surveys, remote-sensing and machine-learning based time-series of atmospheric and land-cover dynamics, spatially explicit simulation modeling and analytical database management. The integration of the heterogeneous data will be implemented in a user oriented database infrastructure and scientific workflow system. Accessible via web-based interfaces, this database and analysis system will allow scientists to manage and analyze monitoring data and scenario computations, as well as allow stakeholders (e. g. land users, policy makers) to retrieve current ecosystem information and seasonal outlooks. We present the concept of the project and show preliminary results of the realization steps towards the integrative savanna management and decision-support system.

SANDS: an architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Transforming user needs into functional requirements for an antibiotic clinical decision support system: explicating content analysis for system design.

PubMed

Bright, T J

2013-01-01

Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). THE APPROACH CONSISTED OF FIVE STEPS: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing needs. As a reusable approach, these techniques can be refined and applied to resolve unmet information needs with informatics interventions in additional domains.

Transforming User Needs into Functional Requirements for an Antibiotic Clinical Decision Support System

PubMed Central

Bright, T.J.

2013-01-01

Summary Background Many informatics studies use content analysis to generate functional requirements for system development. Explication of this translational process from qualitative data to functional requirements can strengthen the understanding and scientific rigor when applying content analysis in informatics studies. Objective To describe a user-centered approach transforming emergent themes derived from focus group data into functional requirements for informatics solutions and to illustrate these methods to the development of an antibiotic clinical decision support system (CDS). Methods The approach consisted of five steps: 1) identify unmet therapeutic planning information needs via Focus Group Study-I, 2) develop a coding framework of therapeutic planning themes to refine the domain scope to antibiotic therapeutic planning, 3) identify functional requirements of an antibiotic CDS system via Focus Group Study-II, 4) discover informatics solutions and functional requirements from coded data, and 5) determine the types of information needed to support the antibiotic CDS system and link with the identified informatics solutions and functional requirements. Results The coding framework for Focus Group Study-I revealed unmet therapeutic planning needs. Twelve subthemes emerged and were clustered into four themes; analysis indicated a need for an antibiotic CDS intervention. Focus Group Study-II included five types of information needs. Comments from the Barrier/Challenge to information access and Function/Feature themes produced three informatics solutions and 13 functional requirements of an antibiotic CDS system. Comments from the Patient, Institution, and Domain themes generated required data elements for each informatics solution. Conclusion This study presents one example explicating content analysis of focus group data and the analysis process to functional requirements from narrative data. Illustration of this 5-step method was used to develop an antibiotic CDS system, resolving unmet antibiotic prescribing needs. As a reusable approach, these techniques can be refined and applied to resolve unmet information needs with informatics interventions in additional domains. PMID:24454586

Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study.

PubMed

Semenic, Sonia; Edwards, Nancy; Premji, Shahirose; Olson, Joanne; Williams, Beverly; Montgomery, Phyllis

2015-03-31

Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada. Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2. Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications. Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

A decision support tool for synchronizing technology advances with strategic mission objectives

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda S.; Willoughby, John K.

1992-01-01

Successful accomplishment of the objectives of many long-range future missions in areas such as space systems, land-use planning, and natural resource management requires significant technology developments. This paper describes the development of a decision-support data-derived tool called MisTec for helping strategic planners to determine technology development alternatives and to synchronize the technology development schedules with the performance schedules of future long-term missions. Special attention is given to the operations, concept, design, and functional capabilities of the MisTec. The MisTec was initially designed for manned Mars mission, but can be adapted to support other high-technology long-range strategic planning situations, making it possible for a mission analyst, planner, or manager to describe a mission scenario, determine the technology alternatives for making the mission achievable, and to plan the R&D activity necessary to achieve the required technology advances.

Toward a Multilingual, Experiential Environment for Learning Decision Technology.

ERIC Educational Resources Information Center

Yeo, Gee Kin; Tan, Seng Teen

1999-01-01

Describes work at the National University of Singapore on the Internet in expanding a simulation game used in supporting a course in decision technology. Topics include decision support systems, multilingual support for cross-cultural decision studies, process support in a World Wide Web-enhanced multiuser domain (MUD) learning environment, and…

Maintenance and operations decision support tool : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

Weather affects almost all maintenance activity decisions. The Federal Highway Administration (FHWA) tested a new decision support system for maintenance in Iowa, Indiana, and Illinois called the Maintenance and Operations Decision Support System (MO...

Decision Support System for an efficient irrigation water management in semi arid environment

NASA Astrophysics Data System (ADS)

Khan, M. A.; Islam, M.; Hafeez, M. M.; Flugel, W. A.

2009-12-01

A significant increase in agricultural productivity over the last few decades has protected the world from episodes of hunger and food shortages. Water management in irrigated agriculture was instrumental in achieving those gains. Water resources are under high pressure due to rapid population growth and increased competition among various sectors. Access to reliable data on water availability, quantity and quality can provide the necessary foundation for sound management of water resources. There are many traditional methods for matching water demand and supply, however imbalances between demand and supply remain inevitable. It is possible to reduce the imbalances considerably through development of appropriate irrigation water management tool that take into account various factors such as soil type, irrigation water supply, and crop water demand. All components of water balance need to be understood and quantified for efficient and sustainable management of water resources. Application of an intelligent Decision Support System (DSS) is becoming significant. A DSS incorporates knowledge and expertise within the decision support framework. It is an integrated set of data, functions, models and other relevant information that efficiently processes input data, simulates models and displays the results in a user friendly format. It helps in decision-making process, to analyse the problem and explore various scenarios to make the most appropriate decision for water management. This paper deals with the Coleambally Irrigation Area (CIA) located in Murrumbidgee catchment, NSW, Australia. An Integrated River Information System called Coleambally IRIS has been developed to improve the irrigation water management ranging from farm to sub-system and system level. It is a web-based information management system with a focus on time series and geospatial hydrological, climatic and remote sensing data including land cover class, surface temperature, soil moisture, Normalized Difference Vegetation Index (NDVI), Leaf Area Index (LAI) and Evapotranspiration (ET). Coleambally IRIS provides user friendly environment for data input and output, and an adaptable set of functions for data analysis, management and decision making to develops strategies for sustainable irrigation water management. Coleambally IRIS is used to assist the managers of irrigation service provider and the farmers in their decision making by providing relevant information over the web. The developed DSS has been practically used in managing irrigation water under the current drought conditions. The DSS will be further extended for forecasting irrigation water demand in the future.

Design Recommendations for Pharmacogenomics Clinical Decision Support Systems

PubMed Central

Khelifi, Maher; Tarczy-Hornoch, Peter; Devine, Emily B.; Pratt, Wanda

2017-01-01

The use of pharmacogenomics (PGx) in clinical practice still faces challenges to fully adopt genetic information in targeting drug therapy. To incorporate genetics into clinical practice, many support the use of Pharmacogenomics Clinical Decision Support Systems (PGx-CDS) for medication prescriptions. This support was fueled by new guidelines to incorporate genetics for optimizing drug dosage and reducing adverse events. In addition, the complexity of PGx led to exploring CDS outside the paradigm of the basic CDS tools embedded in commercial electronic health records. Therefore, designing the right CDS is key to unleashing the full potential of pharmacogenomics and making it a part of clinicians’ daily workflow. In this work, we 1) identify challenges and barriers of the implementation of PGx-CDS in clinical settings, 2) develop a new design approach to CDS with functional characteristics that can improve the adoption of pharmacogenomics guidelines and thus patient safety, and 3) create design guidelines and recommendations for such PGx-CDS tools. PMID:28815136

Design of decision support interventions for medication prescribing.

PubMed

Horsky, Jan; Phansalkar, Shobha; Desai, Amrita; Bell, Douglas; Middleton, Blackford

2013-06-01

Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety. Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. Although HCI and usability principles are well established and robust, CDS and EHR system interfaces rarely conform to the best known design conventions and are seldom conceived and designed well enough to be truly versatile and dependable tools. These relatively novel interventions still require careful monitoring, research and analysis of its track record to mature. Clarity and specificity of alert content and optimal perceptual and cognitive attributes, for example, are essential for providing effective decision support to clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

PubMed

Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

SLUDGE TREATMENT PROJECT KOP CONCEPTUAL DESIGN CONTROL DECISION REPORT

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

CARRO CA

2010-03-09

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

Development of safety performance functions and other decision support tools to assess pedestrian and bicycle safety : final report.

DOT National Transportation Integrated Search

2016-09-30

field study was performed at 40 uncontrolled midblock crosswalks and 26 signalized intersections on low-speed roadways selected from the areas surrounding three major urban college campuses across lower Michigan. An array of existing traffic control ...

SUSTAINABILITY AND ITS IMPACT ON SOLID WASTE MANAGEMENT

EPA Science Inventory

The MSW DST was initially developed in the 1990s and has evolved over the years to better account for changes in waste management practices, waste composition, and improvements in decision support tool design and functionality. The most recent version of the tool is publicly ava...

WATERSHED HEALTH ASSESSMENT TOOLS-INVESTIGATING FISHERIES (WHAT-IF): A MODELING TOOLKIT FOR WATERSHED AND FISHERIES MANAGEMENT

EPA Science Inventory

The Watershed Health Assessment Tools-Investigating Fisheries (WHAT-IF) is a decision-analysis modeling toolkit for personal computers that supports watershed and fisheries management. The WHAT-IF toolkit includes a relational database, help-system functions and documentation, a...

Assessing Multi-scale Reptile and Amphibian Biodiversity: Mojave Ecoregion Case Study

EPA Science Inventory

The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions to maintain the sustainable nature of our environment now and into the future. Because of the variability among living orga...

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

[Quantitative measures for assessing the functional state of the human body during diagnostic procedure].

PubMed

Artemenko, M V

2008-01-01

Two approaches to calculation of the qualitative measures for assessing the functional state level of human body are considered. These approaches are based on image and fuzzy set recognition theories and are used to construct diagnostic decision rules. The first approach uses the data on deviation of detected parameters from those for healthy persons; the second approach analyzes the degree of deviation of detected parameters from the approximants characterizing the correlation differences between the parameters. A method for synthesis of decision rules and the results of blood count-based research for a number of diseases (hemophilia, thrombocytopathy, hypertension, arrhythmia, hepatic cirrhosis, trichophytia) are considered. An effect of a change in the functional link between the cholesterol content in blood and the relative rate of variation of AST and ALT enzymes in blood from direct proportional (healthy state) to inverse proportional (hepatic cirrhosis) is discussed. It is shown that analysis of correlation changes in detected parameters of the human body state during diagnostic process is more effective for application in decision support systems than the state space analysis.

A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation.

PubMed

van der Krieke, Lian; Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-10-07

Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

Identifying Functional Requirements for Flexible Airspace Management Concept Using Human-In-The-Loop Simulations

NASA Technical Reports Server (NTRS)

Lee, Paul U.; Bender, Kim; Pagan, Danielle

2011-01-01

Flexible Airspace Management (FAM) is a mid- term Next Generation Air Transportation System (NextGen) concept that allows dynamic changes to airspace configurations to meet the changes in the traffic demand. A series of human-in-the-loop (HITL) studies have identified procedures and decision support requirements needed to implement FAM. This paper outlines a suggested FAM procedure and associated decision support functionality based on these HITL studies. A description of both the tools used to support the HITLs and the planned NextGen technologies available in the mid-term are presented and compared. The mid-term implementation of several NextGen capabilities, specifically, upgrades to the Traffic Management Unit (TMU), the initial release of an en route automation system, the deployment of a digital data communication system, a more flexible voice communications network, and the introduction of a tool envisioned to manage and coordinate networked ground systems can support the implementation of the FAM concept. Because of the variability in the overall deployment schedule of the mid-term NextGen capabilities, the dependency of the individual NextGen capabilities are examined to determine their impact on a mid-term implementation of FAM. A cursory review of the different technologies suggests that new functionality slated for the new en route automation system is a critical enabling technology for FAM, as well as the functionality to manage and coordinate networked ground systems. Upgrades to the TMU are less critical but important nonetheless for FAM to be fully realized. Flexible voice communications network and digital data communication system could allow more flexible FAM operations but they are not as essential.

How Reasoning, Judgment, and Decision Making are Colored by Gist-based Intuition: A Fuzzy-Trace Theory Approach

PubMed Central

Corbin, Jonathan C.; Reyna, Valerie F.; Weldon, Rebecca B.; Brainerd, Charles J.

2015-01-01

Fuzzy-trace theory distinguishes verbatim (literal, exact) from gist (meaningful) representations, predicting that reliance on gist increases with experience and expertise. Thus, many judgment-and-decision-making biases increase with development, such that cognition is colored by context in ways that violate logical coherence and probability theories. Nevertheless, this increase in gist-based intuition is adaptive: Gist is stable, less sensitive to interference, and easier to manipulate. Moreover, gist captures the functionally significant essence of information, supporting healthier and more robust decision processes. We describe how fuzzy-trace theory accounts for judgment-and-decision making phenomena, predicting the paradoxical arc of these processes with the development of experience and expertise. We present data linking gist memory processes to gist processing in decision making and provide illustrations of gist reliance in medicine, public health, and intelligence analysis. PMID:26664820

How Reasoning, Judgment, and Decision Making are Colored by Gist-based Intuition: A Fuzzy-Trace Theory Approach.

PubMed

Corbin, Jonathan C; Reyna, Valerie F; Weldon, Rebecca B; Brainerd, Charles J

2015-12-01

Fuzzy-trace theory distinguishes verbatim (literal, exact) from gist (meaningful) representations, predicting that reliance on gist increases with experience and expertise. Thus, many judgment-and-decision-making biases increase with development, such that cognition is colored by context in ways that violate logical coherence and probability theories. Nevertheless, this increase in gist-based intuition is adaptive: Gist is stable, less sensitive to interference, and easier to manipulate. Moreover, gist captures the functionally significant essence of information, supporting healthier and more robust decision processes. We describe how fuzzy-trace theory accounts for judgment-and-decision making phenomena, predicting the paradoxical arc of these processes with the development of experience and expertise. We present data linking gist memory processes to gist processing in decision making and provide illustrations of gist reliance in medicine, public health, and intelligence analysis.

An integrated decision support system for diagnosing and managing patients with community-acquired pneumonia.

PubMed Central

Aronsky, D.; Haug, P. J.

1999-01-01

Decision support systems that integrate guidelines have become popular applications to reduce variation and deliver cost-effective care. However, adverse characteristics of decision support systems, such as additional and time-consuming data entry or manually identifying eligible patients, result in a "behavioral bottleneck" that prevents decision support systems to become part of the clinical routine. This paper describes the design and the implementation of an integrated decision support system that explores a novel approach for bypassing the behavioral bottleneck. The real-time decision support system does not require health care providers to enter additional data and consists of a diagnostic and a management component. Images Fig. 1 Fig. 2 Fig. 3 PMID:10566348

Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

USGS Publications Warehouse

Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.

2016-01-01

Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.

Incorporating ecosystem function concept in environmental planning and decision making by means of multi-criteria evaluation: the case-study of Kalloni, Lesbos, Greece.

PubMed

Oikonomou, Vera; Dimitrakopoulos, Panayiotis G; Troumbis, Andreas Y

2011-01-01

Nature provides life-support services which do not merely constitute the basis for ecosystem integrity but also benefit human societies. The importance of such multiple outputs is often ignored or underestimated in environmental planning and decision making. The economic valuation of ecosystem functions or services has been widely used to make these benefits economically visible and thus address this deficiency. Alternatively, the relative importance of the components of ecosystem value can be identified and compared by means of multi-criteria evaluation. Hereupon, this article proposes a conceptual framework that couples ecosystem function analysis, multi criteria evaluation and social research methodologies for introducing an ecosystem function-based planning and management approach. The framework consists of five steps providing the structure of a participative decision making process which is then tested and ratified, by applying the discrete multi-criteria method NAIADE, in the Kalloni Natura 2000 site, on Lesbos, Greece. Three scenarios were developed and evaluated with regard to their impacts on the different types of ecosystem functions and the social actors' value judgements. A conflict analysis permitted the better elaboration of the different views, outlining the coalitions formed in the local community and shaping the way towards reaching a consensus.

Incorporating Ecosystem Function Concept in Environmental Planning and Decision Making by Means of Multi-Criteria Evaluation: The Case-Study of Kalloni, Lesbos, Greece

NASA Astrophysics Data System (ADS)

Oikonomou, Vera; Dimitrakopoulos, Panayiotis G.; Troumbis, Andreas Y.

2011-01-01

Nature provides life-support services which do not merely constitute the basis for ecosystem integrity but also benefit human societies. The importance of such multiple outputs is often ignored or underestimated in environmental planning and decision making. The economic valuation of ecosystem functions or services has been widely used to make these benefits economically visible and thus address this deficiency. Alternatively, the relative importance of the components of ecosystem value can be identified and compared by means of multi-criteria evaluation. Hereupon, this article proposes a conceptual framework that couples ecosystem function analysis, multi criteria evaluation and social research methodologies for introducing an ecosystem function-based planning and management approach. The framework consists of five steps providing the structure of a participative decision making process which is then tested and ratified, by applying the discrete multi-criteria method NAIADE, in the Kalloni Natura 2000 site, on Lesbos, Greece. Three scenarios were developed and evaluated with regard to their impacts on the different types of ecosystem functions and the social actors' value judgements. A conflict analysis permitted the better elaboration of the different views, outlining the coalitions formed in the local community and shaping the way towards reaching a consensus.

“The problem often is that we do not have a family spokesperson but a spokesgroup”: Family Member Informal Roles in End-of-Life Decision-Making in Adult ICUs

PubMed Central

Quinn, Jill R.; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A.; Dombeck, Mary T.; Sellers, Craig R.

2013-01-01

Background To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process. Objective The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs). Methods Ethnographic study. Data were collected via participant observation with field notes and semi-structured interviews on four ICUs in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical ICU, a surgical ICU, a burn and trauma ICU, and a cardiovascular ICU. Participants Participants included health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were:, Primary Caregiver, Primary Decision Maker, Family Spokesperson, Out-of-Towner, Patient Wishes Expert, Protector, Vulnerable Member, and Health Care Expert. The identified informal roles were part of family decision making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision-making within the family system, and between the family and health care domains. Conclusions These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these family member informal roles can assist clinicians to recognize and understand the functions of these roles in family decision making at the end-of-life, and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes. PMID:22210699

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Development of a decision support system for analysis and solutions of prolonged standing in the workplace.

PubMed

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-06-01

Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially.

Development of a Decision Support System for Analysis and Solutions of Prolonged Standing in the Workplace

PubMed Central

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-01-01

Background Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. Methods The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Results Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. Conclusion The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially. PMID:25180141

Data book: Space station/base food system study. Book 3: Study selection rationale sheets

NASA Technical Reports Server (NTRS)

1970-01-01

The supporting rationale sheets are presented which were utilized in the selection and support of the concepts considered in the final phase of the study. Each concept, conceived to fulfill a specific function of the food system, was assessed in terms of the eight critical factors depicted on the rationale sheet. When weighted and totaled, the resulting selection factor was used as a guide in making the final decision.

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Decision Support for Ecosystem Management (Chapter 28)

Treesearch

Keith Reynolds; Jennifer Bjork; Rachel Riemann Hershey; Dan Schmoldt; John Payne; Susan King; Lee DeCola; Mark J. Twery; Pat Cunningham

1999-01-01

This chapter presents a management perspective on decision support for ecosystem management.The Introduction provides a brief historical overview of decision support technology as it has been used in natural resource management, discusses the role of decision support in ecosystem management as we see it, and summarizes the current state of the technology.

Chimpanzees and Bonobos Exhibit Emotional Responses to Decision Outcomes

PubMed Central

Rosati, Alexandra G.; Hare, Brian

2013-01-01

The interface between cognition, emotion, and motivation is thought to be of central importance in understanding complex cognitive functions such as decision-making and executive control in humans. Although nonhuman apes have complex repertoires of emotional expression, little is known about the role of affective processes in ape decision-making. To illuminate the evolutionary origins of human-like patterns of choice, we investigated decision-making in humans' closest phylogenetic relatives, chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). In two studies, we examined these species' temporal and risk preferences, and assessed whether apes show emotional and motivational responses in decision-making contexts. We find that (1) chimpanzees are more patient and more risk-prone than are bonobos, (2) both species exhibit affective and motivational responses following the outcomes of their decisions, and (3) some emotional and motivational responses map onto species-level and individual-differences in decision-making. These results indicate that apes do exhibit emotional responses to decision-making, like humans. We explore the hypothesis that affective and motivational biases may underlie the psychological mechanisms supporting value-based preferences in these species. PMID:23734175

Optimal crop selection and water allocation under limited water supply in irrigation

NASA Astrophysics Data System (ADS)

Stange, Peter; Grießbach, Ulrike; Schütze, Niels

2015-04-01

Due to climate change, extreme weather conditions such as droughts may have an increasing impact on irrigated agriculture. To cope with limited water resources in irrigation systems, a new decision support framework is developed which focuses on an integrated management of both irrigation water supply and demand at the same time. For modeling the regional water demand, local (and site-specific) water demand functions are used which are derived from optimized agronomic response on farms scale. To account for climate variability the agronomic response is represented by stochastic crop water production functions (SCWPF). These functions take into account different soil types, crops and stochastically generated climate scenarios. The SCWPF's are used to compute the water demand considering different conditions, e.g., variable and fixed costs. This generic approach enables the consideration of both multiple crops at farm scale as well as of the aggregated response to water pricing at a regional scale for full and deficit irrigation systems. Within the SAPHIR (SAxonian Platform for High Performance IRrigation) project a prototype of a decision support system is developed which helps to evaluate combined water supply and demand management policies.

A Neuropsychological Approach to Understanding Risk-Taking for Potential Gains and Losses

PubMed Central

Levin, Irwin P.; Xue, Gui; Weller, Joshua A.; Reimann, Martin; Lauriola, Marco; Bechara, Antoine

2012-01-01

Affective neuroscience has helped guide research and theory development in judgment and decision-making by revealing the role of emotional processes in choice behavior, especially when risk is involved. Evidence is emerging that qualitatively and quantitatively different processes may be involved in risky decision-making for gains and losses. We start by reviewing behavioral work by Kahneman and Tversky (1979) and others, which shows that risk-taking differs for potential gains and potential losses. We then turn to the literature in decision neuroscience to support the gain versus loss distinction. Relying in part on data from a new task that separates risky decision-making for gains and losses, we test a neural model that assigns unique mechanisms for risky decision-making involving potential losses. Included are studies using patients with lesions to brain areas specified as important in the model and studies with healthy individuals whose brains are scanned to reveal activation in these and other areas during risky decision-making. In some cases, there is evidence that gains and losses are processed in different regions of the brain, while in other cases the same region appears to process risk in a different manner for gains and losses. At a more general level, we provide strong support for the notion that decisions involving risk-taking for gains and decisions involving risk-taking for losses represent different psychological processes. At a deeper level, we present mounting evidence that different neural structures play different roles in guiding risky choices in these different domains. Some structures are differentially activated by risky gains and risky losses while others respond uniquely in one domain or the other. Taken together, these studies support a clear functional dissociation between risk-taking for gains and risk-taking for losses, and further dissociation at the neural level. PMID:22347161

SANDS: a service-oriented architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2008-12-01

In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:

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.

Logistics support economy and efficiency through consolidation and automation

NASA Technical Reports Server (NTRS)

Savage, G. R.; Fontana, C. J.; Custer, J. D.

1985-01-01

An integrated logistics support system, which would provide routine access to space and be cost-competitive as an operational space transportation system, was planned and implemented to support the NSTS program launch-on-time goal of 95 percent. A decision was made to centralize the Shuttle logistics functions in a modern facility that would provide office and training space and an efficient warehouse area. In this warehouse, the emphasis is on automation of the storage and retrieval function, while utilizing state-of-the-art warehousing and inventory management technology. This consolidation, together with the automation capabilities being provided, will allow for more effective utilization of personnel and improved responsiveness. In addition, this facility will be the prime support for the fully integrated logistics support of the operations era NSTS and reduce the program's management, procurement, transportation, and supply costs in the operations era.

A task-based support architecture for developing point-of-care clinical decision support systems for the emergency department.

PubMed

Wilk, S; Michalowski, W; O'Sullivan, D; Farion, K; Sayyad-Shirabad, J; Kuziemsky, C; Kukawka, B

2013-01-01

The purpose of this study was to create a task-based support architecture for developing clinical decision support systems (CDSSs) that assist physicians in making decisions at the point-of-care in the emergency department (ED). The backbone of the proposed architecture was established by a task-based emergency workflow model for a patient-physician encounter. The architecture was designed according to an agent-oriented paradigm. Specifically, we used the O-MaSE (Organization-based Multi-agent System Engineering) method that allows for iterative translation of functional requirements into architectural components (e.g., agents). The agent-oriented paradigm was extended with ontology-driven design to implement ontological models representing knowledge required by specific agents to operate. The task-based architecture allows for the creation of a CDSS that is aligned with the task-based emergency workflow model. It facilitates decoupling of executable components (agents) from embedded domain knowledge (ontological models), thus supporting their interoperability, sharing, and reuse. The generic architecture was implemented as a pilot system, MET3-AE--a CDSS to help with the management of pediatric asthma exacerbation in the ED. The system was evaluated in a hospital ED. The architecture allows for the creation of a CDSS that integrates support for all tasks from the task-based emergency workflow model, and interacts with hospital information systems. Proposed architecture also allows for reusing and sharing system components and knowledge across disease-specific CDSSs.

The role of medial prefrontal cortex in memory and decision making.

PubMed

Euston, David R; Gruber, Aaron J; McNaughton, Bruce L

2012-12-20

Some have claimed that the medial prefrontal cortex (mPFC) mediates decision making. Others suggest mPFC is selectively involved in the retrieval of remote long-term memory. Yet others suggests mPFC supports memory and consolidation on time scales ranging from seconds to days. How can all these roles be reconciled? We propose that the function of the mPFC is to learn associations between context, locations, events, and corresponding adaptive responses, particularly emotional responses. Thus, the ubiquitous involvement of mPFC in both memory and decision making may be due to the fact that almost all such tasks entail the ability to recall the best action or emotional response to specific events in a particular place and time. An interaction between multiple memory systems may explain the changing importance of mPFC to different types of memories over time. In particular, mPFC likely relies on the hippocampus to support rapid learning and memory consolidation. Copyright © 2012 Elsevier Inc. All rights reserved.

Using ecosystem services in decision-making to support sustainable development: Critiques, model development, a case study, and perspectives.

PubMed

Zagonari, Fabio

2016-04-01

In this paper, I propose a general, consistent, and operational approach that accounts for ecosystem services in a decision-making context: I link ecosystem services to sustainable development criteria; adopt multi-criteria analysis to measure ecosystem services, with weights provided by stakeholders used to account for equity issues; apply both temporal and spatial discount rates; and adopt a technique to order performance of the possible solutions based on their similarity to an ideal solution (TOPSIS) to account for uncertainty about the parameters and functions. Applying this approach in a case study of an offshore research platform in Italy (CNR Acqua Alta) revealed that decisions depend non-linearly on the degree of loss aversion, to a smaller extent on a global focus (as opposed to a local focus), and to the smallest extent on social concerns (as opposed to economic or environmental concerns). Application of the general model to the case study leads to the conclusion that the ecosystem services framework is likely to be less useful in supporting decisions than in identifying the crucial features on which decisions depend, unless experts from different disciplines are involved, stakeholders are represented, and experts and stakeholders achieve mutual understanding. Copyright © 2016 Elsevier B.V. All rights reserved.

A novel decision-making process for tooth retention or extraction.

PubMed

Avila, Gustavo; Galindo-Moreno, Pablo; Soehren, Stephen; Misch, Carl E; Morelli, Thiago; Wang, Hom-Lay

2009-03-01

Implant-supported restorations have become the most popular therapeutic option for professionals and patients for the treatment of total and partial edentulism. When implants are placed in an ideal position, with adequate prosthetic loading and proper maintenance, they can have success rates >90% over 15 years of function. Implants may be considered a better therapeutic alternative than performing more extensive conservative procedures in an attempt to save or maintain a compromised tooth. Inadequate indication for tooth extraction has resulted in the sacrifice of many sound savable teeth. This article presents a chart that can assist clinicians in making the right decision when they are deciding which route to take. Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed. Book sources were also searched. Individual tooth- and patient-related features were thoroughly analyzed, particularly when determining if a tooth should be indicated for extraction. A color-based decision-making chart with six different levels, including several factors, was developed based upon available scientific literature. The rationale for including these factors is provided, and its interpretation is justified with literature support. The decision-making chart provided may serve as a reference guide for dentists when making the decision to save or extract a compromised tooth.

Using Cognitive Work Analysis to Fit Decision Support Tools to Nurse Managers’ Work Flow

PubMed Central

Brewer, Barbara B.; Logue, Melanie D.; Gephart, Sheila; Verran, Joyce A.

2011-01-01

Purpose To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager’s work domain. Methods Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in 3 Arizona hospitals. The WDA described the nurse manager’s environment in terms of the constraints it imposes on the nurse manager’s ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. Results The results highlight the competing priorities, and external and internal constraints that today’s nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering “what if” questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogenous sample and the reliance on interview data targeting safety and quality. PMID:21862397

Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

PubMed

Effken, Judith A; Brewer, Barbara B; Logue, Melanie D; Gephart, Sheila M; Verran, Joyce A

2011-10-01

To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain. Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering "what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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

Cells, circuits, and choices: social influences on perceptual decision making.

PubMed

Mojzisch, Andreas; Krug, Kristine

2008-12-01

Making decisions is an integral part of everyday life. Social psychologists have demonstrated in many studies that humans' decisions are frequently and strongly influenced by the opinions of others--even in simple perceptual decisions, where, for example, participants have to judge what an image looks like. However, because the effect of other people's opinions on decision making has remained largely unaddressed by the neuroimaging and neurophysiology literature, we are only beginning to understand how social influence is integrated into the decision-making process. We put forward the thesis that by probing the neurophysiology of social influence with perceptual decision-making tasks similar to those used in the seminal work of Asch (1952, 1956), this gap could be remedied. Perceptual paradigms are already widely used to probe neuronal mechanisms of decision making in nonhuman primates. There is also increasing evidence about how nonhuman primates' behavior is influenced by observing conspecifics. The high spatial and temporal resolution of neurophysiological recordings in awake monkeys could provide insight into where and how social influence modulates decision making, and thus should enable us to develop detailed functional models of the neural mechanisms that support the integration of social influence into the decision-making process.

THE USE OF SCENARIO ANALYSIS TO ASSESS LANDSCAPE CHANGE ON WATERSHED CONDITION IN THE PACKIFIC NORTHWEST (USA)

EPA Science Inventory

The ability to assess, report, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions which will maintain the sustainable nature of our environmental services and secure these resources into the future. Scenario ana...

Defining ecohydrological function to support low impact development in coastal South Carolina

Treesearch

Daniel Hitchcock; A.D. Jayakaran; T. H. Epps; J.A. Palazzolo; T.M. Williams; D.M. Amatya

2016-01-01

In the face of dual pressures in coastal South Carolina - residential and commercial development, along with potential climate change impacts - stakeholders need clear, accurate, relevant, and easily-accessible information for effective decision-making for watershed management and natural resource protection.

Data Mining and Knowledge Management in Higher Education -Potential Applications.

ERIC Educational Resources Information Center

Luan, Jing

This paper introduces a new decision support tool, data mining, in the context of knowledge management. The most striking features of data mining techniques are clustering and prediction. The clustering aspect of data mining offers comprehensive characteristics analysis of students, while the predicting function estimates the likelihood for a…

Microbial load monitor

NASA Technical Reports Server (NTRS)

Holen, J. T.; Royer, E. R.

1976-01-01

A card configuration which combines the functions of identification, enumeration and antibiotic sensitivity into one card was developed. An instrument package was designed around the card to integrate the card filling, incubation reading, computation and decision making process into one compact unit. Support equipment was also designed to prepare the expandable material used in the MLM.

Measuring research progress in photovoltaics

NASA Technical Reports Server (NTRS)

Jackson, B.; Mcguire, P.

1986-01-01

The role and some results of the project analysis and integration function in the Flat-plate Solar Array (FSA) Project are presented. Activities included supporting the decision-making process, preparation of plans for project direction, setting goals for project activities, measuring progress within the project, and the development and maintenance of analytical models.

The Foundations and Evolution of Institutional Research

ERIC Educational Resources Information Center

Volkwein, J. Fredericks

2008-01-01

What is institutional research (IR)? One of the most widely definition of the institutional research is by Joe Saupe, who emphasized institutional research as a set of activities that support institutional planning, policy formation, and decision making. Institutional researchers and IR functions are embedded in the offices of strategic planning,…

Toward the Modularization of Decision Support Systems

NASA Astrophysics Data System (ADS)

Raskin, R. G.

2009-12-01

Decision support systems are typically developed entirely from scratch without the use of modular components. This “stovepiped” approach is inefficient and costly because it prevents a developer from leveraging the data, models, tools, and services of other developers. Even when a decision support component is made available, it is difficult to know what problem it solves, how it relates to other components, or even that the component exists, The Spatial Decision Support (SDS) Consortium was formed in 2008 to organize the body of knowledge in SDS within a common portal. The portal identifies the canonical steps in the decision process and enables decision support components to be registered, categorized, and searched. This presentation describes how a decision support system can be assembled from modular models, data, tools and services, based on the needs of the Earth science application.

Use of volunteers' information to support proactive inspection of hydraulic structures

NASA Astrophysics Data System (ADS)

Cortes Arevalo, Juliette; Sterlacchini, Simone; Bogaard, Thom; Frigerio, Simone; Junier, Sandra; Schenato, Luca; van den Giesen, Nick

2016-04-01

Proactive management is particularly important to deal with the increasing occurrence of hydro-meteorological hazards in mountain areas were threats are often caused by multiple and sudden onset hazards such as debris flows. Citizen volunteers can be involved in supporting technicians on inspecting the structures' functional status. Such collaborative effort between managing organizations and local volunteers becomes more important under limited resources. To consider volunteers' information in support of proactive inspection of hydraulic structures, we developed a methodology applicable in day-to-day risk management. At first, in collaboration with technicians-in-charge, a data collection approach was developed for first level or pre-screening visual inspections that can be performed by volunteers. Methods comprise of a data collection exercise, an inspection forms and a learning session based on existent procedures in the FVG region and neighbouring regions. To systematically evaluate the individual inspection reports, we designed a support method by means of a multi-criteria method with fuzzy terms. The method allows the technicians-in-charge to categorize the reports in one of three levels, each corresponding with a course of action. To facilitate the evaluation of inspection reports, we transformed the decision support method into a prototype Web-GIS application. The design process of the Web-GIS framework followed a user-centred approach. The conceptual design incorporates four modules for managing the inspection reports: 1) Registered users, 2) Inspection planning; 3) Available reports and 4) Evaluation of reports. The development of the prototype focused on the evaluation module and was implemented based on standard and interoperable open source tools. Finally, we organized a workshop with technicians in the study area to test the decision support method and get insights about the usefulness of the Web-GIS framework. Participants that took part of the workshop included technicians that were not involved in previous research activities. The involvement of new technicians was important due to their fresh perspectives. We looked at the effect of the quality of the input reports on the output of the decision support method. In addition, we compared the differences in the participants' advice during the inspection and the output from the decision support method. Participants' feedback led to a set of suggested improvements in the decision support method and the web-GIS application. We hope that the knowledge, theory and concept behind this decision support method can be developed into a full-scale web-GIS application. The advantage of using this decision support method is that it allows inspections to be carried out by either skilled volunteers or technicians while ensuring technicians-in-charge that they can systematically evaluate the collected reports. Volunteers can become skilled inspectors by teaming up with technicians for the inspection of hydraulic structures. Technicians can become more aware about local impacts and changes in the structures' status by teaming up with volunteers.

Development of a decision analytic model to support decision making and risk communication about thrombolytic treatment.

PubMed

McMeekin, Peter; Flynn, Darren; Ford, Gary A; Rodgers, Helen; Gray, Jo; Thomson, Richard G

2015-11-11

Individualised prediction of outcomes can support clinical and shared decision making. This paper describes the building of such a model to predict outcomes with and without intravenous thrombolysis treatment following ischaemic stroke. A decision analytic model (DAM) was constructed to establish the likely balance of benefits and risks of treating acute ischaemic stroke with thrombolysis. Probability of independence, (modified Rankin score mRS ≤ 2), dependence (mRS 3 to 5) and death at three months post-stroke was based on a calibrated version of the Stroke-Thrombolytic Predictive Instrument using data from routinely treated stroke patients in the Safe Implementation of Treatments in Stroke (SITS-UK) registry. Predictions in untreated patients were validated using data from the Virtual International Stroke Trials Archive (VISTA). The probability of symptomatic intracerebral haemorrhage in treated patients was incorporated using a scoring model from Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) data. The model predicts probabilities of haemorrhage, death, independence and dependence at 3-months, with and without thrombolysis, as a function of 13 patient characteristics. Calibration (and inclusion of additional predictors) of the Stroke-Thrombolytic Predictive Instrument (S-TPI) addressed issues of under and over prediction. Validation with VISTA data confirmed that assumptions about treatment effect were just. The C-statistics for independence and death in treated patients in the DAM were 0.793 and 0.771 respectively, and 0.776 for independence in untreated patients from VISTA. We have produced a DAM that provides an estimation of the likely benefits and risks of thrombolysis for individual patients, which has subsequently been embedded in a computerised decision aid to support better decision-making and informed consent.

Development of a Framework Based on Reflective MCDA to Support Patient-Clinician Shared Decision-Making: The Case of the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the United States.

PubMed

Wagner, Monika; Samaha, Dima; Khoury, Hanane; O'Neil, William M; Lavoie, Louis; Bennetts, Liga; Badgley, Danielle; Gabriel, Sylvie; Berthon, Anthony; Dolan, James; Kulke, Matthew H; Goetghebeur, Mireille

2018-01-01

Well- or moderately differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are often slow-growing, and some patients with unresectable, asymptomatic, non-functioning tumors may face the choice between watchful waiting (WW), or somatostatin analogues (SSA) to delay progression. We developed a comprehensive multi-criteria decision analysis (MCDA) framework to help patients and physicians clarify their values and preferences, consider each decision criterion, and support communication and shared decision-making. The framework was adapted from a generic MCDA framework (EVIDEM) with patient and clinician input. During a workshop, patients and clinicians expressed their individual values and preferences (criteria weights) and, on the basis of two scenarios (treatment vs WW; SSA-1 [lanreotide] vs SSA-2 [octreotide]) with evidence from a literature review, expressed how consideration of each criterion would impact their decision in favor of either option (score), and shared their knowledge and insights verbally and in writing. The framework included benefit-risk criteria and modulating factors, such as disease severity, quality of evidence, costs, and constraints. Overall and progression-free survival being most important, criteria weights ranged widely, highlighting variations in individual values and the need to share them. Scoring and considering each criterion prompted a rich exchange of perspectives and uncovered individual assumptions and interpretations. At the group level, type of benefit, disease severity, effectiveness, and quality of evidence favored treatment; cost aspects favored WW (scenario 1). For scenario 2, most criteria did not favor either option. Patients and clinicians consider many aspects in decision-making. The MCDA framework provided a common interpretive frame to structure this complexity, support individual reflection, and share perspectives. Ipsen Pharma.

Episodic Future Thinking: Mechanisms and Functions.

PubMed

Schacter, Daniel L; Benoit, Roland G; Szpunar, Karl K

2017-10-01

Episodic future thinking refers to the capacity to imagine or simulate experiences that might occur in one's personal future. Cognitive, neuropsychological, and neuroimaging research concerning episodic future thinking has accelerated during recent years. This article discusses research that has delineated cognitive and neural mechanisms that support episodic future thinking as well as the functions that episodic future thinking serves. Studies focused on mechanisms have identified a core brain network that underlies episodic future thinking and have begun to tease apart the relative contributions of particular regions in this network, and the specific cognitive processes that they support. Studies concerned with functions have identified several domains in which episodic future thinking produces performance benefits, including decision making, emotion regulation, prospective memory, and spatial navigation.

A robust optimisation approach to the problem of supplier selection and allocation in outsourcing

NASA Astrophysics Data System (ADS)

Fu, Yelin; Keung Lai, Kin; Liang, Liang

2016-03-01

We formulate the supplier selection and allocation problem in outsourcing under an uncertain environment as a stochastic programming problem. Both the decision-maker's attitude towards risk and the penalty parameters for demand deviation are considered in the objective function. A service level agreement, upper bound for each selected supplier's allocation and the number of selected suppliers are considered as constraints. A novel robust optimisation approach is employed to solve this problem under different economic situations. Illustrative examples are presented with managerial implications highlighted to support decision-making.

Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

This systematic review sought to assess the applications and implications of current medical informatics-based decision support systems related to medication prescribing and use. Studies published between January 2006 and July 2016 which were indexed in PubMed and written in English were reviewed, and 39 studies were ultimately included. Most of the studies looked at computerized provider order entry or clinical decision support systems. Most studies examined decision support systems as a means of reducing errors or risk, particularly associated with medication prescribing, whereas a few studies evaluated the impact medical informatics-based decision support systems have on workflow or operations efficiency. Most studies identified benefits associated with decision support systems, but some indicate there is room for improvement.

Development of a model-based flood emergency management system in Yujiang River Basin, South China

NASA Astrophysics Data System (ADS)

Zeng, Yong; Cai, Yanpeng; Jia, Peng; Mao, Jiansu

2014-06-01

Flooding is the most frequent disaster in China. It affects people's lives and properties, causing considerable economic loss. Flood forecast and operation of reservoirs are important in flood emergency management. Although great progress has been achieved in flood forecast and reservoir operation through using computer, network technology, and geographic information system technology in China, the prediction accuracy of models are not satisfactory due to the unavailability of real-time monitoring data. Also, real-time flood control scenario analysis is not effective in many regions and can seldom provide online decision support function. In this research, a decision support system for real-time flood forecasting in Yujiang River Basin, South China (DSS-YRB) is introduced in this paper. This system is based on hydrological and hydraulic mathematical models. The conceptual framework and detailed components of the proposed DSS-YRB is illustrated, which employs real-time rainfall data conversion, model-driven hydrologic forecasting, model calibration, data assimilation methods, and reservoir operational scenario analysis. Multi-tiered architecture offers great flexibility, portability, reusability, and reliability. The applied case study results show the development and application of a decision support system for real-time flood forecasting and operation is beneficial for flood control.

An integrative model for in-silico clinical-genomics discovery science.

PubMed

Lussier, Yves A; Sarkar, Indra Nell; Cantor, Michael

2002-01-01

Human Genome discovery research has set the pace for Post-Genomic Discovery Research. While post-genomic fields focused at the molecular level are intensively pursued, little effort is being deployed in the later stages of molecular medicine discovery research, such as clinical-genomics. The objective of this study is to demonstrate the relevance and significance of integrating mainstream clinical informatics decision support systems to current bioinformatics genomic discovery science. This paper is a feasibility study of an original model enabling novel "in-silico" clinical-genomic discovery science and that demonstrates its feasibility. This model is designed to mediate queries among clinical and genomic knowledge bases with relevant bioinformatic analytic tools (e.g. gene clustering). Briefly, trait-disease-gene relationships were successfully illustrated using QMR, OMIM, SNOMED-RT, GeneCluster and TreeView. The analyses were visualized as two-dimensional dendrograms of clinical observations clustered around genes. To our knowledge, this is the first study using knowledge bases of clinical decision support systems for genomic discovery. Although this study is a proof of principle, it provides a framework for the development of clinical decision-support-system driven, high-throughput clinical-genomic technologies which could potentially unveil significant high-level functions of genes.

A GIS-based decision support system for regional eco-security assessment and its application on the Tibetan Plateau.

PubMed

Xiaodan, Wang; Xianghao, Zhong; Pan, Gao

2010-10-01

Regional eco-security assessment is an intricate, challenging task. In previous studies, the integration of eco-environmental models and geographical information systems (GIS) usually takes two approaches: loose coupling and tight coupling. However, the present study used a full coupling approach to develop a GIS-based regional eco-security assessment decision support system (ESDSS). This was achieved by merging the pressure-state-response (PSR) model and the analytic hierarchy process (AHP) into ArcGIS 9 as a dynamic link library (DLL) using ArcObjects in ArcGIS and Visual Basic for Applications. Such an approach makes it easy to capitalize on the GIS visualization and spatial analysis functions, thereby significantly supporting the dynamic estimation of regional eco-security. A case study is presented for the Tibetan Plateau, known as the world's "third pole" after the Arctic and Antarctic. Results verified the usefulness and feasibility of the developed method. As a useful tool, the ESDSS can also help local managers to make scientifically-based and effective decisions about Tibetan eco-environmental protection and land use. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Modern data-driven decision support systems: the role of computing with words and computational linguistics

NASA Astrophysics Data System (ADS)

Kacprzyk, Janusz; Zadrożny, Sławomir

2010-05-01

We present how the conceptually and numerically simple concept of a fuzzy linguistic database summary can be a very powerful tool for gaining much insight into the very essence of data. The use of linguistic summaries provides tools for the verbalisation of data analysis (mining) results which, in addition to the more commonly used visualisation, e.g. via a graphical user interface, can contribute to an increased human consistency and ease of use, notably for supporting decision makers via the data-driven decision support system paradigm. Two new relevant aspects of the analysis are also outlined which were first initiated by the authors. First, following Kacprzyk and Zadrożny, it is further considered how linguistic data summarisation is closely related to some types of solutions used in natural language generation (NLG). This can make it possible to use more and more effective and efficient tools and techniques developed in NLG. Second, similar remarks are given on relations to systemic functional linguistics. Moreover, following Kacprzyk and Zadrożny, comments are given on an extremely relevant aspect of scalability of linguistic summarisation of data, using a new concept of a conceptual scalability.

How to guide - transit operations decision support systems (TODSS).

DOT National Transportation Integrated Search

2014-12-01

Transit Operations Decision Support Systems (TODSS) are decision support systems designed to support dispatchers in real-time bus operations management in response to incidents, special events, and other changing conditions in order to restore servic...

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.

CorRECTreatment: A Web-based Decision Support Tool for Rectal Cancer Treatment that Uses the Analytic Hierarchy Process and Decision Tree

PubMed Central

Karakülah, G.; Dicle, O.; Sökmen, S.; Çelikoğlu, C.C.

2015-01-01

Summary Background The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians’ decision making. Objective The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. Methods The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. Results In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. Conclusions The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options. PMID:25848413

CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

PubMed

Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

2015-01-01

The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

Energy Decision Science and Informatics | Integrated Energy Solutions |

Science.gov Websites

Science Advanced decision science methods include multi-objective and multi-criteria decision support. Our decision science methods, including multi-objective and multi-criteria decision support. For example, we

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed

Martinez, Kathryn A; Resnicow, Ken; Williams, Geoffrey C; Silva, Marlene; Abrahamse, Paul; Shumway, Dean A; Wallner, Lauren P; Katz, Steven J; Hawley, Sarah T

2016-12-01

Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed Central

Resnicow, Ken; Williams, Geoffrey C.; Silva, Marlene; Abrahamse, Paul; Shumway, Dean; Wallner, Lauren; Katz, Steven; Hawley, Sarah

2016-01-01

Objective Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Methods Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Results Among the 1,690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Conclusion Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Practice Implications Autonomy-supportive communication by cancer doctors can improve patients’ perceived decision quality. PMID:27395750

The design and implementation of urban earthquake disaster loss evaluation and emergency response decision support systems based on GIS

NASA Astrophysics Data System (ADS)

Yang, Kun; Xu, Quan-li; Peng, Shuang-yun; Cao, Yan-bo

2008-10-01

Based on the necessity analysis of GIS applications in earthquake disaster prevention, this paper has deeply discussed the spatial integration scheme of urban earthquake disaster loss evaluation models and visualization technologies by using the network development methods such as COM/DCOM, ActiveX and ASP, as well as the spatial database development methods such as OO4O and ArcSDE based on ArcGIS software packages. Meanwhile, according to Software Engineering principles, a solution of Urban Earthquake Emergency Response Decision Support Systems based on GIS technologies have also been proposed, which include the systems logical structures, the technical routes,the system realization methods and function structures etc. Finally, the testing systems user interfaces have also been offered in the paper.

Adaptive Peircean decision aid project summary assessments.

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

Senglaub, Michael E.

2007-01-01

This efforts objective was to identify and hybridize a suite of technologies enabling the development of predictive decision aids for use principally in combat environments but also in any complex information terrain. The technologies required included formal concept analysis for knowledge representation and information operations, Peircean reasoning to support hypothesis generation, Mill's's canons to begin defining information operators that support the first two technologies and co-evolutionary game theory to provide the environment/domain to assess predictions from the reasoning engines. The intended application domain is the IED problem because of its inherent evolutionary nature. While a fully functioning integrated algorithm wasmore » not achieved the hybridization and demonstration of the technologies was accomplished and demonstration of utility provided for a number of ancillary queries.« less

Cross-sectoral optimization and visualization of transformation processes in urban water infrastructures in rural areas.

PubMed

Baron, S; Kaufmann Alves, I; Schmitt, T G; Schöffel, S; Schwank, J

2015-01-01

Predicted demographic, climatic and socio-economic changes will require adaptations of existing water supply and wastewater disposal systems. Especially in rural areas, these new challenges will affect the functionality of the present systems. This paper presents a joint interdisciplinary research project with the objective of developing an innovative software-based optimization and decision support system for the implementation of long-term transformations of existing infrastructures of water supply, wastewater and energy. The concept of the decision support and optimization tool is described and visualization methods for the presentation of results are illustrated. The model is tested in a rural case study region in the Southwest of Germany. A transformation strategy for a decentralized wastewater treatment concept and its visualization are presented for a model village.

Decision support environment for medical product safety surveillance.

PubMed

Botsis, Taxiarchis; Jankosky, Christopher; Arya, Deepa; Kreimeyer, Kory; Foster, Matthew; Pandey, Abhishek; Wang, Wei; Zhang, Guangfan; Forshee, Richard; Goud, Ravi; Menschik, David; Walderhaug, Mark; Woo, Emily Jane; Scott, John

2016-12-01

We have developed a Decision Support Environment (DSE) for medical experts at the US Food and Drug Administration (FDA). The DSE contains two integrated systems: The Event-based Text-mining of Health Electronic Records (ETHER) and the Pattern-based and Advanced Network Analyzer for Clinical Evaluation and Assessment (PANACEA). These systems assist medical experts in reviewing reports submitted to the Vaccine Adverse Event Reporting System (VAERS) and the FDA Adverse Event Reporting System (FAERS). In this manuscript, we describe the DSE architecture and key functionalities, and examine its potential contributions to the signal management process by focusing on four use cases: the identification of missing cases from a case series, the identification of duplicate case reports, retrieving cases for a case series analysis, and community detection for signal identification and characterization. Published by Elsevier Inc.

[Evaluation of the capacity of elderly patients to make decisions about their health].

PubMed

Atienza-Martín, F J; Garrido-Lozano, M; Losada-Ruiz, C; Rodríguez-Fernández, L M; Revuelta-Pérez, F; Marín-Andrés, G

2013-09-01

To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P <.0001) and function intellectual intact (OR: 282.750, 95% CI 34.0 to 2351.2, P <.0001). Numeric variables associated with the capacity for decision-making that had a more important effect size were the Barthel index (d: -1.398) and Pfeiffer index (d: 3.084). The prevalence of incapacity to make decisions about their health in elderly patients who are cared for in their homes is high. The level of dependence in activities of daily living and the deterioration of intellectual function are factors associated with the presence of this capacity. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Space applications of Automation, Robotics and Machine Intelligence Systems (ARAMIS). Volume 2: Space projects overview

NASA Technical Reports Server (NTRS)

Miller, R. H.; Minsky, M. L.; Smith, D. B. S.

1982-01-01

Applications of automation, robotics, and machine intelligence systems (ARAMIS) to space activities, and their related ground support functions are studied so that informed decisions can be made on which aspects of ARAMIS to develop. The space project breakdowns, which are used to identify tasks ('functional elements'), are described. The study method concentrates on the production of a matrix relating space project tasks to pieces of ARAMIS.

Designing an Interactive Local and Global Decision Support System for Aircraft Carrier Deck Scheduling

DTIC Science & Technology

2011-03-01

These two elements again address the local and global perspectives of functionality. Upon schedule request, the Variable Ranking Tool ( VRT ) in...Figure 1 enlarges, moves to the interior of the screen, and becomes actionable (Figure 5 provides an enlarged view of the VRT , Figure 6 shows how the...full display is rearranged). The VRT addresses global properties through the handling of groups of entities in the system. Globally, functional

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

PubMed

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

2016-11-01

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

Cancer multidisciplinary team meetings in practice: Results from a multi-institutional quantitative survey and implications for policy change.

PubMed

Rankin, Nicole M; Lai, Michelle; Miller, Danielle; Beale, Philip; Spigelman, Allan; Prest, Gabrielle; Turley, Kim; Simes, John

2018-02-01

Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics. Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence. © 2017 John Wiley & Sons Australia, Ltd.

"Usability of data integration and visualization software for multidisciplinary pediatric intensive care: a human factors approach to assessing technology".

PubMed

Lin, Ying Ling; Guerguerian, Anne-Marie; Tomasi, Jessica; Laussen, Peter; Trbovich, Patricia

2017-08-14

Intensive care clinicians use several sources of data in order to inform decision-making. We set out to evaluate a new interactive data integration platform called T3™ made available for pediatric intensive care. Three primary functions are supported: tracking of physiologic signals, displaying trajectory, and triggering decisions, by highlighting data or estimating risk of patient instability. We designed a human factors study to identify interface usability issues, to measure ease of use, and to describe interface features that may enable or hinder clinical tasks. Twenty-two participants, consisting of bedside intensive care physicians, nurses, and respiratory therapists, tested the T3™ interface in a simulation laboratory setting. Twenty tasks were performed with a true-to-setting, fully functional, prototype, populated with physiological and therapeutic intervention patient data. Primary data visualization was time series and secondary visualizations were: 1) shading out-of-target values, 2) mini-trends with exaggerated maxima and minima (sparklines), and 3) bar graph of a 16-parameter indicator. Task completion was video recorded and assessed using a use error rating scale. Usability issues were classified in the context of task and type of clinician. A severity rating scale was used to rate potential clinical impact of usability issues. Time series supported tracking a single parameter but partially supported determining patient trajectory using multiple parameters. Visual pattern overload was observed with multiple parameter data streams. Automated data processing using shading and sparklines was often ignored but the 16-parameter data reduction algorithm, displayed as a persistent bar graph, was visually intuitive. However, by selecting or automatically processing data, triggering aids distorted the raw data that clinicians use regularly. Consequently, clinicians could not rely on new data representations because they did not know how they were established or derived. Usability issues, observed through contextual use, provided directions for tangible design improvements of data integration software that may lessen use errors and promote safe use. Data-driven decision making can benefit from iterative interface redesign involving clinician-users in simulated environments. This study is a first step in understanding how software can support clinicians' decision making with integrated continuous monitoring data. Importantly, testing of similar platforms by all the different disciplines who may become clinician users is a fundamental step necessary to understand the impact on clinical outcomes of decision aids.

Shaping the Future Landscape: Catchment Systems Engineering and the Decision Support Matrix Approach

NASA Astrophysics Data System (ADS)

Hewett, Caspar; Quinn, Paul; Wilkinson, Mark; Wainwright, John

2017-04-01

Land degradation is widely recognised as one of the great environmental challenges facing humanity today, much of which is directly associated with human activity. The negative impacts of climate change and of the way in which we have engineered the landscape through, for example, agriculture intensification and deforestation, need to be addressed. However, the answer is not a simple matter of doing the opposite of current practice. Nor is non-intervention a viable option. There is a need to bring together approaches from the natural and social sciences both to understand the issues and to act to solve real problems. We propose combining a Catchment Systems Engineering (CSE) approach that builds on existing approaches such as Natural Water Retention Measures, Green infrastructure and Nature-Based Solutions with a multi-scale framework for decision support that has been successfully applied to diffuse pollution and flood risk management. The CSE philosophy follows that of Earth Systems Engineering and Management, which aims to engineer and manage complex coupled human-natural systems in a highly integrated, rational manner. CSE is multi-disciplinary, and necessarily involves a wide range of subject areas including anthropology, engineering, environmental science, ethics and philosophy. It offers a rational approach which accepts the fact that we need to engineer and act to improve the functioning of the existing catchment entity on which we rely. The decision support framework proposed draws on physical and mathematical modelling; Participatory Action Research; and demonstration sites at which practical interventions are implemented. It is predicated on the need to work with stakeholders to co-produce knowledge that leads to proactive interventions to reverse the land degradation we observe today while sustaining the agriculture humanity needs. The philosophy behind CSE and examples of where it has been applied successfully are presented. The Decision Support Matrix (DSM) approach is introduced as a way to engage stakeholders at all scales, helping to inform decision making and motivate intervention. Two existing visualization and communication tools produced using the DSM approach are discussed: The FARM (Floods and Agriculture Risk Matrix) and CAVERTI (Communication And Visualizing Erosion-associated Risks to Infrastructure). Such tools can play a central role in encouraging a more holistic engineering approach to managing catchment system function that combines food production with a reversal of land degradation, providing a 'win-win' situation for all.

Evidence that electronic health records can promote physician counseling for healthy behaviors.

PubMed

Bae, Jaeyong; Hockenberry, Jason M; Rask, Kimberly J; Becker, Edmund R

Health behavior counseling services may help patients manage chronic conditions effectively and slow disease progression. Studies show, however, that many providers fail to provide these services because of time constraints and inability to tailor counseling to individual patient needs. Electronic health records (EHRs) have the potential to increase appropriate counseling by providing pertinent patient information at the point of care and clinical decision support. This study estimates the impact of select EHR functionalities on the rate of health behavior counseling provided during primary care visits. Multivariable regression analyses of the 2007-2010 National Ambulatory Medical Care Survey were conducted to examine whether eight EHR components representing four core functionalities of EHR systems were correlated with the rate of health behavior counseling services. Propensity score matching was used to control for confounding factors given the use of observational data. To address concerns that EHR may only lead to improved documentation of counseling services and not necessarily improved care, the association of EHR functionalities with prescriptions for smoking cessation medications was also estimated. The use of an EHR system with health information and data, order entry and management, result management, decision support, and a notification system for abnormal test results was associated with an approximately 25% increase in the probability of health behavior counseling delivered. Clinical reminders were associated with more health behavior counseling services when available in combination with patient problem lists. The laboratory results viewer was also associated with more counseling services when implemented with a notification system for abnormal results. An EHR system with key supportive functionalities can enhance delivery of preventive health behavior counseling services in primary care settings. Meaningful use criteria should be evaluated to ensure that they encourage the adoption of EHR systems with those functionalities shown to improve clinical care.

Aid decision algorithms to estimate the risk in congenital heart surgery.

PubMed

Ruiz-Fernández, Daniel; Monsalve Torra, Ana; Soriano-Payá, Antonio; Marín-Alonso, Oscar; Triana Palencia, Eddy

2016-04-01

In this paper, we have tested the suitability of using different artificial intelligence-based algorithms for decision support when classifying the risk of congenital heart surgery. In this sense, classification of those surgical risks provides enormous benefits as the a priori estimation of surgical outcomes depending on either the type of disease or the type of repair, and other elements that influence the final result. This preventive estimation may help to avoid future complications, or even death. We have evaluated four machine learning algorithms to achieve our objective: multilayer perceptron, self-organizing map, radial basis function networks and decision trees. The architectures implemented have the aim of classifying among three types of surgical risk: low complexity, medium complexity and high complexity. Accuracy outcomes achieved range between 80% and 99%, being the multilayer perceptron method the one that offered a higher hit ratio. According to the results, it is feasible to develop a clinical decision support system using the evaluated algorithms. Such system would help cardiology specialists, paediatricians and surgeons to forecast the level of risk related to a congenital heart disease surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Tool for Ranking Research Options

NASA Technical Reports Server (NTRS)

Ortiz, James N.; Scott, Kelly; Smith, Harold

2005-01-01

Tool for Research Enhancement Decision Support (TREDS) is a computer program developed to assist managers in ranking options for research aboard the International Space Station (ISS). It could likely also be adapted to perform similar decision-support functions in industrial and academic settings. TREDS provides a ranking of the options, based on a quantifiable assessment of all the relevant programmatic decision factors of benefit, cost, and risk. The computation of the benefit for each option is based on a figure of merit (FOM) for ISS research capacity that incorporates both quantitative and qualitative inputs. Qualitative inputs are gathered and partly quantified by use of the time-tested analytical hierarchical process and used to set weighting factors in the FOM corresponding to priorities determined by the cognizant decision maker(s). Then by use of algorithms developed specifically for this application, TREDS adjusts the projected benefit for each option on the basis of levels of technical implementation, cost, and schedule risk. Based partly on Excel spreadsheets, TREDS provides screens for entering cost, benefit, and risk information. Drop-down boxes are provided for entry of qualitative information. TREDS produces graphical output in multiple formats that can be tailored by users.

Decision support system for diabetic retinopathy using discrete wavelet transform.

PubMed

Noronha, K; Acharya, U R; Nayak, K P; Kamath, S; Bhandary, S V

2013-03-01

Prolonged duration of the diabetes may affect the tiny blood vessels of the retina causing diabetic retinopathy. Routine eye screening of patients with diabetes helps to detect diabetic retinopathy at the early stage. It is very laborious and time-consuming for the doctors to go through many fundus images continuously. Therefore, decision support system for diabetic retinopathy detection can reduce the burden of the ophthalmologists. In this work, we have used discrete wavelet transform and support vector machine classifier for automated detection of normal and diabetic retinopathy classes. The wavelet-based decomposition was performed up to the second level, and eight energy features were extracted. Two energy features from the approximation coefficients of two levels and six energy values from the details in three orientations (horizontal, vertical and diagonal) were evaluated. These features were fed to the support vector machine classifier with various kernel functions (linear, radial basis function, polynomial of orders 2 and 3) to evaluate the highest classification accuracy. We obtained the highest average classification accuracy, sensitivity and specificity of more than 99% with support vector machine classifier (polynomial kernel of order 3) using three discrete wavelet transform features. We have also proposed an integrated index called Diabetic Retinopathy Risk Index using clinically significant wavelet energy features to identify normal and diabetic retinopathy classes using just one number. We believe that this (Diabetic Retinopathy Risk Index) can be used as an adjunct tool by the doctors during the eye screening to cross-check their diagnosis.

Development and Validation of a Portable Platform for Deploying Decision-Support Algorithms in Prehospital Settings

PubMed Central

Reisner, A. T.; Khitrov, M. Y.; Chen, L.; Blood, A.; Wilkins, K.; Doyle, W.; Wilcox, S.; Denison, T.; Reifman, J.

2013-01-01

Summary Background Advanced decision-support capabilities for prehospital trauma care may prove effective at improving patient care. Such functionality would be possible if an analysis platform were connected to a transport vital-signs monitor. In practice, there are technical challenges to implementing such a system. Not only must each individual component be reliable, but, in addition, the connectivity between components must be reliable. Objective We describe the development, validation, and deployment of the Automated Processing of Physiologic Registry for Assessment of Injury Severity (APPRAISE) platform, intended to serve as a test bed to help evaluate the performance of decision-support algorithms in a prehospital environment. Methods We describe the hardware selected and the software implemented, and the procedures used for laboratory and field testing. Results The APPRAISE platform met performance goals in both laboratory testing (using a vital-sign data simulator) and initial field testing. After its field testing, the platform has been in use on Boston MedFlight air ambulances since February of 2010. Conclusion These experiences may prove informative to other technology developers and to healthcare stakeholders seeking to invest in connected electronic systems for prehospital as well as in-hospital use. Our experiences illustrate two sets of important questions: are the individual components reliable (e.g., physical integrity, power, core functionality, and end-user interaction) and is the connectivity between components reliable (e.g., communication protocols and the metadata necessary for data interpretation)? While all potential operational issues cannot be fully anticipated and eliminated during development, thoughtful design and phased testing steps can reduce, if not eliminate, technical surprises. PMID:24155791

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study.

PubMed

McWilliams, Lorna; Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-04-12

Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach.

PubMed

Shegog, Ross; Begley, Charles E

2017-01-01

Epilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient's epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient's needs, and increase the patient's self-efficacy to achieve those goals. The purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.

A Squeezed Artificial Neural Network for the Symbolic Network Reliability Functions of Binary-State Networks.

PubMed

Yeh, Wei-Chang

Network reliability is an important index to the provision of useful information for decision support in the modern world. There is always a need to calculate symbolic network reliability functions (SNRFs) due to dynamic and rapid changes in network parameters. In this brief, the proposed squeezed artificial neural network (SqANN) approach uses the Monte Carlo simulation to estimate the corresponding reliability of a given designed matrix from the Box-Behnken design, and then the Taguchi method is implemented to find the appropriate number of neurons and activation functions of the hidden layer and the output layer in ANN to evaluate SNRFs. According to the experimental results of the benchmark networks, the comparison appears to support the superiority of the proposed SqANN method over the traditional ANN-based approach with at least 16.6% improvement in the median absolute deviation in the cost of extra 2 s on average for all experiments.Network reliability is an important index to the provision of useful information for decision support in the modern world. There is always a need to calculate symbolic network reliability functions (SNRFs) due to dynamic and rapid changes in network parameters. In this brief, the proposed squeezed artificial neural network (SqANN) approach uses the Monte Carlo simulation to estimate the corresponding reliability of a given designed matrix from the Box-Behnken design, and then the Taguchi method is implemented to find the appropriate number of neurons and activation functions of the hidden layer and the output layer in ANN to evaluate SNRFs. According to the experimental results of the benchmark networks, the comparison appears to support the superiority of the proposed SqANN method over the traditional ANN-based approach with at least 16.6% improvement in the median absolute deviation in the cost of extra 2 s on average for all experiments.

Rhetorical Use of Inscriptions in Students' Written Arguments About Socioscientific Issues

NASA Astrophysics Data System (ADS)

Xiao, Sihan

2018-05-01

Educators expect that students be able to make informed decisions about science-related problems in their everyday lives. Engaging science in such problems often entails evaluating available evidence for given arguments. This study explores how students use inscriptions as evidence to argue about socioscientific issues. Fifth- and sixth-grade students (N = 102) in two intact classrooms completed written argument tasks in which they were asked to cite given inscriptions to support their decisions about energy use or genetically modified organisms. Qualitative content analyses of these written arguments, which focused on the coordination between inscriptions and claims, show three patterns of rhetorical use of inscriptions: seeing is believing, believing is seeing, and asserting is inferring. What counts as evidence was not the inscriptions per se, but the rhetorical functions they performed in particular arguments. These findings suggest that justifying socioscientific decisions is functionally different from explaining scientific phenomena. Linking these two activities in school may help students more productively engage with science in their everyday lives.

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders.

PubMed

Cappelli, Christopher; Ames, Susan; Shono, Yusuke; Dust, Mark; Stacy, Alan

2017-09-01

This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders. The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual's alcohol use and if decision-making ability could potentially modify the influence of these associations. 168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use. Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use. These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

PubMed

Hakkennes, Sharon; Hill, Keith D; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2013-01-01

This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke. Multi-site prospective observational cohort study. Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation. Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation. Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05). This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems.

PubMed

DesAutels, Spencer J; Fox, Zachary E; Giuse, Dario A; Williams, Annette M; Kou, Qing-Hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems.

Medication-related clinical decision support in computerized provider order entry systems: a review.

PubMed

Kuperman, Gilad J; Bobb, Anne; Payne, Thomas H; Avery, Anthony J; Gandhi, Tejal K; Burns, Gerard; Classen, David C; Bates, David W

2007-01-01

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

Research on web-based decision support system for sports competitions

NASA Astrophysics Data System (ADS)

Huo, Hanqiang

2010-07-01

This paper describes the system architecture and implementation technology of the decision support system for sports competitions, discusses the design of decision-making modules, management modules and security of the system, and proposes the development idea of building a web-based decision support system for sports competitions.

Organizational Perspectives on Rapid Response Team Structure, Function, and Cost: A Qualitative Study.

PubMed

Smith, Patricia L; McSweeney, Jean

Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs. The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs. Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics. The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost. It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.

Integrating Climate and Risk-Informed Science to Support Critical Decisions

ScienceCinema

None

2018-01-16

The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.

Integrating Climate and Risk-Informed Science to Support Critical Decisions

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

None

2016-07-27

The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.

Use of handheld computers in clinical practice: a systematic review.

PubMed

Mickan, Sharon; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl; Tilson, Julie K

2014-07-06

Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals' use of handheld computers improve their access to information and support clinical decision making at the point of care? A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study's aim for assessing the impact of handheld computer use. We included seven randomised trials investigating medical or nursing staffs' use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Healthcare professionals' use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes.

Use of handheld computers in clinical practice: a systematic review

PubMed Central

2014-01-01

Background Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals’ use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study’s aim for assessing the impact of handheld computer use. Results We included seven randomised trials investigating medical or nursing staffs’ use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Conclusion Healthcare professionals’ use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes. PMID:24998515

Nurse managers and the sandwich support model.

PubMed

Chisengantambu, Christine; Robinson, Guy M; Evans, Nina

2018-03-01

To explore the interplay between the work of nurse managers and the support they receive and provide. Support is the cornerstone of management practices and is pivotal in employees feeling committed to an organisation. Support for nurse managers is integral to effective health sector management; its characteristics merit more attention. The experiences of 15 nurse managers in rural health institutions in South Australia were explored using structured interviews, observation and document review. Effective decision making requires adequate support, which influences the perceptions and performance of nurse managers, creating an environment in which they feel appreciated and valued. An ideal support system is proposed, the "sandwich support model," to promote effective functioning and desirable patient outcomes via support "from above" and "from below." The need to support nurse managers effectively is crucial to how they function. The sandwich support model can improve management practices, more effectively assisting nurse managers. Organisations should revisit and strengthen support processes for nurse managers to maximize efficiencies. This paper contributes to understanding the importance of supporting nurse managers, identifying the processes used and the type of support offered. It highlights challenges and issues affecting support practices within the health sector. © 2017 John Wiley & Sons Ltd.

Space Environments and Spacecraft Effects Concept: Transitioning Research to Operations and Applications

NASA Technical Reports Server (NTRS)

Edwards, D. L.; Burns, H. D.; Clinton, R. G.; Schumacher, D.; Spann, J. F.

2012-01-01

The National Aeronautics and Space Administration (NASA) is embarking on a course to expand human presence beyond Low Earth Orbit (LEO) while expanding its mission to explore the solar system. Destinations such as Near Earth Asteroids (NEA), Mars and its moons, and the outer planets are but a few of the mission targets. NASA has established numerous organizations specializing in specific space environments disciplines that will serve to enable these missions. To complement these existing discipline organizations, a concept is presented focusing on the development of a space environment and spacecraft effects organization. This includes space climate, space weather, natural and induced space environments, and effects on spacecraft materials and systems. This space environment and spacecraft effects organization would be comprised of Technical Working Groups (TWG) focusing on, for example: a) Charged Particles (CP), b) Space Environmental Effects (SEE), and c) Interplanetary and Extraterrestrial Environments (IEE). These technical working groups will generate products and provide knowledge supporting four functional areas: design environments, environment effects, operational support, and programmatic support. The four functional areas align with phases in the program mission lifecycle and are briefly described below. Design environments are used primarily in the mission concept and design phases of a program. Environment effects focuses on the material, component, sub-system and system-level selection and the testing to verify design and operational performance. Operational support provides products based on real time or near real time space weather observations to mission operators to aid in real time and near-term decision-making. The programmatic support function maintains an interface with the numerous programs within NASA and other federal agencies to ensure that communications are well established and the needs of the programs are being met. The programmatic support function also includes working in coordination with the program in anomaly resolution and generation of lesson learned documentation. The goal of this space environment and spacecraft effects organization is to develop decision-making tools and engineering products to support the mission phases of mission concept through operations by focusing on transitioning research to application. Products generated by this space environments and spacecraft effects organization are suitable for use in anomaly investigations. This paper will describe the organizational structure for this space environments and spacecraft effects organization, and outline the scope of conceptual TWG's and their relationship to the functional areas.

A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

PubMed Central

Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-01-01

Background Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. Objective This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. Methods The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. Results In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. Conclusions The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate. Trial Registration Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS). PMID:24100091

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

PubMed

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

2018-04-01

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

A hydrophysical database to develop pedotransfer functions for Brazilian soils: challenges and perspectives

USDA-ARS?s Scientific Manuscript database

Access to soil hydrological data is vital for hydrology projects and for supporting decision-making in issues related to the availability of food and water and the forecasting of phenomena related to soil surface stability. Brazil is a country of continental dimensions and has accumulated a signific...

Educational Supports for High Functioning Youth with ASD: The Postsecondary Pathway to College

ERIC Educational Resources Information Center

Zeedyk, Sasha M.; Tipton, Leigh Ann; Blacher, Jan

2016-01-01

This article provides direction for educational decision making specifically for individuals with autism spectrum disorder (ASD), who have the cognitive and adaptive capabilities required to pursue postsecondary college education. The purpose is to draw attention to the available postsecondary pathways, 2- and 4-year college options, by addressing…

Super's Career Stages and the Decision to Change Careers.

ERIC Educational Resources Information Center

Smart, Roslyn; Peterson, Candida

1997-01-01

Australians (n=226) in one of four stages of a second career (contemplating, choosing a field, implementing, change completed) were compared with 81 nonchangers. Job satisfaction varied as a function of stage. Results supported Super's theory that career changers cycle through the full set of career stages a second time. (SK)

Increasing the Efficiency of Program Status Reporting by Residential Direct Care Staff

ERIC Educational Resources Information Center

Bastien, James S.; Burns, William J.; Kelly, Francis D.; Schumm, Patricia A.; Allen, Theresa P.

2005-01-01

In large residential treatment centers for adolescent youth, program administrators and clinical staff rely on the information imparted to them by direct care staff to make appropriate decisions regarding administrative and clinical support functions so that the residents in care can receive the best treatment possible. This study was designed to…

A Successful Implementation Strategy to Support Adoption of Decision Making in Mental Health Services.

PubMed

MacDonald-Wilson, Kim L; Hutchison, Shari L; Karpov, Irina; Wittman, Paul; Deegan, Patricia E

2017-04-01

Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centers (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilization of components of the toolkit improved significantly over time (p < .0001). Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model.

Stimulating debate: ethics in a multidisciplinary functional neurosurgery committee

PubMed Central

Ford, Paul J; Kubu, Cynthia S

2006-01-01

Multidisciplinary healthcare committees meet regularly to discuss patients' candidacy for emerging functional neurosurgical procedures, such as Deep Brain Stimulation (DBS). Through debate and discussion around the surgical candidacy of particular patients, functional neurosurgery programs begin to mold practice and policy supported both by scientific evidence and clear value choices. These neurosurgical decisions have special considerations not found in non‐neurologic committees. The professional time used to resolve these conflicts provides opportunities for the emergence of careful, ethical practices simultaneous with the expansion of therapy applications PMID:16446416

The Association Between Social Support and Stages of Change in Survivors of Intimate Partner Violence.

PubMed

Zapor, Heather; Wolford-Clevenger, Caitlin; Johnson, Dawn M

2018-04-01

For survivors of intimate partner violence (IPV), it is often difficult to take steps to establish safety and obtain a violence free life. Researchers have applied stage of change theory to aid in understanding the experience of survivors, as well as, the factors that can help women who desire to make changes in or break free from a violent relationship. Social support is one factor that can be helpful to IPV survivors who are attempting to make changes in their relationship. The purpose of the current study was to examine the differences in social support experienced by women who are at varying points in the process of change. Shelter residents ( N = 191) participated in this cross-sectional non-experimental study. Analyses demonstrated five distinct clusters or profiles of change among study participants and were labeled by the authors as follows: preparticipation, decision making, engagement, ambivalent, and action. All forms of social support (i.e., structural, functional, and satisfaction) were generally higher for individuals more engaged in the process of change. More specifically, differences were noted between the action and decision-making clusters and the engagement and decision-making clusters. These findings suggest that it is vital that clinicians working with survivors of IPV not only assess but also tailor interventions to meet survivors where they are in the process of change. Further, interventions that foster survivors' abilities to develop reliable and satisfying social support networks will be beneficial for survivors of IPV.

Search for supporting methodologies - Or how to support SEI for 35 years

NASA Technical Reports Server (NTRS)

Handley, Thomas H., Jr.; Masline, Richard C.

1991-01-01

Concepts relevant to the development of an evolvable information management system are examined in terms of support for the Space Exploration Initiative. The issues of interoperability within NASA and industry initiatives are studied including the Open Systems Interconnection standard and the operating system of the Open Software Foundation. The requirements of partitioning functionality into separate areas are determined with attention given to the infrastructure required to ensure system-wide compliance. The need for a decision-making context is a key to the distributed implementation of the program, and this environment is concluded to be next step in developing an evolvable, interoperable, and securable support network.

Overview of EPA tools for supporting local-, state- and regional-level decision makers addressing energy and environmental issues: NYC MARKAL Energy Systems Model and Municipal Solid Waste Decision Support Tool

EPA Science Inventory

A workshop will be conducted to demonstrate and focus on two decision support tools developed at EPA/ORD: 1. Community-scale MARKAL model: an energy-water technology evaluation tool and 2. Municipal Solid Waste Decision Support Tool (MSW DST). The Workshop will be part of Southea...

Surface transportation weather decision support requirements : operational concept description : advanced-integrated decision support using weather information for surface transportation decisions makers : draft version 2.0

DOT National Transportation Integrated Search

2000-07-14

This is a draft document for the Surface Transportation Weather Decision Support Requirements (STWDSR) project. The STWDSR project is being conducted for the FHWAs Office of Transportation Operations (HOTO) Road Weather Management Program by Mitre...

Analytical Support Capabilities of Turkish General Staff Scientific Decision Support Centre (SDSC) to Defence Transformation

DTIC Science & Technology

2005-04-01

RTO-MP-SAS-055 4 - 1 UNCLASSIFIED/UNLIMITED UNCLASSIFIED/UNLIMITED Analytical Support Capabilities of Turkish General Staff Scientific...the end failed to achieve anything commensurate with the effort. The analytical support capabilities of Turkish Scientific Decision Support Center to...percent of the İpekkan, Z.; Özkil, A. (2005) Analytical Support Capabilities of Turkish General Staff Scientific Decision Support Centre (SDSC) to

A functional near-infrared spectroscopy study of lexical decision task supports the dual route model and the phonological deficit theory of dyslexia.

PubMed

Sela, Itamar; Izzetoglu, Meltem; Izzetoglu, Kurtulus; Onaral, Banu

2014-01-01

The dual route model (DRM) of reading suggests two routes of reading development: the phonological and the orthographic routes. It was proposed that although the two routes are active in the process of reading; the first is more involved at the initial stages of reading acquisition, whereas the latter needs more reading training to mature. A number of studies have shown that deficient phonological processing is a core deficit in developmental dyslexia. According to the DRM, when the Lexical Decision Task (LDT) is performed, the orthographic route should also be involved when decoding words, whereas it is clear that when decoding pseudowords the phonological route should be activated. Previous functional near-infrared spectroscopy (fNIR) studies have suggested that the upper left frontal lobe is involved in decision making in the LDT. The current study used fNIR to compare left frontal lobe activity during LDT performance among three reading-level groups: 12-year-old children, young adult dyslexic readers, and young adult typical readers. Compared to typical readers, the children demonstrated lower activity under the word condition only, whereas the dyslexic readers showed lower activity under the pseudoword condition only. The results provide evidence for upper left frontal lobe involvement in LDT and support the DRM and the phonological deficit theory of dyslexia.

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

[Diagnosis and the technology for optimizing the medical support of a troop unit].

PubMed

Korshever, N G; Polkovov, S V; Lavrinenko, O V; Krupnov, P A; Anastasov, K N

2000-05-01

The work is devoted to investigation of the system of military unit medical support with the use of principles and states of organizational diagnosis; development of the method allowing to assess its functional activity; and determination of optimization trends. Basing on the conducted organizational diagnosis and expert inquiry the informative criteria were determined which characterize the stages of functioning of the military unit medical support system. To evaluate the success of military unit medical support the complex multi-criteria pattern was developed and algorithm of this process optimization was substantiated. Using the results obtained, particularly realization of principles and states of decision taking theory in machine program it is possible to solve more complex problem of comparison between any number of military units: to dispose them according to priority decrease; to select the programmed number of the best and worst; to determine the trends of activity optimization in corresponding medical service personnel.

Representing Human Expertise by the OWL Web Ontology Language to Support Knowledge Engineering in Decision Support Systems.

PubMed

Ramzan, Asia; Wang, Hai; Buckingham, Christopher

2014-01-01

Clinical decision support systems (CDSSs) often base their knowledge and advice on human expertise. Knowledge representation needs to be in a format that can be easily understood by human users as well as supporting ongoing knowledge engineering, including evolution and consistency of knowledge. This paper reports on the development of an ontology specification for managing knowledge engineering in a CDSS for assessing and managing risks associated with mental-health problems. The Galatean Risk and Safety Tool, GRiST, represents mental-health expertise in the form of a psychological model of classification. The hierarchical structure was directly represented in the machine using an XML document. Functionality of the model and knowledge management were controlled using attributes in the XML nodes, with an accompanying paper manual for specifying how end-user tools should behave when interfacing with the XML. This paper explains the advantages of using the web-ontology language, OWL, as the specification, details some of the issues and problems encountered in translating the psychological model to OWL, and shows how OWL benefits knowledge engineering. The conclusions are that OWL can have an important role in managing complex knowledge domains for systems based on human expertise without impeding the end-users' understanding of the knowledge base. The generic classification model underpinning GRiST makes it applicable to many decision domains and the accompanying OWL specification facilitates its implementation.

Managing controversy through consultation: a qualitative study of communication and trust around MMR vaccination decisions

PubMed Central

McMurray, Robert; Cheater, Francine M; Weighall, Anna; Nelson, Carolyn; Schweiger, Martin; Mukherjee, Suzanne

2004-01-01

Background: Controversy over the measles, mumps, and rubella (MMR) vaccine has reduced uptake, raising concerns of a future disease epidemic. Aims: To explore parents' accounts of decision making relating to the MMR vaccine controversy, identifying uptake determinants and education needs. Design of study: Qualitative interviews analysed using the ‘framework’ approach. Setting: Five general practices in the Leeds area, 2002–2003. Method: Sixty-nine interviews conducted with parents of children aged between 4 and 5 years, and 12 interviews with primary care practitioners, managers and immunisation coordinators serving participating sites. Participants were interviewed one-to-one in a place of their choice. Results: The vaccination decision is primarily a function of parental assessments of the relative acceptability and likelihood of possible outcomes. For most parents the evidence of science and medicine plays little role in the decision. Although local general practitioners and health visitors are trusted information sources, the influence of primary care providers on the vaccination decision is limited by concerns over consultation legitimacy, discussion opportunity, and perceptions of financial and political partiality. Parents and practitioners identify a need for new approaches to support decisions and learning when faced with this and similar healthcare controversies. These include new collaborative approaches to information exchange designed to transform rather than supplant existing parent knowledge as part of an ongoing learning process. Conclusion: The study identified new ways in which parents and practitioners need to be supported in order to increase understanding of medical science and secure more informed decisions in the face of health controversy. PMID:15239914

Managing depression-related occupational disability: a pragmatic approach.

PubMed

Bilsker, Dan; Wiseman, Stephen; Gilbert, Merv

2006-02-01

To identify the crucial issues that arise for psychiatrists and other physicians when dealing with occupational disability in their patients with depression and to suggest practical strategies for responding more effectively to the challenges of this aspect of patient functioning. We identify fundamental concepts in the occupational disability domain and draw crucial distinctions. The wider context for occupational disability is articulated, involving the workplace environment and the disability insurance industry. Research with direct relevance to clinical decision making in this area is highlighted. We make pragmatic suggestions for effective management of occupational disability in patients with depression. To successfully manage issues of occupational disability, psychiatrists and other physicians must understand the distinction between impairment and disability. To make this decision fairly and accurately, the adjudicator requires particular types of information from the physician, with requirements varying across short-term or long-term disability claims; failing to provide relevant information may cause substantial stress or financial harm to the patient. Balanced and collaborative decision making regarding whether and for how long to take work absence will greatly help to maintain occupational function in the long-term. Realistic expectations and support of the patient's sense of personal competence foster recovery of occupational function. Management of depression-related disability is challenging. Thoughtful evaluation of the patient's functional status, careful response to the requirements of disability determination, and a focus on functional recovery yield substantial benefits.

Bi-Level Decision Making for Supporting Energy and Water Nexus

NASA Astrophysics Data System (ADS)

Zhang, X.; Vesselinov, V. V.

2016-12-01

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

Development of transportation asset management decision support tools : final report.

DOT National Transportation Integrated Search

2017-08-09

This study developed a web-based prototype decision support platform to demonstrate the benefits of transportation asset management in monitoring asset performance, supporting asset funding decisions, planning budget tradeoffs, and optimizing resourc...

Regional resources buffer the impact of functional limitations on perceived autonomy in older adults with multiple illnesses.

PubMed

Schüz, Benjamin; Westland, Josh N; Wurm, Susanne; Tesch-Römer, Clemens; Wolff, Julia K; Warner, Lisa M; Schwarzer, Ralf

2016-03-01

Retaining perceptions of autonomy is a key component of successful aging. Perceived autonomy refers to the capacity to make and enact self-directed decisions. These perceptions are often threatened in older adults with multiple illnesses, when functional limitations resulting from these illnesses impede the enactment of self-directed decisions. Regional resources (in Germany specifically at the level of administrative districts) might counteract these impediments of autonomy. Economically stronger districts can provide more-concrete support resources for older adults, buffering the negative effect of functional limitations on self-perceived autonomy. This study assessed participants aged over 65 with 2 or more chronic conditions. In total, N = 287 provided data (Mage = 73.3, SD = 5.07), and n = 97 were women. Gross domestic product (GDP) per capita was used as a proxy measure of administrative district wealth in Germany. Hierarchical multilevel regression analyses with cross-level interactions were conducted. Results suggest that the detrimental effect of functional limitations on perceived autonomy is less pronounced for participants residing in higher GDP districts. Conversely, for participants in lower GDP districts, the effect is exacerbated. This finding suggests that districts with greater financial resources might be better able to invest in supports that promote and facilitate autonomy and, thus, provide a buffer against threats to individual perceived autonomy. (c) 2016 APA, all rights reserved).

Right-hemispheric processing of non-linguistic word features: implications for mapping language recovery after stroke.

PubMed

Baumgaertner, Annette; Hartwigsen, Gesa; Roman Siebner, Hartwig

2013-06-01

Verbal stimuli often induce right-hemispheric activation in patients with aphasia after left-hemispheric stroke. This right-hemispheric activation is commonly attributed to functional reorganization within the language system. Yet previous evidence suggests that functional activation in right-hemispheric homologues of classic left-hemispheric language areas may partly be due to processing nonlinguistic perceptual features of verbal stimuli. We used functional MRI (fMRI) to clarify the role of the right hemisphere in the perception of nonlinguistic word features in healthy individuals. Participants made perceptual, semantic, or phonological decisions on the same set of auditorily and visually presented word stimuli. Perceptual decisions required judgements about stimulus-inherent changes in font size (visual modality) or fundamental frequency contour (auditory modality). The semantic judgement required subjects to decide whether a stimulus is natural or man-made; the phonologic decision required a decision on whether a stimulus contains two or three syllables. Compared to phonologic or semantic decision, nonlinguistic perceptual decisions resulted in a stronger right-hemispheric activation. Specifically, the right inferior frontal gyrus (IFG), an area previously suggested to support language recovery after left-hemispheric stroke, displayed modality-independent activation during perceptual processing of word stimuli. Our findings indicate that activation of the right hemisphere during language tasks may, in some instances, be driven by a "nonlinguistic perceptual processing" mode that focuses on nonlinguistic word features. This raises the possibility that stronger activation of right inferior frontal areas during language tasks in aphasic patients with left-hemispheric stroke may at least partially reflect increased attentional focus on nonlinguistic perceptual aspects of language. Copyright © 2012 Wiley Periodicals, Inc.

Implicit knowledge of visual uncertainty guides decisions with asymmetric outcomes.

PubMed

Whiteley, Louise; Sahani, Maneesh

2008-03-06

Perception is an "inverse problem," in which the state of the world must be inferred from the sensory neural activity that results. However, this inference is both ill-posed (Helmholtz, 1856; Marr, 1982) and corrupted by noise (Green & Swets, 1989), requiring the brain to compute perceptual beliefs under conditions of uncertainty. Here we show that human observers performing a simple visual choice task under an externally imposed loss function approach the optimal strategy, as defined by Bayesian probability and decision theory (Berger, 1985; Cox, 1961). In concert with earlier work, this suggests that observers possess a model of their internal uncertainty and can utilize this model in the neural computations that underlie their behavior (Knill & Pouget, 2004). In our experiment, optimal behavior requires that observers integrate the loss function with an estimate of their internal uncertainty rather than simply requiring that they use a modal estimate of the uncertain stimulus. Crucially, they approach optimal behavior even when denied the opportunity to learn adaptive decision strategies based on immediate feedback. Our data thus support the idea that flexible representations of uncertainty are pre-existing, widespread, and can be propagated to decision-making areas of the brain.

Effects of automation of information-processing functions on teamwork.

PubMed

Wright, Melanie C; Kaber, David B

2005-01-01

We investigated the effects of automation as applied to different stages of information processing on team performance in a complex decision-making task. Forty teams of 2 individuals performed a simulated Theater Defense Task. Four automation conditions were simulated with computer assistance applied to realistic combinations of information acquisition, information analysis, and decision selection functions across two levels of task difficulty. Multiple measures of team effectiveness and team coordination were used. Results indicated different forms of automation have different effects on teamwork. Compared with a baseline condition, an increase in automation of information acquisition led to an increase in the ratio of information transferred to information requested; an increase in automation of information analysis resulted in higher team coordination ratings; and automation of decision selection led to better team effectiveness under low levels of task difficulty but at the cost of higher workload. The results support the use of early and intermediate forms of automation related to acquisition and analysis of information in the design of team tasks. Decision-making automation may provide benefits in more limited contexts. Applications of this research include the design and evaluation of automation in team environments.

Integrating multiple fitting regression and Bayes decision for cancer diagnosis with transcriptomic data from tumor-educated blood platelets.

PubMed

Huang, Guangzao; Yuan, Mingshun; Chen, Moliang; Li, Lei; You, Wenjie; Li, Hanjie; Cai, James J; Ji, Guoli

2017-10-07

The application of machine learning in cancer diagnostics has shown great promise and is of importance in clinic settings. Here we consider applying machine learning methods to transcriptomic data derived from tumor-educated platelets (TEPs) from individuals with different types of cancer. We aim to define a reliability measure for diagnostic purposes to increase the potential for facilitating personalized treatments. To this end, we present a novel classification method called MFRB (for Multiple Fitting Regression and Bayes decision), which integrates the process of multiple fitting regression (MFR) with Bayes decision theory. MFR is first used to map multidimensional features of the transcriptomic data into a one-dimensional feature. The probability density function of each class in the mapped space is then adjusted using the Gaussian probability density function. Finally, the Bayes decision theory is used to build a probabilistic classifier with the estimated probability density functions. The output of MFRB can be used to determine which class a sample belongs to, as well as to assign a reliability measure for a given class. The classical support vector machine (SVM) and probabilistic SVM (PSVM) are used to evaluate the performance of the proposed method with simulated and real TEP datasets. Our results indicate that the proposed MFRB method achieves the best performance compared to SVM and PSVM, mainly due to its strong generalization ability for limited, imbalanced, and noisy data.

Visualising Pareto-optimal trade-offs helps move beyond monetary-only criteria for water management decisions

NASA Astrophysics Data System (ADS)

Hurford, Anthony; Harou, Julien

2014-05-01

Water related eco-system services are important to the livelihoods of the poorest sectors of society in developing countries. Degradation or loss of these services can increase the vulnerability of people decreasing their capacity to support themselves. New approaches to help guide water resources management decisions are needed which account for the non-market value of ecosystem goods and services. In case studies from Brazil and Kenya we demonstrate the capability of many objective Pareto-optimal trade-off analysis to help decision makers balance economic and non-market benefits from the management of existing multi-reservoir systems. A multi-criteria search algorithm is coupled to a water resources management simulator of each basin to generate a set of Pareto-approximate trade-offs representing the best case management decisions. In both cases, volume dependent reservoir release rules are the management decisions being optimised. In the Kenyan case we further assess the impacts of proposed irrigation investments, and how the possibility of new investments impacts the system's trade-offs. During the multi-criteria search (optimisation), performance of different sets of management decisions (policies) is assessed against case-specific objective functions representing provision of water supply and irrigation, hydropower generation and maintenance of ecosystem services. Results are visualised as trade-off surfaces to help decision makers understand the impacts of different policies on a broad range of stakeholders and to assist in decision-making. These case studies show how the approach can reveal unexpected opportunities for win-win solutions, and quantify the trade-offs between investing to increase agricultural revenue and negative impacts on protected ecosystems which support rural livelihoods.

The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage.

PubMed

Bechara, Antoine

2004-06-01

Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information normally suggest that people make judgments not only by evaluating the consequences and their probability of occurring, but also and even sometimes primarily at a gut or emotional level. Lesions of the ventromedial (which includes the orbitofrontal) sector of the prefrontal cortex interfere with the normal processing of "somatic" or emotional signals, while sparing most basic cognitive functions. Such damage leads to impairments in the decision-making process, which seriously compromise the quality of decisions in daily life. The aim of this paper is to review evidence in support of "The Somatic Marker Hypothesis," which provides a systems-level neuroanatomical and cognitive framework for decision-making and suggests that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. The implications of this theoretical framework for the normal and abnormal development of the orbitofrontal cortex are also discussed.

Neuro-Oncology Branch patient emotional support services | Center for Cancer Research

Cancer.gov

Emotional Support Services The diagnosis of a brain tumor elicits many different and sometimes difficult emotions, not only for the patient, but also for their family members. Patients may encounter changes in cognitive functioning and language, a diminished ability to focus or make decisions, or short-term memory loss, all of which can greatly affect their personal and professional lives. We are dedicated to helping patients and their families deal with the physical and emotional facets of this disease.

Modifications and integration of the electronic tracking board in a pediatric emergency department.

PubMed

Dexheimer, Judith W; Kennebeck, Stephanie

2013-07-01

Electronic health records (EHRs) are used for data storage; provider, laboratory, and patient communication; clinical decision support; procedure and medication orders; and decision support alerts. Clinical decision support is part of any EHR and is designed to help providers make better decisions. The emergency department (ED) poses a unique environment to the use of EHRs and clinical decision support. Used effectively, computerized tracking boards can help improve flow, communication, and the dissemination of pertinent visit information between providers and other departments in a busy ED. We discuss the unique modifications and decisions made in the implementation of an EHR and computerized tracking board in a pediatric ED. We discuss the changing views based on provider roles, customization to the user interface including the layout and colors, decision support, tracking board best practices collected from other institutions and colleagues, and a case study of using reminders on the electronic tracking board to drive pain reassessments.

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 (...

The design of patient decision support interventions: addressing the theory-practice gap.

PubMed

Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky

2011-08-01

Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions. © 2010 Blackwell Publishing Ltd.

Advanced decision support for winter road maintenance

DOT National Transportation Integrated Search

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

Detroit deicing decision support tool : description, operation, and simulation results

DOT National Transportation Integrated Search

2006-01-01

The John A. Volpe National Transportation Systems Center, sponsored by the National Aeronautics and Space Administration, : developed a deicing decision support tool, for Detroit Metropolitan Wayne County Airport (DTW).1 The deicing decision support ...

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.

Exploring the oxygen supply and demand framework as a learning tool in undergraduate nursing education.

PubMed

Gillespie, Mary; Shackell, Eileen

2017-11-01

In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education. A pretest/post-test assessment and reflective journal were used to gather data. Findings indicated the Oxygen Supply and Demand Framework guided the development of pattern recognition and thinking processes and supported knowledge development, knowledge application and clinical decision-making. The Oxygen Supply and Demand Framework supports undergraduate students learning to provide safe and effective nursing care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluating models of object-decision priming: evidence from event-related potential repetition effects.

PubMed

Soldan, Anja; Mangels, Jennifer A; Cooper, Lynn A

2006-03-01

This study was designed to differentiate between structural description and bias accounts of performance in the possible/impossible object-decision test. Two event-related potential (ERP) studies examined how the visual system processes structurally possible and impossible objects. Specifically, the authors investigated the effects of object repetition on a series of early posterior components during structural (Experiment 1) and functional (Experiment 2) encoding and the relationship of these effects to behavioral measures of priming. In both experiments, the authors found repetition enhancement of the posterior N1 and N2 for possible objects only. In addition, the magnitude of the N1 repetition effect for possible objects was correlated with priming for possible objects. Although the behavioral results were more ambiguous, these ERP results fail to support bias models that hold that both possible and impossible objects are processed similarly in the visual system. Instead, they support the view that priming is supported by a structural description system that encodes the global 3-dimensional structure of an object.

Shared motion signals for human perceptual decisions and oculomotor actions

NASA Technical Reports Server (NTRS)

Stone, Leland S.; Krauzlis, Richard J.

2003-01-01

A fundamental question in primate neurobiology is to understand to what extent motor behaviors are driven by shared neural signals that also support conscious perception or by independent subconscious neural signals dedicated to motor control. Although it has clearly been established that cortical areas involved in processing visual motion support both perception and smooth pursuit eye movements, it remains unknown whether the same or different sets of neurons within these structures perform these two functions. Examination of the trial-by-trial variation in human perceptual and pursuit responses during a simultaneous psychophysical and oculomotor task reveals that the direction signals for pursuit and perception are not only similar on average but also co-vary on a trial-by-trial basis, even when performance is at or near chance and the decisions are determined largely by neural noise. We conclude that the neural signal encoding the direction of target motion that drives steady-state pursuit and supports concurrent perceptual judgments emanates from a shared ensemble of cortical neurons.

Breast Cancer Detection with Reduced Feature Set.

PubMed

Mert, Ahmet; Kılıç, Niyazi; Bilgili, Erdem; Akan, Aydin

2015-01-01

This paper explores feature reduction properties of independent component analysis (ICA) on breast cancer decision support system. Wisconsin diagnostic breast cancer (WDBC) dataset is reduced to one-dimensional feature vector computing an independent component (IC). The original data with 30 features and reduced one feature (IC) are used to evaluate diagnostic accuracy of the classifiers such as k-nearest neighbor (k-NN), artificial neural network (ANN), radial basis function neural network (RBFNN), and support vector machine (SVM). The comparison of the proposed classification using the IC with original feature set is also tested on different validation (5/10-fold cross-validations) and partitioning (20%-40%) methods. These classifiers are evaluated how to effectively categorize tumors as benign and malignant in terms of specificity, sensitivity, accuracy, F-score, Youden's index, discriminant power, and the receiver operating characteristic (ROC) curve with its criterion values including area under curve (AUC) and 95% confidential interval (CI). This represents an improvement in diagnostic decision support system, while reducing computational complexity.

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…

Supported Decision Making: A Synthesis of the Literature across Intellectual Disability, Mental Health, and Aging

ERIC Educational Resources Information Center

Shogren, Karrie A.; Wehmeyer, Michael L.; Lassmann, Heather; Forber-Pratt, Anjali J.

2017-01-01

Supported decision making (SDM) has begun to receive significant attention as means to enable people to exercise autonomy and self-determination over decisions about their life. Practice frameworks that can be used to promote the provision of supports for decision making are needed. This paper integrates the literature across intellectual and…

CHAMPION: Intelligent Hierarchical Reasoning Agents for Enhanced Decision Support

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

Hohimer, Ryan E.; Greitzer, Frank L.; Noonan, Christine F.

2011-11-15

We describe the design and development of an advanced reasoning framework employing semantic technologies, organized within a hierarchy of computational reasoning agents that interpret domain specific information. Designed based on an inspirational metaphor of the pattern recognition functions performed by the human neocortex, the CHAMPION reasoning framework represents a new computational modeling approach that derives invariant knowledge representations through memory-prediction belief propagation processes that are driven by formal ontological language specification and semantic technologies. The CHAMPION framework shows promise for enhancing complex decision making in diverse problem domains including cyber security, nonproliferation and energy consumption analysis.

Contribution to solving the energy crisis - Simulating the prospects for low cost energy through silicon solar cells

NASA Technical Reports Server (NTRS)

Kran, A.

1978-01-01

PECAN (Photovoltaic Energy Conversion Analysis) is a highly interactive decision analysis and support system. It simulates the prospects for widespread use of solar cells for the generation of electrical power. PECAN consists of a set of integrated APL functions for evaluating the potential of terrestrial photovoltaics. Specifically, the system is a deterministic simulator, which translates present and future manufacturing technology into economic and financial terms, using the production unit concept. It guides solar cell development in three areas: tactical decision making, strategic planning, and the formulation of alternative options.

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

NASA Astrophysics Data System (ADS)

Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

2013-03-01

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

Model-based choices involve prospective neural activity

PubMed Central

Doll, Bradley B.; Duncan, Katherine D.; Simon, Dylan A.; Shohamy, Daphna; Daw, Nathaniel D.

2015-01-01

Decisions may arise via “model-free” repetition of previously reinforced actions, or by “model-based” evaluation, which is widely thought to follow from prospective anticipation of action consequences using a learned map or model. While choices and neural correlates of decision variables sometimes reflect knowledge of their consequences, it remains unclear whether this actually arises from prospective evaluation. Using functional MRI and a sequential reward-learning task in which paths contained decodable object categories, we found that humans’ model-based choices were associated with neural signatures of future paths observed at decision time, suggesting a prospective mechanism for choice. Prospection also covaried with the degree of model-based influences on neural correlates of decision variables, and was inversely related to prediction error signals thought to underlie model-free learning. These results dissociate separate mechanisms underlying model-based and model-free evaluation and support the hypothesis that model-based influences on choices and neural decision variables result from prospection. PMID:25799041

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

PubMed

Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

2013-03-01

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

Decision-making and planning in full recovery of anorexia nervosa.

PubMed

Lindner, Susanne E; Fichter, Manfred M; Quadflieg, Norbert

2012-11-01

Based on findings of persisting neuropsychological impairments in women recovered from anorexia nervosa (rec AN), this study examined decision-making and planning, for achieving a desired goal, as central executive functions in a large sample of rec AN. The definition of recovery included physiological, behavioral, and psychological variables. A total of 100 rec AN women were compared to 100 healthy women, 1:1 matched for age and educational level. Decision-making was assessed with the Iowa Gambling Task and planning with the Tower of London. Expert interviews and self-ratings were used for assessing the inclusion/exclusion criteria and control variables. Compared to healthy controls, rec AN women were better in decision-making and worse in planning even after considering control variables. This study does not support results from other studies showing that rec AN participants perform better in decision-making. Results from this study show that planning is impaired even after full recovery from AN. Copyright © 2012 Wiley Periodicals, Inc.

Prefrontal contributions to metacognition in perceptual decision-making

PubMed Central

Fleming, Stephen M.; Huijgen, Josefien; Dolan, Raymond J.

2012-01-01

Neuroscience has made considerable progress in understanding the neural substrates supporting cognitive performance in a number of domains, including memory, perception and decision-making. In contrast, how the human brain generates metacognitive awareness of task performance remains unclear. Here, we address this question by asking participants to perform perceptual decisions while providing concurrent metacognitive reports, during fMRI scanning. We show that activity in right rostrolateral prefrontal cortex (rlPFC) satisfies three constraints for a role in metacognitive aspects of decision-making. Right rlPFC showed greater activity during self-report compared to a matched control condition; activity in this region correlated with reported confidence; and the strength of the relationship between activity and confidence predicted metacognitive ability across individuals. In addition, functional connectivity between right rlPFC and both contralateral PFC and visual cortex increased during metacognitive reports. We discuss these findings in a theoretical framework where rlPFC re-represents object-level decision uncertainty to facilitate metacognitive report. PMID:22553018

Enhancing User Customization through Novel Software Architecture for Utility Scale Solar Siting Software

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

Brant Peery; Sam Alessi; Randy Lee

2014-06-01

There is a need for a spatial decision support application that allows users to create customized metrics for comparing proposed locations of a new solar installation. This document discusses how PVMapper was designed to overcome the customization problem through the development of loosely coupled spatial and decision components in a JavaScript plugin architecture. This allows the user to easily add functionality and data to the system. The paper also explains how PVMapper provides the user with a dynamic and customizable decision tool that enables them to visually modify the formulas that are used in the decision algorithms that convert datamore » to comparable metrics. The technologies that make up the presentation and calculation software stack are outlined. This document also explains the architecture that allows the tool to grow through custom plugins created by the software users. Some discussion is given on the difficulties encountered while designing the system.« less

Processing of social and monetary rewards in the human striatum.

PubMed

Izuma, Keise; Saito, Daisuke N; Sadato, Norihiro

2008-04-24

Despite an increasing focus on the neural basis of human decision making in neuroscience, relatively little attention has been paid to decision making in social settings. Moreover, although human social decision making has been explored in a social psychology context, few neural explanations for the observed findings have been considered. To bridge this gap and improve models of human social decision making, we investigated whether acquiring a good reputation, which is an important incentive in human social behaviors, activates the same reward circuitry as monetary rewards. In total, 19 subjects participated in functional magnetic resonance imaging (fMRI) experiments involving monetary and social rewards. The acquisition of one's good reputation robustly activated reward-related brain areas, notably the striatum, and these overlapped with the areas activated by monetary rewards. Our findings support the idea of a "common neural currency" for rewards and represent an important first step toward a neural explanation for complex human social behaviors.

Automation in future air traffic management: effects of decision aid reliability on controller performance and mental workload.

PubMed

Metzger, Ulla; Parasuraman, Raja

2005-01-01

Future air traffic management concepts envisage shared decision-making responsibilities between controllers and pilots, necessitating that controllers be supported by automated decision aids. Even as automation tools are being introduced, however, their impact on the air traffic controller is not well understood. The present experiments examined the effects of an aircraft-to-aircraft conflict decision aid on performance and mental workload of experienced, full-performance level controllers in a simulated Free Flight environment. Performance was examined with both reliable (Experiment 1) and inaccurate automation (Experiment 2). The aid improved controller performance and reduced mental workload when it functioned reliably. However, detection of a particular conflict was better under manual conditions than under automated conditions when the automation was imperfect. Potential or actual applications of the results include the design of automation and procedures for future air traffic control systems.

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

Quick Fix for Managing Risks

NASA Technical Reports Server (NTRS)

2002-01-01

Under a Phase II SBIR contract, Kennedy and Lumina Decision Systems, Inc., jointly developed the Schedule and Cost Risk Analysis Modeling (SCRAM) system, based on a version of Lumina's flagship software product, Analytica(R). Acclaimed as "the best single decision-analysis program yet produced" by MacWorld magazine, Analytica is a "visual" tool used in decision-making environments worldwide to build, revise, and present business models, minus the time-consuming difficulty commonly associated with spreadsheets. With Analytica as their platform, Kennedy and Lumina created the SCRAM system in response to NASA's need to identify the importance of major delays in Shuttle ground processing, a critical function in project management and process improvement. As part of the SCRAM development project, Lumina designed a version of Analytica called the Analytica Design Engine (ADE) that can be easily incorporated into larger software systems. ADE was commercialized and utilized in many other developments, including web-based decision support.

Flight deck engine advisor

NASA Technical Reports Server (NTRS)

Shontz, W. D.; Records, R. M.; Antonelli, D. R.

1992-01-01

The focus of this project is on alerting pilots to impending events in such a way as to provide the additional time required for the crew to make critical decisions concerning non-normal operations. The project addresses pilots' need for support in diagnosis and trend monitoring of faults as they affect decisions that must be made within the context of the current flight. Monitoring and diagnostic modules developed under the NASA Faultfinder program were restructured and enhanced using input data from an engine model and real engine fault data. Fault scenarios were prepared to support knowledge base development activities on the MONITAUR and DRAPhyS modules of Faultfinder. An analysis of the information requirements for fault management was included in each scenario. A conceptual framework was developed for systematic evaluation of the impact of context variables on pilot action alternatives as a function of event/fault combinations.

Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

PubMed Central

Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

2007-01-01

The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

Integrating Personalized and Community Services for Mobile Travel Planning and Management

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih

Personalized and community services have been noted as keys to enhance and facilitate e-tourism as well as mobile applications. This paper aims at proposing an integrated service framework for combining personalized and community functions to support mobile travel planning and management. Major mobile tourism related planning and decision support functions specified include personalized profile management, information search and notification, evaluation and recommendation, do-it-yourself planning and design, community and collaboration management, auction and negotiation, transaction and payment, as well as trip tracking and quality control. A system implementation process with an example prototype is also presented for illustrating the feasibility and effectiveness of the proposed system framework, process model, and development methodology.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

PubMed

Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems

PubMed Central

DesAutels, Spencer J.; Fox, Zachary E.; Giuse, Dario A.; Williams, Annette M.; Kou, Qing-hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems. PMID:28269846

A Web-Based Earth-Systems Knowledge Portal and Collaboration Platform

NASA Astrophysics Data System (ADS)

D'Agnese, F. A.; Turner, A. K.

2010-12-01

In support of complex water-resource sustainability projects in the Great Basin region of the United States, Earth Knowledge, Inc. has developed several web-based data management and analysis platforms that have been used by its scientists, clients, and public to facilitate information exchanges, collaborations, and decision making. These platforms support accurate water-resource decision-making by combining second-generation internet (Web 2.0) technologies with traditional 2D GIS and web-based 2D and 3D mapping systems such as Google Maps, and Google Earth. Most data management and analysis systems use traditional software systems to address the data needs and usage behavior of the scientific community. In contrast, these platforms employ more accessible open-source and “off-the-shelf” consumer-oriented, hosted web-services. They exploit familiar software tools using industry standard protocols, formats, and APIs to discover, process, fuse, and visualize earth, engineering, and social science datasets. Thus, they respond to the information needs and web-interface expectations of both subject-matter experts and the public. Because the platforms continue to gather and store all the contributions of their broad-spectrum of users, each new assessment leverages the data, information, and expertise derived from previous investigations. In the last year, Earth Knowledge completed a conceptual system design and feasibility study for a platform, which has a Knowledge Portal providing access to users wishing to retrieve information or knowledge developed by the science enterprise and a Collaboration Environment Module, a framework that links the user-access functions to a Technical Core supporting technical and scientific analyses including Data Management, Analysis and Modeling, and Decision Management, and to essential system administrative functions within an Administrative Module. The over-riding technical challenge is the design and development of a single technical platform that is accessed through a flexible series of knowledge portal and collaboration environment styles reflecting the information needs and user expectations of a diverse community of users. Recent investigations have defined the information needs and expectations of the major end-users and also have reviewed and assessed a wide variety of modern web-based technologies. Combining these efforts produced design specifications and recommendations for the selection and integration of web- and client-based tools. When fully developed, the resulting platform will: -Support new, advanced information systems and decision environments that take full advantage of multiple data sources and platforms; -Provide a distribution network tailored to the timely delivery of products to a broad range of users that are needed to support applications in disaster management, resource management, energy, and urban sustainability; -Establish new integrated multiple-user requirements and knowledge databases that support researchers and promote infusion of successful technologies into existing processes; and -Develop new decision support strategies and presentation methodologies for applied earth science applications to reduce risk, cost, and time.

A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery.

PubMed

Fowler, G E; Baker, D M; Lee, M J; Brown, S R

2017-11-01

The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8). Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.

Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: an introduction.

PubMed

Gent, David H; De Wolf, Erick; Pethybridge, Sarah J

2011-06-01

Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence

PubMed Central

2014-01-01

Background Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. Methods We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Results Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Conclusion Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs. PMID:25167807

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence.

PubMed

Pevnick, Joshua M; Li, Ning; Asch, Steven M; Jackevicius, Cynthia A; Bell, Douglas S

2014-08-28

Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs.

Decision Support Systems for Research and Management in Advanced Life Support

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.

2004-01-01

Decision support systems have been implemented in many applications including strategic planning for battlefield scenarios, corporate decision making for business planning, production planning and control systems, and recommendation generators like those on Amazon.com(Registered TradeMark). Such tools are reviewed for developing a similar tool for NASA's ALS Program. DSS are considered concurrently with the development of the OPIS system, a database designed for chronicling of research and development in ALS. By utilizing the OPIS database, it is anticipated that decision support can be provided to increase the quality of decisions by ALS managers and researchers.

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

PubMed

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

2008-05-01

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

Decision Support Systems and the Conflict Model of Decision Making: A Stimulus for New Computer-Assisted Careers Guidance Systems.

ERIC Educational Resources Information Center

Ballantine, R. Malcolm

Decision Support Systems (DSSs) are computer-based decision aids to use when making decisions which are partially amenable to rational decision-making procedures but contain elements where intuitive judgment is an essential component. In such situations, DSSs are used to improve the quality of decision-making. The DSS approach is based on Simon's…

Collaborative Response and Recovery from a Foot-and-Mouth Disease Animal Health Emergency: Supporting Decision Making in a Complex Environment with Multiple Stakeholders

DTIC Science & Technology

2013-12-01

RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING IN A COMPLEX ENVIRONMENT WITH MULTIPLE...Thesis 4. TITLE AND SUBTITLE COLLABORATIVE RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING...200 words ) This thesis recommends ways to support decision makers who must operate within the multi-stakeholder complex situation of response and

SANDS: A Service-Oriented Architecture for Clinical Decision Support in a National Health Information Network

PubMed Central

Wright, Adam; Sittig, Dean F.

2008-01-01

In this paper we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. PMID:18434256

AppBuilder for DSSTools; an application development environment for developing decision support systems in Prolog

Treesearch

Geneho Kim; Donald Nute; H. Michael Rauscher; David L. Loftis

2000-01-01

A programming environment for developing complex decision support systems (DSSs) should support rapid prototyping and modular design, feature a flexible knowledge representation scheme and sound inference mechanisms, provide project management, and be domain independent. We have previously developed DSSTools (Decision Support System Tools), a reusable, domain-...

Withholding and withdrawing of life support from patients with severe head injury.

PubMed

O'Callahan, J G; Fink, C; Pitts, L H; Luce, J M

1995-09-01

To characterize the withholding or withdrawing of life support from patients with severe head injury. San Francisco General Hospital, a city and county hospital with a Level I trauma center. A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score of < or = 7) patients admitted to the medical-surgical intensive care unit, and to interview the patients' physician and family members. Forty-seven patients who were admitted to a medical-surgical intensive care unit over a 1-yr period. Twenty-four patients had life support withheld or withdrawn, and 23 patients did not. Physician and family separately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p < .001) prognosis on admission. Prognosis improved for two patients from the first group and five from the latter. Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p < .001). Physicians' ability to convey the prognosis appeared to influence families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from "likely death" to "vegetative." Care was therefore continued, and both patients remained vegetative 6 months after admission to the hospital and discharge to chronic care facilities. Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocal consideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.

Changing hospitals, choosing chemotherapy and deciding you've made the right choice: Understanding the role of online support groups in different health decision-making activities.

PubMed

Sillence, Elizabeth; Bussey, Lauren

2017-05-01

To investigate the ways in which people use online support groups (OSGs) in relation to their health decision-making and to identify the key features of the resource that support those activities. Eighteen participants who used OSGs for a range of health conditions participated in qualitative study in which they were interviewed about their experiences of using OSGs in relation to decision-making. Exploration of their experiences was supported by discussion of illustrative quotes. Across the health conditions OSGs supported two main decision-making activities: (i) prompting decision making and (ii) evaluating and confirming decisions already made. Depending on the activity, participants valued information about the process, the experience and the outcome of patient narratives. The importance of forum interactivity was highlighted in relation to advice-seeking and the selection of relevant personal experiences. People use OSGs in different ways to support their health related decision-making valuing the different content types of the narratives and the interactivity provided by the resource. Engaging with OSGs helps people in a number of different ways in relation to decision-making. However, it only forms one part of people's decision-making strategies and appropriate resources should be signposted where possible. Copyright © 2017 Elsevier B.V. All rights reserved.

Which species? A decision-support tool to guide plant selection in stormwater biofilters

NASA Astrophysics Data System (ADS)

Payne, Emily G. I.; Pham, Tracey; Deletic, Ana; Hatt, Belinda E.; Cook, Perran L. M.; Fletcher, Tim D.

2018-03-01

Plant species are diverse in form, function and environmental response. This provides enormous potential for designing nature-based stormwater treatment technologies, such as biofiltration systems. However, species can vary dramatically in their pollutant-removal performance, particularly for nitrogen removal. Currently, there is a lack of information on how to efficiently select from the vast palette of species. This study aimed to identify plant traits beneficial to performance and create a decision-support tool to screen species for further testing. A laboratory experiment using 220 biofilter columns paired plant morphological characteristics with nitrogen removal and water loss for 20 Australian native species and two lawn grasses. Testing was undertaken during wet and dry conditions, for two biofilter designs (saturated zone and free-draining). An extensive root system and high total biomass were critical to the effective removal of total nitrogen (TN) and nitrate (NO3-), driven by high nitrogen assimilation. The same characteristics were key to performance under dry conditions, and were associated with high water use for Australian native plants; linking assimilation and transpiration. The decision-support tool uses these scientific relationships and readily-available information to identify the morphology, natural distribution and stress tolerances likely to be good predictors of plant nitrogen and water uptake.

Use (and abuse) of expert elicitation in support of decision making for public policy

PubMed Central

Morgan, M. Granger

2014-01-01

The elicitation of scientific and technical judgments from experts, in the form of subjective probability distributions, can be a valuable addition to other forms of evidence in support of public policy decision making. This paper explores when it is sensible to perform such elicitation and how that can best be done. A number of key issues are discussed, including topics on which there are, and are not, experts who have knowledge that provides a basis for making informed predictive judgments; the inadequacy of only using qualitative uncertainty language; the role of cognitive heuristics and of overconfidence; the choice of experts; the development, refinement, and iterative testing of elicitation protocols that are designed to help experts to consider systematically all relevant knowledge when they make their judgments; the treatment of uncertainty about model functional form; diversity of expert opinion; and when it does or does not make sense to combine judgments from different experts. Although it may be tempting to view expert elicitation as a low-cost, low-effort alternative to conducting serious research and analysis, it is neither. Rather, expert elicitation should build on and use the best available research and analysis and be undertaken only when, given those, the state of knowledge will remain insufficient to support timely informed assessment and decision making. PMID:24821779

Assessment, design and control strategy development of a fuel cell hybrid electric vehicle for CSU's EcoCAR

NASA Astrophysics Data System (ADS)

Fox, Matthew D.

Advanced automotive technology assessment and powertrain design are increasingly performed through modeling, simulation, and optimization. But technology assessments usually target many competing criteria making any individual optimization challenging and arbitrary. Further, independent design simulations and optimizations take considerable time to execute, and design constraints and objectives change throughout the design process. Changes in design considerations usually require re-processing of simulations and more time. In this thesis, these challenges are confronted through CSU's participation in the EcoCAR2 hybrid vehicle design competition. The complexity of the competition's design objectives leveraged development of a decision support system tool to aid in multi-criteria decision making across technologies and to perform powertrain optimization. To make the decision support system interactive, and bypass the problem of long simulation times, a new approach was taken. The result of this research is CSU's architecture selection and component sizing, which optimizes a composite objective function representing the competition score. The selected architecture is an electric vehicle with an onboard range extending hydrogen fuel cell system. The vehicle has a 145kW traction motor, 18.9kWh of lithium ion battery, a 15kW fuel cell system, and 5kg of hydrogen storage capacity. Finally, a control strategy was developed that improves the vehicles performance throughout the driving range under variable driving conditions. In conclusion, the design process used in this research is reviewed and evaluated against other common design methodologies. I conclude, through the highlighted case studies, that the approach is more comprehensive than other popular design methodologies and is likely to lead to a higher quality product. The upfront modeling work and decision support system formulation will pay off in superior and timely knowledge transfer and more informed design decisions. The hypothesis is supported by the three case studies examined in this thesis.

The Design and Use of Decision Support Systems by Academic Departments. AIR 1987 Annual Forum Paper.

ERIC Educational Resources Information Center

Johnson, F. Craig

The design and use of a departmental decision support system at Florida State University are described from the perspective of a department head. The decisions selected for study are ones of adequacy, equitability, quality, efficiency, and consistency. The complexity of the decision is related to the complexity of the support system. The major…

A DICOM-RT radiation oncology ePR with decision support utilizing a quantified knowledge base from historical data

NASA Astrophysics Data System (ADS)

Documet, Jorge R.; Liu, Brent; Le, Anh; Law, Maria

2008-03-01

During the last 2 years we have been working on developing a DICOM-RT (Radiation Therapy) ePR (Electronic Patient Record) with decision support that will allow physicists and radiation oncologists during their decision-making process. This ePR allows offline treatment dose calculations and plan evaluation, while at the same time it compares and quantifies treatment planning algorithms using DICOM-RT objects. The ePR framework permits the addition of visualization, processing, and analysis tools, which combined with the core functionality of reporting, importing and exporting of medical studies, creates a very powerful application that can improve the efficiency while planning cancer treatments. Usually a Radiation Oncology department will have disparate and complex data generated by the RT modalities as well as data scattered in RT Information/Management systems, Record & Verify systems, and Treatment Planning Systems (TPS) which can compromise the efficiency of the clinical workflow since the data crucial for a clinical decision may be time-consuming to retrieve, temporarily missing, or even lost. To address these shortcomings, the ACR-NEMA Standards Committee extended its DICOM (Digital Imaging & Communications in Medicine) standard from Radiology to RT by ratifying seven DICOM RT objects starting in 1997 [1,2]. However, they are not broadly used yet by the RT community in daily clinical operations. In the past, the research focus of an RT department has primarily been developing new protocols and devices to improve treatment process and outcomes of cancer patients with minimal effort dedicated to integration of imaging and information systems. Our attempt is to show a proof-of-concept that a DICOM-RT ePR system can be developed as a foundation to perform medical imaging informatics research in developing decision-support tools and knowledge base for future data mining applications.

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

ERIC Educational Resources Information Center

Erskine, Michael A.

2013-01-01

As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…

Advancing the use of performance evaluation in health care.

PubMed

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

2014-01-01

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

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative

PubMed Central

Streiff, Michael B; Carolan, Howard T; Hobson, Deborah B; Kraus, Peggy S; Holzmueller, Christine G; Demski, Renee; Lau, Brandyn D; Biscup-Horn, Paula; Pronovost, Peter J

2012-01-01

Problem Venous thromboembolism (VTE) is a common cause of potentially preventable mortality, morbidity, and increased medical costs. Risk-appropriate prophylaxis can prevent most VTE events, but only a small fraction of patients at risk receive this treatment. Design Prospective quality improvement programme. Setting Johns Hopkins Hospital, Baltimore, Maryland, USA. Strategies for change A multidisciplinary team established a VTE Prevention Collaborative in 2005. The collaborative applied the four step TRIP (translating research into practice) model to develop and implement a mandatory clinical decision support tool for VTE risk stratification and risk-appropriate VTE prophylaxis for all hospitalised adult patients. Initially, paper based VTE order sets were implemented, which were then converted into 16 specialty-specific, mandatory, computerised, clinical decision support modules. Key measures for improvement VTE risk stratification within 24 hours of hospital admission and provision of risk-appropriate, evidence based VTE prophylaxis. Effects of change The VTE team was able to increase VTE risk assessment and ordering of risk-appropriate prophylaxis with paper based order sets to a limited extent, but achieved higher compliance with a computerised clinical decision support tool and the data feedback which it enabled. Risk-appropriate VTE prophylaxis increased from 26% to 80% for surgical patients and from 25% to 92% for medical patients in 2011. Lessons learnt A computerised clinical decision support tool can increase VTE risk stratification and risk-appropriate VTE prophylaxis among hospitalised adult patients admitted to a large urban academic medical centre. It is important to ensure the tool is part of the clinician’s normal workflow, is mandatory (computerised forcing function), and offers the requisite modules needed for every clinical specialty. PMID:22718994

Impaired decision making and delayed memory are related with anxiety and depressive symptoms in acromegaly.

PubMed

Crespo, Iris; Santos, Alicia; Valassi, Elena; Pires, Patricia; Webb, Susan M; Resmini, Eugenia

2015-12-01

Evaluation of cognitive function in acromegaly has revealed contradictory findings; some studies report normal cognition in patients with long-term cured acromegaly, while others show attention and memory deficits. Moreover, the presence of affective disorders in these patients is common. Our aim was to evaluate memory and decision making in acromegalic patients and explore their relationship with affective disorders like anxiety and depressive symptoms. Thirty-one patients with acromegaly (mean age 49.5 ± 8.5 years, 14 females and 17 males) and thirty-one healthy controls participated in this study. The Iowa Gambling Task (IGT), Rey Auditory Verbal Learning Test, State-Trait Anxiety Inventory, and Beck Depression Inventory-II (BDI-II) were used to evaluate decision making, verbal memory, anxiety, and depressive symptoms, respectively. Acromegalic patients showed impairments in delayed verbal memory (p < 0.05) and more anxiety and depressive symptoms (p < 0.05) than controls. In the IGT, acromegalic patients presented an altered decision-making strategy compared to controls, choosing a lower number of the safer cards (p < 0.05) and higher number of the riskier cards (p < 0.05). Moreover, multiple correlations between anxiety and depressive symptoms and performance in memory and decision making were found. Impaired delayed memory and decision making observed in acromegalic patients are related to anxiety and depressive symptoms. Providing emotional support to the patients could improve their cognitive function. A key clinical application of this research is the finding that depressive symptoms and anxiety are essentially modifiable factors.

From Different to Differentiated: Using "Ecological Framework" to Support Personally Relevant Access to General Curriculum for Students with Significant Intellectual Disabilities

ERIC Educational Resources Information Center

Trela, Katherine; Jimenez, Bree A.

2013-01-01

Language used in the field of special education is important; it can serve to influence both curriculum and placement decisions for students with intellectual disability. Historically, "Functional Curriculum" was used to describe curriculum adaptations necessary for students to access their environment (school and community). However,…

Computer-Mediated Counter-Arguments and Individual Learning

ERIC Educational Resources Information Center

Hsu, Jack Shih-Chieh; Huang, Hsieh-Hong; Linden, Lars P.

2011-01-01

This study explores a de-bias function for a decision support systems (DSS) that is designed to help a user avoid confirmation bias by increasing the user's learning opportunities. Grounded upon the theory of mental models, the use of DSS is viewed as involving a learning process, whereby a user is directed to build mental models so as to reduce…

Teradata University Network: A No Cost Web-Portal for Teaching Database, Data Warehousing, and Data-Related Subjects

ERIC Educational Resources Information Center

Jukic, Nenad; Gray, Paul

2008-01-01

This paper describes the value that information systems faculty and students in classes dealing with database management, data warehousing, decision support systems, and related topics, could derive from the use of the Teradata University Network (TUN), a free comprehensive web-portal. A detailed overview of TUN functionalities and content is…

Developing an Excel Decision Support System Using In-Transit Visibility to Decrease DoD Transportation Delays

DTIC Science & Technology

2008-03-01

Fortunately, built into Excel is the capability to use ActiveX Data Objects (ADO), a software feature which uses VBA to interface with external...part of Excel’s ActiveX Direct Objects (ADO) functionality, Excel can execute SQL queries in Access with VBA. An SQL query statement can be written

The treatment implementation advisor: a component of the GypsES project

Treesearch

Michael C. Saunders; Michael A. Foster

1991-01-01

The treatment implementation advisor is one of the knowledge based advisory modules of GypsES, a knowledge system environment for decision support in gypsy moth management. Its function is to provide detailed advice on intervention tactics for gypsy moth: e.g. aerial and ground application of insecticides and microbials, inundative or augmentative releases of...

Attack of the Teenage Brain! Understanding and Supporting the Weird and Wonderful Adolescent Learner

ERIC Educational Resources Information Center

Medina, John

2018-01-01

"Marvel" at the neuroscientific reasons why smart teens make dumb decisions! "Behold" the mind-controlling power of executive function! "Thrill" to a vision of a better school for the teenage brain! Whether you're a parent interacting with one adolescent or a teacher interacting with many, you know teens can be hard…

Information systems in ADOT : an analysis of intra-function flow, decision support needs, existing systems utility and user attitudes. Final report, volume 3 : appendices

DOT National Transportation Integrated Search

1985-03-01

A report is offered on a study of the information activities within the Right-of-Way section of ADOT. The objectives of the study were to adapt and apply techniques to measure user-perceived needs, satisfaction and utility of services provided Right-...

Information systems in ADOT : an analysis of intra-function flow, decision support needs, existing systems utility and user attitudes. Final report, volume 1

DOT National Transportation Integrated Search

1985-03-01

A report is offered on a study of the information activities within the Right-of-Way section of ADOT. The objectives of the study were to adapt and apply techniques to measure user-perceived needs, satisfaction and utility of services provided Right-...

Institutional Research in the USA: Adapting to Meet New Challenges

ERIC Educational Resources Information Center

Swing, Randy L.

2009-01-01

The varied roles and scope of the field of institutional research (IR) make any overview of this administrative function difficult. In the USA, colleges and universities may have a large, well-defined administrative unit performing data tasks to support decision-making, or they may have only a part-time individual who coordinates basic reporting…

Language differences in the brain network for reading in naturalistic story reading and lexical decision.

PubMed

Wang, Xiaojuan; Yang, Jianfeng; Yang, Jie; Mencl, W Einar; Shu, Hua; Zevin, Jason David

2015-01-01

Differences in how writing systems represent language raise important questions about whether there could be a universal functional architecture for reading across languages. In order to study potential language differences in the neural networks that support reading skill, we collected fMRI data from readers of alphabetic (English) and morpho-syllabic (Chinese) writing systems during two reading tasks. In one, participants read short stories under conditions that approximate natural reading, and in the other, participants decided whether individual stimuli were real words or not. Prior work comparing these two writing systems has overwhelmingly used meta-linguistic tasks, generally supporting the conclusion that the reading system is organized differently for skilled readers of Chinese and English. We observed that language differences in the reading network were greatly dependent on task. In lexical decision, a pattern consistent with prior research was observed in which the Middle Frontal Gyrus (MFG) and right Fusiform Gyrus (rFFG) were more active for Chinese than for English, whereas the posterior temporal sulcus was more active for English than for Chinese. We found a very different pattern of language effects in a naturalistic reading paradigm, during which significant differences were only observed in visual regions not typically considered specific to the reading network, and the middle temporal gyrus, which is thought to be important for direct mapping of orthography to semantics. Indeed, in areas that are often discussed as supporting distinct cognitive or linguistic functions between the two languages, we observed interaction. Specifically, language differences were most pronounced in MFG and rFFG during the lexical decision task, whereas no language differences were observed in these areas during silent reading of text for comprehension.

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

PubMed Central

Gisbert, Javier P; Calvet, Xavier

2013-01-01

OBJECTIVES: Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic–therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia. METHODS: Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses. RESULTS: Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori. CONCLUSIONS: The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that “the only good H. pylori is a dead H. pylori”. PMID:23535826

Information prioritization for control and automation of space operations

NASA Technical Reports Server (NTRS)

Ray, Asock; Joshi, Suresh M.; Whitney, Cynthia K.; Jow, Hong N.

1987-01-01

The applicability of a real-time information prioritization technique to the development of a decision support system for control and automation of Space Station operations is considered. The steps involved in the technique are described, including the definition of abnormal scenarios and of attributes, measures of individual attributes, formulation and optimization of a cost function, simulation of test cases on the basis of the cost function, and examination of the simulation scenerios. A list is given comparing the intrinsic importances of various Space Station information data.

From guideline modeling to guideline execution: defining guideline-based decision-support services.

PubMed Central

Tu, S. W.; Musen, M. A.

2000-01-01

We describe our task-based approach to defining the guideline-based decision-support services that the EON system provides. We categorize uses of guidelines in patient-specific decision support into a set of generic tasks--making of decisions, specification of work to be performed, interpretation of data, setting of goals, and issuance of alert and reminders--that can be solved using various techniques. Our model includes constructs required for representing the knowledge used by these techniques. These constructs form a toolkit from which developers can select modeling solutions for guideline task. Based on the tasks and the guideline model, we define a guideline-execution architecture and a model of interactions between a decision-support server and clients that invoke services provided by the server. These services use generic interfaces derived from guideline tasks and their associated modeling constructs. We describe two implementations of these decision-support services and discuss how this work can be generalized. We argue that a well-defined specification of guideline-based decision-support services will facilitate sharing of tools that implement computable clinical guidelines. PMID:11080007

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

PubMed

Williams, Iestyn P; Bryan, Stirling

2007-11-01

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

Tools to support GHG emissions reduction : a regional effort, part 1 - carbon footprint estimation and decision support.

DOT National Transportation Integrated Search

2010-09-01

Tools are proposed for carbon footprint estimation of transportation construction projects and decision support : for construction firms that must make equipment choice and usage decisions that affect profits, project duration : and greenhouse gas em...

Decision Support Framework (DSF) (Formerly Decision Support Platform)

EPA Science Inventory

The Science Advisory Board (SAB) provided several comments on the draft Ecosystem Services Research Program's (ESRP's) Multi-Year Plan (MYP). This presentation provides a response to comments related to the decision support framework (DSF) part of Long-Term Goal 1. The comments...

The Feasibility of a Decision Support System for the Determination of Source Selection Evaluation Criteria

DTIC Science & Technology

1984-09-01

is not only difficult and time consuming , but also crucial to the success of the project, the question is whether a decision support system designed...KtI I - uAujvhIMtf IENE In THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR THE DETERMINATION OF SOURCE SELECTION EVALUATION ’CRITERIA THESIS .2...INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DZM=0N STATEMENT A ,’r !’ILMILSHIM S /8 4 THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR

Application of a web-based Decision Support System in risk management

NASA Astrophysics Data System (ADS)

Aye, Zar Chi; Jaboyedoff, Michel; Derron, Marc-Henri

2013-04-01

Increasingly, risk information is widely available with the help of advanced technologies such as earth observation satellites, global positioning technologies, coupled with hazard modeling and analysis, and geographical information systems (GIS). Even though it exists, no effort will be put into action if it is not properly presented to the decision makers. These information need to be communicated clearly and show its usefulness so that people can make better informed decision. Therefore, communicating available risk information has become an important challenge and decision support systems have been one of the significant approaches which can help not only in presenting risk information to the decision makers but also in making efficient decisions while reducing human resources and time needed. In this study, the conceptual framework of an internet-based decision support system is presented to highlight its importance role in risk management framework and how it can be applied in case study areas chosen. The main purpose of the proposed system is to facilitate the available risk information in risk reduction by taking into account of the changes in climate, land use and socio-economic along with the risk scenarios. It allows the users to formulate, compare and select risk reduction scenarios (mainly for floods and landslides) through an enhanced participatory platform with diverse stakeholders' involvement in the decision making process. It is based on the three-tier (client-server) architecture which integrates web-GIS plus DSS functionalities together with cost benefit analysis and other supporting tools. Embedding web-GIS provides its end users to make better planning and informed decisions referenced to a geographical location, which is the one of the essential factors in disaster risk reduction programs. Different risk reduction measures of a specific area (local scale) will be evaluated using this web-GIS tool, available risk scenarios obtained from Probabilistic Risk Assessment (PRA) model and the knowledge collected from experts. The visualization of the risk reduction scenarios can also be shared among the users on the web to support the on-line participatory process. In addition, cost-benefit ratios of the different risk reduction scenarios can be prepared in order to serve as inputs for high-level decision makers. The most appropriate risk reduction scenarios will be chosen using Multi-Criteria Evaluation (MCE) method by weighting different parameters according to the preferences and criteria defined by the users. The role of public participation has been changing from one-way communication between authorities, experts, stakeholders and citizens towards more intensive two-way interaction. Involving the affected public and interest groups can enhance the level of legitimacy, transparency, and confidence in the decision making process. Due to its important part in decision making, online participatory tool is included in the DSS in order to allow the involved stakeholders interactively in risk reduction and be aware of the existing vulnerability conditions of the community. Moreover, it aims to achieve a more transparent and better informed decision-making process. The system is under in progress and the first tools implemented will be presented showing the wide possibilities of new web technologies which can have a great impact on the decision making process. It will be applied in four pilot areas in Europe: French Alps, North Eastern Italy, Romania and Poland. Nevertheless, the framework will be designed and implemented in a way to be applicable in any other regions.

Design and development of a mobile system for supporting emergency triage.

PubMed

Michalowski, W; Slowinski, R; Wilk, S; Farion, K J; Pike, J; Rubin, S

2005-01-01

Our objective was to design and develop a mobile clinical decision support system for emergency triage of different acute pain presentations. The system should interact with existing hospital information systems, run on mobile computing devices (handheld computers) and be suitable for operation in weak-connectivity conditions (with unstable connections between mobile clients and a server). The MET (Mobile Emergency Triage) system was designed following an extended client-server architecture. The client component, responsible for triage decision support, is built as a knowledge-based system, with domain ontology separated from generic problem solving methods and used for the automatic creation of a user interface. The MET system is well suited for operation in the Emergency Department of a hospital. The system's external interactions are managed by the server, while the MET clients, running on handheld computers are used by clinicians for collecting clinical data and supporting triage at the bedside. The functionality of the MET client is distributed into specialized modules, responsible for triaging specific types of acute pain presentations. The modules are stored on the server, and on request they can be transferred and executed on the mobile clients. The modular design provides for easy extension of the system's functionality. A clinical trial of the MET system validated the appropriateness of the system's design, and proved the usefulness and acceptance of the system in clinical practice. The MET system captures the necessary hospital data, allows for entry of patient information, and provides triage support. By operating on handheld computers, it fits into the regular emergency department workflow without introducing any hindrances or disruptions. It supports triage anytime and anywhere, directly at the point of care, and also can be used as an electronic patient chart, facilitating structured data collection.

Interpersonal reactivity and the attribution of emotional reactions.

PubMed

Haas, Brian W; Anderson, Ian W; Filkowski, Megan M

2015-06-01

The ability to identify the cause of another person's emotional reaction is an important component associated with improved success of social relationships and survival. Although many studies have investigated the mechanisms involved in emotion recognition, very little is currently known regarding the processes involved during emotion attribution decisions. Research on complementary "emotion understanding" mechanisms, including empathy and theory of mind, has demonstrated that emotion understanding decisions are often made through relatively emotion- or cognitive-based processing streams. The current study was designed to investigate the behavioral and brain mechanisms involved in emotion attribution decisions. We predicted that dual processes, emotional and cognitive, are engaged during emotion attribution decisions. Sixteen healthy adults completed the Interpersonal Reactivity Index to characterize individual differences in tendency to make emotion- versus cognitive-based interpersonal decisions. Participants then underwent functional MRI while making emotion attribution decisions. We found neuroimaging evidence that emotion attribution decisions engage a similar brain network as other forms of emotion understanding. Further, we found evidence in support of a dual processes model involved during emotion attribution decisions. Higher scores of personal distress were associated with quicker emotion attribution decisions and increased anterior insula activity. Conversely, higher scores in perspective taking were associated with delayed emotion attribution decisions and increased prefrontal cortex and premotor activity. These findings indicate that the making of emotion attribution decisions relies on dissociable emotional and cognitive processing streams within the brain. (c) 2015 APA, all rights reserved).

Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

PubMed

Jones, Emily; Wittie, Michael

2015-01-01

To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging. © Copyright 2015 by the American Board of Family Medicine.

A multiobjective decision support/numerical modeling approach for design and evaluation of shallow landfill burial systems

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

Ascough, II, James Clifford

1992-05-01

The capability to objectively evaluate design performance of shallow landfill burial (SLB) systems is of great interest to diverse scientific disciplines, including hydrologists, engineers, environmental scientists, and SLB regulators. The goal of this work was to develop and validate a procedure for the nonsubjective evaluation of SLB designs under actual or simulated environmental conditions. A multiobjective decision module (MDM) based on scoring functions (Wymore, 1988) was implemented to evaluate SLB design performance. Input values to the MDM are provided by hydrologic models. The MDM assigns a total score to each SLB design alternative, thereby allowing for rapid and repeatable designmore » performance evaluation. The MDM was validated for a wide range of SLB designs under different climatic conditions. Rigorous assessment of SLB performance also requires incorporation of hydrologic probabilistic analysis and hydrologic risk into the overall design. This was accomplished through the development of a frequency analysis module. The frequency analysis module allows SLB design event magnitudes to be calculated based on the hydrologic return period. The multiobjective decision and freqeuncy anslysis modules were integrated in a decision support system (DSS) framework, SLEUTH (Shallow Landfill Evaluation Using Transport and Hydrology). SLEUTH is a Microsoft Windows {trademark} application, and is written in the Knowledge Pro Windows (Knowledge Garden, Inc., 1991) development language.« less

Evaluating the independence of sex and expression in judgments of faces.

PubMed

Le Gal, Patricia M; Bruce, Vicki

2002-02-01

Face recognition models suggest independent processing for functionally different types of information, such as identity, expression, sex, and facial speech. Interference between sex and expression information was tested using both a rating study and Garner's selective attention paradigm using speeded sex and expression decisions. When participants were asked to assess the masculinity of male and female angry and surprised faces, they found surprised faces to be more feminine than angry ones (Experiment 1). However, in a speeded-classification situation in the laboratory in which the sex decision was either "easy" relative to the expression decision (Experiment 2) or of more equivalent difficulty (Experiment 3), it was possible for participants to attend selectively to either dimension without interference from the other. Qualified support is offered for independent processing routes.

Adaptation of a Knowledge-Based Decision-Support System in the Tactical Environment.

DTIC Science & Technology

1981-12-01

002-04-6411S1CURITY CL All PICATION OF 1,416 PAGE (00HIR Onto ea0aOW .L10 *GU9WVC 4bGSI.CAYON S. Voss 10466lVka t... OftesoE ’ making decisons . The...noe..aaw Ad tdlalttt’ IV 680011 MMib) Artificial Intelligence; Decision-Support Systems; Tactical Decision- making ; Knowledge-based Decision-support...tactical information to assist tactical commanders in making decisions. The system, TAC*, for "Tactical Adaptable Consultant," incorporates a database

Our Selections and Decisions: Inherent Features of the Nervous System?

NASA Astrophysics Data System (ADS)

Rösler, Frank

The chapter summarizes findings on the neuronal bases of decisionmaking. Taking the phenomenon of selection it will be explained that systems built only from excitatory and inhibitory neuron (populations) have the emergent property of selecting between different alternatives. These considerations suggest that there exists a hierarchical architecture with central selection switches. However, in such a system, functions of selection and decision-making are not localized, but rather emerge from an interaction of several participating networks. These are, on the one hand, networks that process specific input and output representations and, on the other hand, networks that regulate the relative activation/inhibition of the specific input and output networks. These ideas are supported by recent empirical evidence. Moreover, other studies show that rather complex psychological variables, like subjective probability estimates, expected gains and losses, prediction errors, etc., do have biological correlates, i.e., they can be localized in time and space as activation states of neural networks and single cells. These findings suggest that selections and decisions are consequences of an architecture which, seen from a biological perspective, is fully deterministic. However, a transposition of such nomothetic functional principles into the idiographic domain, i.e., using them as elements for comprehensive 'mechanistic' explanations of individual decisions, seems not to be possible because of principle limitations. Therefore, individual decisions will remain predictable by means of probabilistic models alone.

Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

PubMed

Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

2016-01-01

Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. Copyright 2016, SLACK Incorporated.

Developing a Decision Support System for Flood Response: NIMS/ICS Fundamentals

NASA Astrophysics Data System (ADS)

Gutenson, J. L.; Zhang, X.; Ernest, A. N. S.; Oubeidillah, A.; Zhu, L.

2015-12-01

Effective response to regional disasters such as floods requires a multipronged, non-linear approach to reduce loss of life, property and harm to the environment. These coordinated response actions are typically undertaken by multiple jurisdictions, levels of government, functional agencies and other responsible entities. A successful response is highly dependent on the effectiveness and efficiency of each coordinated response action undertaken across a broad spectrum of organizations and activities. In order to provide a unified framework for those responding to incidents or planned events, FEMA provides a common and flexible approach for managing incidents, regardless of cause, size, location or complexity, referred to as the National Incident Management System (NIMS). Integral to NIMS is the Incident Command System (ICS), which establishes a common, pre-defined organizational structure to ensure coordination and management of procedures, resources and communications, for efficient incident management. While being both efficient and rigorous, NIMS, and ICS to a lesser extent, is an inherently complex framework that requires significant amount of training for planners, responders and managers to master, especially considering the wide array of incident types that Local Emergency Planning Committees (LEPCs) must be prepared to respond to. The existing Water-Wizard Decision Support System (DSS), developed to support water distribution system recovery operations for Decontamination (Decon), Operational Optimization (WDS), and Economic Consequence Assessment (Econ), is being evolved to integrate incident response functions. Water-Wizard runs on both mobile and desktop devices, and is being extended to utilize smartphone and mobile device specific data streams (e.g GPS location) to augment its fact-base in real-time for situational-aware DSS recommendations. In addition, the structured NIMS and ICS frameworks for incident management and response are being incorporated into the Water-Wizard knowledgebase, with a mid-term goal of integrating flood-specific emergency response domain knowledge to provide a real-time flood responder decision support.

An Investment Behavior Analysis using by Brain Computer Interface

NASA Astrophysics Data System (ADS)

Suzuki, Kyoko; Kinoshita, Kanta; Miyagawa, Kazuhiro; Shiomi, Shinichi; Misawa, Tadanobu; Shimokawa, Tetsuya

In this paper, we will construct a new Brain Computer Interface (BCI), for the purpose of analyzing human's investment decision makings. The BCI is made up of three functional parts which take roles of, measuring brain information, determining market price in an artificial market, and specifying investment decision model, respectively. When subjects make decisions, their brain information is conveyed to the part of specifying investment decision model through the part of measuring brain information, whereas, their decisions of investment order are sent to the part of artificial market to form market prices. Both the support vector machine and the 3 layered perceptron are used to assess the investment decision model. In order to evaluate our BCI, we conduct an experiment in which subjects and a computer trader agent trade shares of stock in the artificial market and test how the computer trader agent can forecast market price formation and investment decision makings from the brain information of subjects. The result of the experiment shows that the brain information can improve the accuracy of forecasts, and so the computer trader agent can supply market liquidity to stabilize market volatility without his loss.

Reward-related decision making in eating and weight disorders: A systematic review and meta-analysis of the evidence from neuropsychological studies.

PubMed

Wu, Mudan; Brockmeyer, Timo; Hartmann, Mechthild; Skunde, Mandy; Herzog, Wolfgang; Friederich, Hans-Christoph

2016-02-01

Eating disorders (EDs) and overweight/obesity (OW/OB) are serious public health concerns that share common neuropsychological features and patterns of disturbed eating. Reward-related decision making as a basic neurocognitive function may trans-diagnostically underlie both pathological overeating and restricted eating. The present meta-analysis synthesizes the evidence from N=82 neuropsychological studies for altered reward-related decision making in all ED subtypes, OW and OB. The overall effect sizes for the differences between currently-ill ED patients and OW/OB people and controls were Hedge's g=-0.49 [CI: -0.63; -0.35], and Hedge's g=-0.39 [CI: -0.53; -0.25], respectively. Decision making was found to be altered to similar degrees in all ED subtypes and OB. Effect sizes, however, diverged for the different measures of decision making. Adolescents appear to be less affected than adults. When foods were used as rewarding stimuli, decision making was found to be intact in OB. The findings support that altered general reward-related decision making is a salient neuropsychological factor across eating and weight disorders in adulthood. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Contribution of a Decision Support System to Educational Decision-Making Processes

ERIC Educational Resources Information Center

Klein, Joseph; Ronen, Herman

2003-01-01

In the light of reports of bias, the present study investigated the hypothesis that administrative educational decisions assisted by Decision Support Systems (DSS) are characterized by different pedagogical and organizational orientation than decisions made without computer assistance. One hundred and ten high school teachers were asked to suggest…

Strategies to facilitate shared decision-making about pediatric oncology clinical trial enrollment: A systematic review.

PubMed

Robertson, Eden G; Wakefield, Claire E; Signorelli, Christina; Cohn, Richard J; Patenaude, Andrea; Foster, Claire; Pettit, Tristan; Fardell, Joanna E

2018-07-01

We conducted a systematic review to identify the strategies that have been recommended in the literature to facilitate shared decision-making regarding enrolment in pediatric oncology clinical trials. We searched seven databases for peer-reviewed literature, published 1990-2017. Of 924 articles identified, 17 studies were eligible for the review. We assessed study quality using the 'Mixed-Methods Appraisal Tool'. We coded the results and discussions of papers line-by-line using nVivo software. We categorized strategies thematically. Five main themes emerged: 1) decision-making as a process, 2) individuality of the process; 3) information provision, 4) the role of communication, or 5) decision and psychosocial support. Families should have adequate time to make a decision. HCPs should elicit parents' and patients' preferences for level of information and decision involvement. Information should be clear and provided in multiple modalities. Articles also recommended providing training for healthcare professionals and access to psychosocial support for families. High quality, individually-tailored information, open communication and psychosocial support appear vital in supporting decision-making regarding enrollment in clinical trials. These data will usefully inform future decision-making interventions/tools to support families making clinical trial decisions. A solid evidence-base for effective strategies which facilitate shared decision-making is needed. Copyright © 2018 Elsevier B.V. All rights reserved.

Introduction to Decision Support Systems for Risk Based Management of Contaminated Sites

EPA Science Inventory

A book on Decision Support Systems for Risk-based Management of contaminated sites is appealing for two reasons. First, it addresses the problem of contaminated sites, which has worldwide importance. Second, it presents Decision Support Systems (DSSs), which are powerful comput...

Decision support systems in water and wastewater treatment process selection and design: a review.

PubMed

Hamouda, M A; Anderson, W B; Huck, P M

2009-01-01

The continuously changing drivers of the water treatment industry, embodied by rigorous environmental and health regulations and the challenge of emerging contaminants, necessitates the development of decision support systems for the selection of appropriate treatment trains. This paper explores a systematic approach to developing decision support systems, which includes the analysis of the treatment problem(s), knowledge acquisition and representation, and the identification and evaluation of criteria controlling the selection of optimal treatment systems. The objective of this article is to review approaches and methods used in decision support systems developed to aid in the selection, sequencing of unit processes and design of drinking water, domestic wastewater, and industrial wastewater treatment systems. Not surprisingly, technical considerations were found to dominate the logic of the developed systems. Most of the existing decision-support tools employ heuristic knowledge. It has been determined that there is a need to develop integrated decision support systems that are generic, usable and consider a system analysis approach.

Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition.

PubMed

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems.

A decision-supported outpatient practice system.

PubMed Central

Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

1996-01-01

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

Big-Data Based Decision-Support Systems to Improve Clinicians’ Cognition

PubMed Central

Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians’ cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems. PMID:27990498

The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt

PubMed Central

Miller, Randolph A.; Waitman, Lemuel R.; Chen, Sutin; Rosenbloom, S. Trent

2006-01-01

The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt’s inpatient “WizOrder” care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. From their empirical observations, the authors have developed a generic model for decision support within inpatient CPOE systems. They believe that the model’s utility extends beyond Vanderbilt, because it is based on characteristics of end-user workflows and on decision support considerations that are common to a variety of inpatient settings and CPOE systems. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create (for which the authors describe 4 general categories); when to introduce the intervention into the user’s workflow (for which the authors present 7 categories), and how disruptive, during use of the system, the intervention might be to end-users’ workflows (for which the authors describe 6 categories). Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise. PMID:16290243

Home care decision support using an Arden engine--merging smart home and vital signs data.

PubMed

Marschollek, Michael; Bott, Oliver J; Wolf, Klaus-H; Gietzelt, Matthias; Plischke, Maik; Madiesh, Moaaz; Song, Bianying; Haux, Reinhold

2009-01-01

The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary. The aim of our research work is to present a laboratory prototype home care architecture that integrates data from different sources and uses a decision support system based on the HL7 standard Arden Syntax for Medical Logical Modules. Data from environmental sensors connected to a home bus system are stored in a data base along with data from wireless medical sensors. All data are analyzed using an Arden engine with the medical knowledge represented in Medical Logic Modules. Multi-modal data from four different sensors in the home environment are stored in a single data base and are analyzed using an HL7 standard conformant decision support system. Individualized home care decision support must be based on all data available, including context data from smart home systems and medical data from electronic health records. Our prototype implementation shows the feasibility of using an Arden engine for decision support in a home setting. Our future work will include the utilization of medical background knowledge for individualized decision support, as there is no one-size-fits-all knowledge base in medicine.

Knowledge mobilisation for policy development: implementing systems approaches through participatory dynamic simulation modelling.

PubMed

Freebairn, Louise; Rychetnik, Lucie; Atkinson, Jo-An; Kelly, Paul; McDonnell, Geoff; Roberts, Nick; Whittall, Christine; Redman, Sally

2017-10-02

Evidence-based decision-making is an important foundation for health policy and service planning decisions, yet there remain challenges in ensuring that the many forms of available evidence are considered when decisions are being made. Mobilising knowledge for policy and practice is an emergent process, and one that is highly relational, often messy and profoundly context dependent. Systems approaches, such as dynamic simulation modelling can be used to examine both complex health issues and the context in which they are embedded, and to develop decision support tools. This paper reports on the novel use of participatory simulation modelling as a knowledge mobilisation tool in Australian real-world policy settings. We describe how this approach combined systems science methodology and some of the core elements of knowledge mobilisation best practice. We describe the strategies adopted in three case studies to address both technical and socio-political issues, and compile the experiential lessons derived. Finally, we consider the implications of these knowledge mobilisation case studies and provide evidence for the feasibility of this approach in policy development settings. Participatory dynamic simulation modelling builds on contemporary knowledge mobilisation approaches for health stakeholders to collaborate and explore policy and health service scenarios for priority public health topics. The participatory methods place the decision-maker at the centre of the process and embed deliberative methods and co-production of knowledge. The simulation models function as health policy and programme dynamic decision support tools that integrate diverse forms of evidence, including research evidence, expert knowledge and localised contextual information. Further research is underway to determine the impact of these methods on health service decision-making.

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

PubMed

Gillespie, Mary

2010-11-01

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

Decision support models for solid waste management: Review and game-theoretic approaches

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

Karmperis, Athanasios C., E-mail: athkarmp@mail.ntua.gr; Army Corps of Engineers, Hellenic Army General Staff, Ministry of Defence; Aravossis, Konstantinos

Highlights: ► The mainly used decision support frameworks for solid waste management are reviewed. ► The LCA, CBA and MCDM models are presented and their strengths, weaknesses, similarities and possible combinations are analyzed. ► The game-theoretic approach in a solid waste management context is presented. ► The waste management bargaining game is introduced as a specific decision support framework. ► Cooperative and non-cooperative game-theoretic approaches to decision support for solid waste management are discussed. - Abstract: This paper surveys decision support models that are commonly used in the solid waste management area. Most models are mainly developed within three decisionmore » support frameworks, which are the life-cycle assessment, the cost–benefit analysis and the multi-criteria decision-making. These frameworks are reviewed and their strengths and weaknesses as well as their critical issues are analyzed, while their possible combinations and extensions are also discussed. Furthermore, the paper presents how cooperative and non-cooperative game-theoretic approaches can be used for the purpose of modeling and analyzing decision-making in situations with multiple stakeholders. Specifically, since a waste management model is sustainable when considering not only environmental and economic but also social aspects, the waste management bargaining game is introduced as a specific decision support framework in which future models can be developed.« less

Symbrachydactyly.

PubMed

Goodell, Parker B; Bauer, Andrea S; Sierra, Francisco J A; James, Michelle A

2016-09-01

Background: Symbrachydactyly is a unilateral congenital hand malformation characterized by failure of formation of fingers and the presence of rudimentary digit nubbins. The management is variable and are investigated in this review. Methods: A detailed review of the literature was compiled into succinct clinically relevant categories. Results: Etiology, classification, non-surgical management, surgical intervention, and patient oriented outcomes are discussed. Conclusions: All interventions should prioritize realistic, evidence-supported appearance and functional gains. Studies of the baseline function and quality of life of children with symbrachydactyly would allow surgeons to better understand functional changes associated with various interventions and would help surgeons and parents to make the best treatment decisions.

New integrated and multiscale decision-aiding framework in a context of imperfect information: application to the assessment of torrent checkdams' effectiveness.

NASA Astrophysics Data System (ADS)

Tacnet, Jean-Marc; Carladous, Simon; Dezert, Jean; Batton-Hubert, Mireille

2017-04-01

Mountain natural phenomena (e.g. torrential floods) put people and buildings at risk. Civil engineering protection works such as torrent check-dams are designed to mitigate those natural risks. Protection works act on both causes and effects of phenomena to reduce consequences and therefore risks. For instance, check-dams control sediment production and liquid/solid flow of torrential floods: several series of dams are located in the headwaters of a watershed, each having specific functions. All those works are damaged by time passing and flood impacts. Effectiveness assessment is needed to define, compare or choose strategies for investment and maintenance which are essential issues in risk management process. Decision support tools are expected to analyze at different scales both their technical effectiveness (related to their structural state and functional effects on phenomena such as stopping, braking, guiding, etc.) and their economic efficiency through comparison between benefits and costs. Several methods, often based on expert knowledge, have already been developed to care about decision under risk. But uncertainty has also to be considered, since decisions are indeed often taken in a context of lack of information and knowledge on natural phenomena, heterogeneity of available information and, finally, reliability of sources. First methods derived from classical industrial contexts, such as dependability analysis, are used to formalize expert knowledge used for decision-making. After having defined the concept of effectiveness, dependability analysis are used to identify decision contexts and problems: criteria and indicators are identified in relation with structural or functional features. Then, innovative and multi-scales multi-criteria decision-making methods (MCDMs) and frameworks are proposed to help assessing protection works effectiveness. They combine classical MCDM approaches, belief function, fuzzy sets and possibility theories. Those methods allow to make decisions based on heterogeneous, imprecise and uncertain evaluation of criteria provided by more or less reliable sources in an uncertain context: COWA-ER (Cautious Ordered Weighted Averaging with Evidential Reasoning), Fuzzy-Cautious OWA or ER-MCDA (Evidential Reasoning for Multi Criteria Decision Analysis) are thus applied to several scales of torrent check-dams' effectiveness assessment. Those methods are then improved for a better knowledge representation and final decision. Enhanced methods are then associated together. Finally, individual problems and associated methods are integrated in a generic methodology to move from torrential protective single measure effectiveness assessment to complete protection systems at watershed scale.

Surface transportation weather decision support requirements : advanced-integrated decision support using weather information for surface transportation decisions makers : draft (truncated*) version 1.0

DOT National Transportation Integrated Search

1997-09-19

This report gives an overview of the National Intelligent Transportation Infrastructure Initiative (NITI). NITI refers to the integrated electronics, communications, and hardware and software elements that are available to support Intelligent Transpo...

E-Estuary: Developing a Decision-support System for Coastal Management in the Conterminous United States

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The United States Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E...

Prosthodontic decision-making relating to dentitions with compromised molars: the perspective of Swedish General Dental Practitioners.

PubMed

Korduner, E-K; Collin Bagewitz, I; Vult von Steyern, P; Wolf, E

2016-12-01

The aim of this investigation was to study the clinical prosthodontic decision-making process relating to dentitions with compromised molars among Swedish general dental practitioners (GDPs). Eleven Swedish GDPs were purposively selected, and all agreed to participate. Then, in-depth, semi-structured interviews were conducted and covered treatment considerations concerning two authentic patient cases, initially with complete dental arches, and later, a final treatment based on a shortened dental arch (SDA) was discussed. The cases involved patients with compromised teeth situated mainly in the molar regions. One patient suffered from extensive caries and the other from severe periodontal disease. Qualitative content analysis was used to analyse the data. In the systematic analysis, two main categories were identified: holistic and functional approach. Among the interviewed GDPs, focus was put on patients' needs, background history and motivation for treatment as well as the preservation of molar support. Within the limitations of this study, the following can be concluded: keeping a dental arch with molars seems to be important to Swedish general dental practitioners. The SDA concept does not seem to have a substantial impact on the prosthodontic decision-making relating to dentitions with compromised molars. The dentist's experiences, as well as colleagues' or consulting specialist advice together with aetiological factors and the patient's individual situation, influence the decision-making more than the SDA concept. The conflicting results in the prosthetic decision-making process concerning the relevance of age and the need for molar support need further investigation, for example based on decisions made in the dentist's own clinical practice. © 2016 John Wiley & Sons Ltd.

Visualization-based decision support for value-driven system design

NASA Astrophysics Data System (ADS)

Tibor, Elliott

In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations with a Value-Driven Design formulation. The visualization methods are also used to assist in the decomposition of a value function, by representing attribute sensitivities to aid with trade-off studies. Lastly, visualization is used to enable greater understanding of the subsystem relationships, by displaying derivative-based couplings, and the design uncertainties, through implementation of utility theory. The use of these visualization methods is shown to enhance the decision-making capabilities of the designer by granting them a more holistic view of the complex design space.

New approaches for real time decision support systems

NASA Technical Reports Server (NTRS)

Hair, D. Charles; Pickslay, Kent

1994-01-01

NCCOSC RDT&E Division (NRaD) is conducting research into ways of improving decision support systems (DSS) that are used in tactical Navy decision making situations. The research has focused on the incorporation of findings about naturalistic decision-making processes into the design of the DSS. As part of that research, two computer tools were developed that model the two primary naturalistic decision-making strategies used by Navy experts in tactical settings. Current work is exploring how best to incorporate the information produced by those tools into an existing simulation of current Navy decision support systems. This work has implications for any applications involving the need to make decisions under time constraints, based on incomplete or ambiguous data.

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

GWM-a ground-water management process for the U.S. Geological Survey modular ground-water model (MODFLOW-2000)

USGS Publications Warehouse

Ahlfeld, David P.; Barlow, Paul M.; Mulligan, Anne E.

2005-01-01

GWM is a Ground?Water Management Process for the U.S. Geological Survey modular three?dimensional ground?water model, MODFLOW?2000. GWM uses a response?matrix approach to solve several types of linear, nonlinear, and mixed?binary linear ground?water management formulations. Each management formulation consists of a set of decision variables, an objective function, and a set of constraints. Three types of decision variables are supported by GWM: flow?rate decision variables, which are withdrawal or injection rates at well sites; external decision variables, which are sources or sinks of water that are external to the flow model and do not directly affect the state variables of the simulated ground?water system (heads, streamflows, and so forth); and binary variables, which have values of 0 or 1 and are used to define the status of flow?rate or external decision variables. Flow?rate decision variables can represent wells that extend over one or more model cells and be active during one or more model stress periods; external variables also can be active during one or more stress periods. A single objective function is supported by GWM, which can be specified to either minimize or maximize the weighted sum of the three types of decision variables. Four types of constraints can be specified in a GWM formulation: upper and lower bounds on the flow?rate and external decision variables; linear summations of the three types of decision variables; hydraulic?head based constraints, including drawdowns, head differences, and head gradients; and streamflow and streamflow?depletion constraints. The Response Matrix Solution (RMS) Package of GWM uses the Ground?Water Flow Process of MODFLOW to calculate the change in head at each constraint location that results from a perturbation of a flow?rate variable; these changes are used to calculate the response coefficients. For linear management formulations, the resulting matrix of response coefficients is then combined with other components of the linear management formulation to form a complete linear formulation; the formulation is then solved by use of the simplex algorithm, which is incorporated into the RMS Package. Nonlinear formulations arise for simulated conditions that include water?table (unconfined) aquifers or head?dependent boundary conditions (such as streams, drains, or evapotranspiration from the water table). Nonlinear formulations are solved by sequential linear programming; that is, repeated linearization of the nonlinear features of the management problem. In this approach, response coefficients are recalculated for each iteration of the solution process. Mixed?binary linear (or mildly nonlinear) formulations are solved by use of the branch and bound algorithm, which is also incorporated into the RMS Package. Three sample problems are provided to demonstrate the use of GWM for typical ground?water flow management problems. These sample problems provide examples of how GWM input files are constructed to specify the decision variables, objective function, constraints, and solution process for a GWM run. The GWM Process runs with the MODFLOW?2000 Global and Ground?Water Flow Processes, but in its current form GWM cannot be used with the Observation, Sensitivity, Parameter?Estimation, or Ground?Water Transport Processes. The GWM Process is written with a modular structure so that new objective functions, constraint types, and solution algorithms can be added.

Exploring the existential function of religion: the effect of religious fundamentalism and mortality salience on faith-based medical refusals.

PubMed

Vess, Matthew; Arndt, Jamie; Cox, Cathy R; Routledge, Clay; Goldenberg, Jamie L

2009-08-01

Decisions to rely on religious faith over medical treatment for health conditions represent an important but understudied phenomenon. In an effort to understand some of the psychological underpinnings of such decisions, the present research builds from terror management theory to examine whether reminders of death motivate individuals strongly invested in a religious worldview (i.e., fundamentalists) to rely on religious beliefs when making medical decisions. The results showed that heightened concerns about mortality led those high in religious fundamentalism to express greater endorsement of prayer as a medical substitute (Study 1) and to perceive prayer as a more effective medical treatment (Study 2). Similarly, high fundamentalists were more supportive of religiously motivated medical refusals (Study 3) and reported an increased willingness to rely on faith alone for medical treatment (Study 4) following reminders of death. Finally, affirmations of the legitimacy of divine intervention in health contexts functioned to solidify a sense of existential meaning among fundamentalists who were reminded of personal mortality (Study 5). The existential importance of religious faith and the health-relevant implications of these findings are discussed.

Flexible establishment of functional brain networks supports attentional modulation of unconscious cognition.

PubMed

Ulrich, Martin; Adams, Sarah C; Kiefer, Markus

2014-11-01

In classical theories of attention, unconscious automatic processes are thought to be independent of higher-level attentional influences. Here, we propose that unconscious processing depends on attentional enhancement of task-congruent processing pathways implemented by a dynamic modulation of the functional communication between brain regions. Using functional magnetic resonance imaging, we tested our model with a subliminally primed lexical decision task preceded by an induction task preparing either a semantic or a perceptual task set. Subliminal semantic priming was significantly greater after semantic compared to perceptual induction in ventral occipito-temporal (vOT) and inferior frontal cortex, brain areas known to be involved in semantic processing. The functional connectivity pattern of vOT varied depending on the induction task and successfully predicted the magnitude of behavioral and neural priming. Together, these findings support the proposal that dynamic establishment of functional networks by task sets is an important mechanism in the attentional control of unconscious processing. © 2014 Wiley Periodicals, Inc.

Audio-video decision support for patients: the documentary genré as a basis for decision aids.

PubMed

Volandes, Angelo E; Barry, Michael J; Wood, Fiona; Elwyn, Glyn

2013-09-01

Decision support tools are increasingly using audio-visual materials. However, disagreement exists about the use of audio-visual materials as they may be subjective and biased. This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio-visual materials. Three concerns arising from documentary film studies as they apply to the use of audio-visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio-visual materials (selection bias) and how to ensure objectivity (editorial bias). Decision science needs to start a debate about how audio-visual materials are to be used in decision support tools. Simply because audio-visual materials may be subjective and open to bias does not mean that we should not use them. Methods need to be found to ensure consensus around balance and editorial control, such that audio-visual materials can be used. © 2011 John Wiley & Sons Ltd.

Audio‐video decision support for patients: the documentary genré as a basis for decision aids

PubMed Central

Volandes, Angelo E.; Barry, Michael J.; Wood, Fiona; Elwyn, Glyn

2011-01-01

Abstract Objective  Decision support tools are increasingly using audio‐visual materials. However, disagreement exists about the use of audio‐visual materials as they may be subjective and biased. Methods  This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. Results  The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio‐visual materials. Three concerns arising from documentary film studies as they apply to the use of audio‐visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio‐visual materials (selection bias) and how to ensure objectivity (editorial bias). Discussion  Decision science needs to start a debate about how audio‐visual materials are to be used in decision support tools. Simply because audio‐visual materials may be subjective and open to bias does not mean that we should not use them. Conclusion  Methods need to be found to ensure consensus around balance and editorial control, such that audio‐visual materials can be used. PMID:22032516

Gratitude: a tool for reducing economic impatience.

PubMed

DeSteno, David; Li, Ye; Dickens, Leah; Lerner, Jennifer S

2014-06-01

The human mind tends to excessively discount the value of delayed rewards relative to immediate ones, and it is thought that "hot" affective processes drive desires for short-term gratification. Supporting this view, recent findings demonstrate that sadness exacerbates financial impatience even when the sadness is unrelated to the economic decision at hand. Such findings might reinforce the view that emotions must always be suppressed to combat impatience. But if emotions serve adaptive functions, then certain emotions might be capable of reducing excessive impatience for delayed rewards. We found evidence supporting this alternative view. Specifically, we found that (a) the emotion gratitude reduces impatience even when real money is at stake, and (b) the effects of gratitude are differentiable from those of the more general positive state of happiness. These findings challenge the view that individuals must tamp down affective responses through effortful self-regulation to reach more patient and adaptive economic decisions. © The Author(s) 2014.

Design of a Multi-mode Flight Deck Decision Support System for Airborne Conflict Management

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Krishnamurthy, Karthik

2004-01-01

NASA Langley has developed a multi-mode decision support system for pilots operating in a Distributed Air-Ground Traffic Management (DAG-TM) environment. An Autonomous Operations Planner (AOP) assists pilots in performing separation assurance functions, including conflict detection, prevention, and resolution. Ongoing AOP design has been based on a comprehensive human factors analysis and evaluation results from previous human-in-the-loop experiments with airline pilot test subjects. AOP considers complex flight mode interactions and provides flight guidance to pilots consistent with the current aircraft control state. Pilots communicate goals to AOP by setting system preferences and actively probing potential trajectories for conflicts. To minimize training requirements and improve operational use, AOP design leverages existing alerting philosophies, displays, and crew interfaces common on commercial aircraft. Future work will consider trajectory prediction uncertainties, integration with the TCAS collision avoidance system, and will incorporate enhancements based on an upcoming air-ground coordination experiment.

The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

NASA Technical Reports Server (NTRS)

Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

2009-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

Probabilistic Decision Making with Spikes: From ISI Distributions to Behaviour via Information Gain.

PubMed

Caballero, Javier A; Lepora, Nathan F; Gurney, Kevin N

2015-01-01

Computational theories of decision making in the brain usually assume that sensory 'evidence' is accumulated supporting a number of hypotheses, and that the first accumulator to reach threshold triggers a decision in favour of its associated hypothesis. However, the evidence is often assumed to occur as a continuous process whose origins are somewhat abstract, with no direct link to the neural signals - action potentials or 'spikes' - that must ultimately form the substrate for decision making in the brain. Here we introduce a new variant of the well-known multi-hypothesis sequential probability ratio test (MSPRT) for decision making whose evidence observations consist of the basic unit of neural signalling - the inter-spike interval (ISI) - and which is based on a new form of the likelihood function. We dub this mechanism s-MSPRT and show its precise form for a range of realistic ISI distributions with positive support. In this way we show that, at the level of spikes, the refractory period may actually facilitate shorter decision times, and that the mechanism is robust against poor choice of the hypothesized data distribution. We show that s-MSPRT performance is related to the Kullback-Leibler divergence (KLD) or information gain between ISI distributions, through which we are able to link neural signalling to psychophysical observation at the behavioural level. Thus, we find the mean information needed for a decision is constant, thereby offering an account of Hick's law (relating decision time to the number of choices). Further, the mean decision time of s-MSPRT shows a power law dependence on the KLD offering an account of Piéron's law (relating reaction time to stimulus intensity). These results show the foundations for a research programme in which spike train analysis can be made the basis for predictions about behavior in multi-alternative choice tasks.

Probabilistic Decision Making with Spikes: From ISI Distributions to Behaviour via Information Gain

PubMed Central

Caballero, Javier A.; Lepora, Nathan F.; Gurney, Kevin N.

2015-01-01

Computational theories of decision making in the brain usually assume that sensory 'evidence' is accumulated supporting a number of hypotheses, and that the first accumulator to reach threshold triggers a decision in favour of its associated hypothesis. However, the evidence is often assumed to occur as a continuous process whose origins are somewhat abstract, with no direct link to the neural signals - action potentials or 'spikes' - that must ultimately form the substrate for decision making in the brain. Here we introduce a new variant of the well-known multi-hypothesis sequential probability ratio test (MSPRT) for decision making whose evidence observations consist of the basic unit of neural signalling - the inter-spike interval (ISI) - and which is based on a new form of the likelihood function. We dub this mechanism s-MSPRT and show its precise form for a range of realistic ISI distributions with positive support. In this way we show that, at the level of spikes, the refractory period may actually facilitate shorter decision times, and that the mechanism is robust against poor choice of the hypothesized data distribution. We show that s-MSPRT performance is related to the Kullback-Leibler divergence (KLD) or information gain between ISI distributions, through which we are able to link neural signalling to psychophysical observation at the behavioural level. Thus, we find the mean information needed for a decision is constant, thereby offering an account of Hick's law (relating decision time to the number of choices). Further, the mean decision time of s-MSPRT shows a power law dependence on the KLD offering an account of Piéron's law (relating reaction time to stimulus intensity). These results show the foundations for a research programme in which spike train analysis can be made the basis for predictions about behavior in multi-alternative choice tasks. PMID:25923907

Decision-Making Amplification under Uncertainty: An Exploratory Study of Behavioral Similarity and Intelligent Decision Support Systems

ERIC Educational Resources Information Center

Campbell, Merle Wayne

2013-01-01

Intelligent decision systems have the potential to support and greatly amplify human decision-making across a number of industries and domains. However, despite the rapid improvement in the underlying capabilities of these "intelligent" systems, increasing their acceptance as decision aids in industry has remained a formidable challenge.…

The design of aircraft using the decision support problem technique

NASA Technical Reports Server (NTRS)

Mistree, Farrokh; Marinopoulos, Stergios; Jackson, David M.; Shupe, Jon A.

1988-01-01

The Decision Support Problem Technique for unified design, manufacturing and maintenance is being developed at the Systems Design Laboratory at the University of Houston. This involves the development of a domain-independent method (and the associated software) that can be used to process domain-dependent information and thereby provide support for human judgment. In a computer assisted environment, this support is provided in the form of optimal solutions to Decision Support Problems.

Functional Freedom: A Psychological Model of Freedom in Decision-Making.

PubMed

Lau, Stephan; Hiemisch, Anette

2017-07-05

The freedom of a decision is not yet sufficiently described as a psychological variable. We present a model of functional decision freedom that aims to fill that role. The model conceptualizes functional freedom as a capacity of people that varies depending on certain conditions of a decision episode. It denotes an inner capability to consciously shape complex decisions according to one's own values and needs. Functional freedom depends on three compensatory dimensions: it is greatest when the decision-maker is highly rational, when the structure of the decision is highly underdetermined, and when the decision process is strongly based on conscious thought and reflection. We outline possible research questions, argue for psychological benefits of functional decision freedom, and explicate the model's implications on current knowledge and research. In conclusion, we show that functional freedom is a scientific variable, permitting an additional psychological foothold in research on freedom, and that is compatible with a deterministic worldview.

E-Estuary: Developing a Decision Support System for Coastal Management in the Conterminous United States (IAHR)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-Estuary: Developing a Decision-support System for Coastal Management in the Counterminous Untied States (Coastal Geotools 09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-estuary: A Decision Support System for Coastal Water and Ecosystem Management in the US (CZ09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

Becoming a Mother: Supported Decision-Making in Context

ERIC Educational Resources Information Center

Jamieson, Rhiann; Theodore, Kate; Raczka, Roman

2016-01-01

Little is known about how women with intellectual disabilities make decisions in relation to pregnancy. Social support is important for mothers with intellectual disabilities in many areas. This study explored how the support network influenced the decision-making of women with intellectual disabilities in relation to pregnancy. The study extended…

Moving toward climate-informed agricultural decision support - can we use PRISM data for more than just monthly averages?

USDA-ARS?s Scientific Manuscript database

Decision support systems/models for agriculture are varied in target application and complexity, ranging from simple worksheets to near real-time forecast systems requiring significant computational and manpower resources. Until recently, most such decision support systems have been constructed with...

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation.

PubMed

Jiang, Yun; Sereika, Susan M; DeVito Dabbs, Annette; Handler, Steven M; Schlenk, Elizabeth A

2016-10-01

Lung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH(®), a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators. To examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation. A cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support. Of the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n=23) were less likely to follow technology decision support than the high (odds ratio [OR]=0.11, p=0.02) and low (OR=0.04, p=0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR=0.01, p=0.01) or who had longer hospital stays (OR=0.94, p=0.004). A significant interaction was found between gender and past technology experience (OR=0.21, p=0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women. The majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

PubMed

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.