The Media and National Security Decision-Making

DTIC Science & Technology

2004-02-29

2002. Muller, Kerstin, “The CNN effect, media and global governance,” Speech by Minister of State Kerstin Muller to Open the Forum Global Issues on...time to analyze, develop and arrive at a decision is acutely abbreviated. Many factors influence this, and the increasing public awareness on global ... issues , thanks to the abundance of information, makes this a complex task. The attention and support Americans give to an issue is in direct

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

PubMed

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

2004-01-01

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

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

NASA Astrophysics Data System (ADS)

Yurchenko, I. F.

2018-05-01

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

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…

"From where I Stand:" African American Teacher Candidates on Their Decision to Teach

ERIC Educational Resources Information Center

Williams, Ereka R.; Graham, Anthony; McCary-Henderson, Stephen; Floyd, Loury

2009-01-01

Multiple studies explore the issue of the absence of teachers of color in the profession at large. Few studies, however, address the issue from the angle of the teacher candidate of color. With so many competing professions, why do they ultimately make the decision to join the profession? What are the contexts that influence and support that…

The Supreme Court Spanking Ruling: An Issue in Debate.

ERIC Educational Resources Information Center

Welsh, Ralph S.; And Others

Few issues have polarized the educational community so completely as the 1975 and 1977 decisions by the U.S. Supreme Court to allow corporal punishment in the schools. The symposium reported here was organized and conducted following the 1975 decision but prior to the 1977 one. Three papers in support and three papers against the ruling were read,…

Nurse Managers' Decisions: Fast and Favoring Remediation

PubMed Central

Effken, Judith A.; Verran, Joyce A.; Logue, Melanie D.; Hsu, Ya-Chuan

2010-01-01

How do nurse managers make decisions about quality issues on their units? We asked 10 nurse managers in 3 Arizona hospitals to describe how they resolved a recent quality issue. The managers tended to use a linear, but cognitively expensive strategy, often jumping from problem to solution without a clear goal and selecting solutions biased toward remedial education. Decision support tools should help managers think more systemically, systematically and efficiently, while encouraging consideration of more alternatives to reach targeted goals. PMID:20305465

Visualising Uncertainty for Decision Support

DTIC Science & Technology

2016-12-01

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

Natural resource assessment and decision support tools for bird conservation planning

Treesearch

Carl E. Korschgen; Melinda G. Knutson; Timothy J. Fox; Leslie Holland-Bartels; Henry C. Dehaan; Charles H. Theiling; Jason J. Rohweder; Kevin Kenow; Linda E. Leake; Tom Will

2005-01-01

We have used a place-based decision support system for several years to identify bird conservation issues relating to the management and planning needs of resource managers. Public and private land managers are constantly seeking better ways to incorporate landscape, species, and habitat relationships into the conservation planning process. The U.S. Fish and Wildlife...

Family support in cancer survivorship.

PubMed

Muhamad, Mazanah; Afshari, Mojgan; Kazilan, Fitrisehara

2011-01-01

This paper raises issues about the role of family members in providing support for breast cancer survivors. Data were collected from 400 breast cancer survivors in Peninsular Malaysia through a custom-designed questionnaire fielded at hospitals and support group meetings. The data were analyzed using descriptive statistics. The analyses show that all family members could be supportive, especially in decision making and help with emotional issues. The spouse was the main support provider among the family members (others were children, parents, siblings and more distant relatives). The results also indicated that a significant percentage practiced collaborative decision-making. Breast cancer survivors needed their family members' support for information on survivorship strategies such as managing emotions, health, life style and dietary practice. The family members' supportive role may be linked to the Malaysian strong family relationship culture. For family members to contribute more adequately to cancer survivorship, it is suggested that appropriate educational intervention also be provided to them.

Uncertainty management, spatial and temporal reasoning, and validation of intelligent environmental decision support systems

USGS Publications Warehouse

Sànchez-Marrè, Miquel; Gilbert, Karina; Sojda, Rick S.; Steyer, Jean Philippe; Struss, Peter; Rodríguez-Roda, Ignasi; Voinov, A.A.; Jakeman, A.J.; Rizzoli, A.E.

2006-01-01

There are inherent open problems arising when developing and running Intelligent Environmental Decision Support Systems (IEDSS). During daily operation of IEDSS several open challenge problems appear. The uncertainty of data being processed is intrinsic to the environmental system, which is being monitored by several on-line sensors and off-line data. Thus, anomalous data values at data gathering level or even uncertain reasoning process at later levels such as in diagnosis or decision support or planning can lead the environmental process to unsafe critical operation states. At diagnosis level or even at decision support level or planning level, spatial reasoning or temporal reasoning or both aspects can influence the reasoning processes undertaken by the IEDSS. Most of Environmental systems must take into account the spatial relationships between the environmental goal area and the nearby environmental areas and the temporal relationships between the current state and the past states of the environmental system to state accurate and reliable assertions to be used within the diagnosis process or decision support process or planning process. Finally, a related issue is a crucial point: are really reliable and safe the decisions proposed by the IEDSS? Are we sure about the goodness and performance of proposed solutions? How can we ensure a correct evaluation of the IEDSS? Main goal of this paper is to analyse these four issues, review some possible approaches and techniques to cope with them, and study new trends for future research within the IEDSS field.

XWeB: The XML Warehouse Benchmark

NASA Astrophysics Data System (ADS)

Mahboubi, Hadj; Darmont, Jérôme

With the emergence of XML as a standard for representing business data, new decision support applications are being developed. These XML data warehouses aim at supporting On-Line Analytical Processing (OLAP) operations that manipulate irregular XML data. To ensure feasibility of these new tools, important performance issues must be addressed. Performance is customarily assessed with the help of benchmarks. However, decision support benchmarks do not currently support XML features. In this paper, we introduce the XML Warehouse Benchmark (XWeB), which aims at filling this gap. XWeB derives from the relational decision support benchmark TPC-H. It is mainly composed of a test data warehouse that is based on a unified reference model for XML warehouses and that features XML-specific structures, and its associate XQuery decision support workload. XWeB's usage is illustrated by experiments on several XML database management systems.

48 CFR 9.105-2 - Determinations and documentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... integrity and business ethics; and (C) The Small Business Administration does not issue a Certificate of...'s decision to issue a Certificate of Competency and award the contract to the concern. (b) Support...

E-DECIDER Disaster Response and Decision Support Cyberinfrastructure: Technology and Challenges

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Parker, J. W.; Pierce, M. E.; Wang, J.; Eguchi, R. T.; Huyck, C. K.; Hu, Z.; Chen, Z.; Yoder, M. R.; Rundle, J. B.; Rosinski, A.

2014-12-01

Timely delivery of critical information to decision makers during a disaster is essential to response and damage assessment. Key issues to an efficient emergency response after a natural disaster include rapidly processing and delivering this critical information to emergency responders and reducing human intervention as much as possible. Essential elements of information necessary to achieve situational awareness are often generated by a wide array of organizations and disciplines, using any number of geospatial and non-geospatial technologies. A key challenge is the current state of practice does not easily support information sharing and technology interoperability. NASA E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) has worked with the California Earthquake Clearinghouse and its partners to address these issues and challenges by adopting the XChangeCore Web Service Data Orchestration technology and participating in several earthquake response exercises. The E-DECIDER decision support system provides rapid delivery of advanced situational awareness data products to operations centers and emergency responders in the field. Remote sensing and hazard data, model-based map products, information from simulations, damage detection, and crowdsourcing is integrated into a single geospatial view and delivered through a service oriented architecture for improved decision-making and then directly to mobile devices of responders. By adopting a Service Oriented Architecture based on Open Geospatial Consortium standards, the system provides an extensible, comprehensive framework for geospatial data processing and distribution on Cloud platforms and other distributed environments. While the Clearinghouse and its partners are not first responders, they do support the emergency response community by providing information about the damaging effects earthquakes. It is critical for decision makers to maintain a situational awareness that is knowledgeable of potential and current conditions, possible impacts on populations and infrastructure, and other key information. E-DECIDER and the Clearinghouse have worked together to address many of these issues and challenges to deliver interoperable, authoritative decision support products.

The Selection of Test Items for Decision Making with a Computer Adaptive Test.

ERIC Educational Resources Information Center

Spray, Judith A.; Reckase, Mark D.

The issue of test-item selection in support of decision making in adaptive testing is considered. The number of items needed to make a decision is compared for two approaches: selecting items from an item pool that are most informative at the decision point or selecting items that are most informative at the examinee's ability level. The first…

A Decision Support System for effective use of probability forecasts

NASA Astrophysics Data System (ADS)

De Kleermaeker, Simone; Verkade, Jan

2013-04-01

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

Toward geodesign for watershed restoration on the Fremont-Winema National Forest, Pacific Northwest, USA

Treesearch

Keith Reynolds; Philip Murphy; Steven Paplanus

2017-01-01

Spatial decision support systems for forest management have steadily evolved over the past 20+ years in order to better address the complexities of contemporary forest management issues such as the sustainability and resilience of ecosystems on forested landscapes. In this paper, we describe and illustrate new features of the Ecosystem Management Decision Support (EMDS...

Fertility preservation and cancer: Challenges for adolescent and young adult patients

PubMed Central

Benedict, Catherine; Thom, Bridgette; Kelvin, Joanne

2016-01-01

Purpose of review With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. Recent findings A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Summary Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options. PMID:26730794

24 CFR 17.110 - Determination of indebtedness and appeal from determination.

Code of Federal Regulations, 2010 CFR

2010-04-01

... determination. (a) Following the hearing or the review of the record, the DAS or designee will issue a written decision which includes the supporting rationale for the decision. The decision of the DAS or designee is the final agency action with regard to the particular administrative offset. (b) Copies of the DAS...

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.

Web-services-based spatial decision support system to facilitate nuclear waste siting

NASA Astrophysics Data System (ADS)

Huang, L. Xinglai; Sheng, Grant

2006-10-01

The availability of spatial web services enables data sharing among managers, decision and policy makers and other stakeholders in much simpler ways than before and subsequently has created completely new opportunities in the process of spatial decision making. Though generally designed for a certain problem domain, web-services-based spatial decision support systems (WSDSS) can provide a flexible problem-solving environment to explore the decision problem, understand and refine problem definition, and generate and evaluate multiple alternatives for decision. This paper presents a new framework for the development of a web-services-based spatial decision support system. The WSDSS is comprised of distributed web services that either have their own functions or provide different geospatial data and may reside in different computers and locations. WSDSS includes six key components, namely: database management system, catalog, analysis functions and models, GIS viewers and editors, report generators, and graphical user interfaces. In this study, the architecture of a web-services-based spatial decision support system to facilitate nuclear waste siting is described as an example. The theoretical, conceptual and methodological challenges and issues associated with developing web services-based spatial decision support system are described.

Supporting decision-making processes for evidence-based mental health promotion.

PubMed

Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

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.

The effect of values and culture on life-support decisions.

PubMed Central

Klessig, J

1992-01-01

Withdrawing life support is always difficult. When patients and health professionals are from different ethnic backgrounds, value systems that form the basis for such decisions may conflict. Many cultural groups do not place the same emphasis on patient autonomy and self-determination that Western society does and find the idea of terminating life support offensive. Although physicians should never assume patients will respond in a particular way because of their ethnic background, issues of life support should be discussed in a culturally sensitive way. African-American, Chinese, Jewish, Iranian, Filipino, Mexican-American, and Korean patients were surveyed about their views on life support. The findings reported here, although not meant to be definitive, should add to health professionals' understanding about diverse beliefs around life-and-death issues. By becoming aware of this diversity of beliefs, health professionals can avoid the damage to the physician-patient relationship caused by conflicting value systems. PMID:1413777

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.

A Decision Support Tool for Sustainable Land Use, Transportation, Buildings/Infrastructure, and Materials Management

EPA Science Inventory

One issue for community groups, local and regional planners, and politicians, is that they require relevant information to develop programs and initiatives for incorporating sustainability principles into their physical infrastructure, operations, and decision-making processes. T...

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

PubMed

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

2015-06-11

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

Computer-aided decision support systems for endoscopy in the gastrointestinal tract: a review.

PubMed

Liedlgruber, Michael; Uhl, Andreas

2011-01-01

Today, medical endoscopy is a widely used procedure to inspect the inner cavities of the human body. The advent of endoscopic imaging techniques-allowing the acquisition of images or videos-created the possibility for the development of the whole new branch of computer-aided decision support systems. Such systems aim at helping physicians to identify possibly malignant abnormalities more accurately. At the beginning of this paper, we give a brief introduction to the history of endoscopy, followed by introducing the main types of endoscopes which emerged so far (flexible endoscope, wireless capsule endoscope, and confocal laser endomicroscope). We then give a brief introduction to computer-aided decision support systems specifically targeted at endoscopy in the gastrointestinal tract. Then we present general facts and figures concerning computer-aided decision support systems and summarize work specifically targeted at computer-aided decision support in the gastrointestinal tract. This summary is followed by a discussion of some common issues concerning the approaches reviewed and suggestions of possible ways to resolve them.

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

21 CFR 13.30 - Proceedings of a Board.

Code of Federal Regulations, 2010 CFR

2010-04-01

... persons making and participating in the presentation and Federal Government executive branch employees and... prepare a decision on all issues. The decision is to include specific findings and references supporting and explaining the Board's conclusions, and a detailed statement of the reasoning on which the...

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

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.

Co-evolution of transportation and land use : modeling historical dependencies in land use and transportation decision making.

DOT National Transportation Integrated Search

2009-11-01

The interaction between land use and transportation has long been the central issue in urban and regional planning. Models of such : interactions provide vital information to support many public policy decisions, such as land supply, infrastructure p...

Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review.

PubMed

Munro, Sarah; Stacey, Dawn; Lewis, Krystina B; Bansback, Nick

2016-04-01

To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation. A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n=8). Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures. Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Sustaining Financial Support through Workforce Development Grants and Contracts

ERIC Educational Resources Information Center

Brumbach, Mary A.

2005-01-01

Workforce development grants and contracts are important methods for sustaining financial support for community colleges. This chapter details decision factors, college issues, possible pitfalls, and methods for procuring and handling government contracts and grants for workforce training.

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

EPA Science Inventory

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

Comparative community case studies as research tools: A national effort to support local sustainability planning

EPA Science Inventory

The provisioning of aquatic ecosystem goods and services (EGS) is a key concept in USEPA Office of Research and Development research programs. This is a national issue, yet many decisions affecting EGS sustainability are made at the local level where decisions can have substanti...

Involving Students in Natural Resource Decision-Making Groups.

ERIC Educational Resources Information Center

Ellsworth, Peter; Ellsworth, Judith

2001-01-01

Describes the Coordinated Resource Management (CRM) in the Classroom project, in which Wyoming high school students work on an authentic natural resource problem, using a decision-making process based on consensus to reach agreement on solutions to the problem. Notes implementation issues of professional development and support, and considers…

The Course Development Plan: Macro-Level Decisions and Micro-Level Processes

ERIC Educational Resources Information Center

Franker, Karen; James, Dennis

2016-01-01

A key step in distance learning project management is the creation of a course development plan. The plan should account for decisions related to materials, curriculum, delivery methods, staffing, technology applications, resources, reporting lines, and project management--issues that may require administrator involvement and support, particularly…

24 CFR 17.153 - Determination of the Administrative Judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Administrative Judge shall issue a written decision which includes the supporting rationale for the decision. The... Department, the Department's Office of Finance and Accounting, the debtor, and the debtor's attorney or other... determination is received by the Department's Chief Financial Officer. No referral will be made to the IRS or...

21 CFR 12.93 - Summary decisions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... participant may move, with or without supporting affidavits, for a summary decision on any issue in the hearing. Any other participant may, within 10 days after service of the motion, which time may be extended..., affidavits, and other material filed in connection with the hearing, or matters officially noticed, show that...

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

Responding to and Supporting Students with Disabilities: Risk Management Considerations

ERIC Educational Resources Information Center

Lundquist, Anne; Shackelford, Allan

2011-01-01

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

Intelligent Decisions? Intelligent Support? Agenda and Participants for the Internal Workshop on Intelligent Decision Support Systems : Retrospects and Prospects, August 29 - September 2, 2005, Certosa di Pontignano (Siena), Italy

DTIC Science & Technology

2005-09-01

ENGINEERING APPROACH TO INTELLIGENT OPERATOR ASSISTANCE AND AUTONOMOUS VEHICLE GUIDANCE ..................100 27. SHARPLE, SARAH (WITH COX, GEMMA & STEDMON...104 30. TANGO, FABIO: CONCEPT OF AUTONOMIC COMPUTING APPLIED TO TRANSPORTATION ISSUES: THE SENSITIVE CAR .....105 31. TAYLOR, ROBERT: POSITION...SYSTEMS ENGINEERING APPROACH TO INTELLIGENT OPERATOR ASSISTANCE AND AUTONOMOUS VEHICLE GUIDANCE Today’s automation systems are typically introduced

A decision support system for drinking water production integrating health risks assessment.

PubMed

Delpla, Ianis; Monteith, Donald T; Freeman, Chris; Haftka, Joris; Hermens, Joop; Jones, Timothy G; Baurès, Estelle; Jung, Aude-Valérie; Thomas, Olivier

2014-07-18

The issue of drinking water quality compliance in small and medium scale water services is of paramount importance in relation to the 98/83/CE European Drinking Water Directive (DWD). Additionally, concerns are being expressed over the implementation of the DWD with respect to possible impacts on water quality from forecast changes in European climate with global warming and further anticipated reductions in north European acid emissions. Consequently, we have developed a decision support system (DSS) named ARTEM-WQ (AwaReness Tool for the Evaluation and Mitigation of drinking Water Quality issues resulting from environmental changes) to support decision making by small and medium plant operators and other water stakeholders. ARTEM-WQ is based on a sequential risk analysis approach that includes consideration of catchment characteristics, climatic conditions and treatment operations. It provides a holistic evaluation of the water system, while also assessing human health risks of organic contaminants potentially present in treated waters (steroids, pharmaceuticals, pesticides, bisphenol-a, polychlorobiphenyls, polycyclic aromatic hydrocarbons, petrochemical hydrocarbons and disinfection by-products; n = 109). Moreover, the system provides recommendations for improvement while supporting decision making in its widest context. The tool has been tested on various European catchments and shows a promising potential to inform water managers of risks and appropriate mitigative actions. Further improvements should include toxicological knowledge advancement, environmental background pollutant concentrations and the assessment of the impact of distribution systems on water quality variation.

Adapting the coping in deliberation (CODE) framework: a multi-method approach in the context of familial ovarian cancer risk management.

PubMed

Witt, Jana; Elwyn, Glyn; Wood, Fiona; Rogers, Mark T; Menon, Usha; Brain, Kate

2014-11-01

To test whether the coping in deliberation (CODE) framework can be adapted to a specific preference-sensitive medical decision: risk-reducing bilateral salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer. We performed a systematic literature search to identify issues important to women during deliberations about RRSO. Three focus groups with patients (most were pre-menopausal and untested for genetic mutations) and 11 interviews with health professionals were conducted to determine which issues mattered in the UK context. Data were used to adapt the generic CODE framework. The literature search yielded 49 relevant studies, which highlighted various issues and coping options important during deliberations, including mutation status, risks of surgery, family obligations, physician recommendation, peer support and reliable information sources. Consultations with UK stakeholders confirmed most of these factors as pertinent influences on deliberations. Questions in the generic framework were adapted to reflect the issues and coping options identified. The generic CODE framework was readily adapted to a specific preference-sensitive medical decision, showing that deliberations and coping are linked during deliberations about RRSO. Adapted versions of the CODE framework may be used to develop tailored decision support methods and materials in order to improve patient-centred care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Protecting the Marine Environment

EPA Pesticide Factsheets

EPA works with U.S. government agency partners, foreign nations, industry and nongovernmental organizations to ensure that international decisions and management of marine pollution issues support EPA's mission

Longitudinal associations between mothers' perceptions of nonresidential fathers' investment of resources and influence in decision-making.

PubMed

Fagan, Jay; Palkovitz, Rob

2018-02-01

Nonresidential fathers are challenged to remain involved with their children across time in both direct and indirect ways, including influencing decision-making around important issues such as school attendance and medical care. An analytic sample of 1,350 families with residential mothers and nonresidential fathers was selected from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) to examine the longitudinal relationships between mothers' reports of nonresidential fathers' influence in decision-making and their provision of resources to their children. Findings indicate that fathers' voluntary contribution of tangible resources (informal child support, caregiving time) when children are 2 years old positively predict fathers' influence in decision-making regarding the care of their 4-year-old children. Fathers' early formal child support is not related to later decision-making. Fathers' communication with mother about the child at 24 months is related to later decision-making among daughters but not sons. Fathers' early decision-making is longitudinally related to later informal child support, caregiving time, and coparenting communication. The findings support the utility of a resource theory of fathering for understanding and predicting observed patterns of father involvement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Evaluation of Role-Playing in the Context of Teaching Climate Change

ERIC Educational Resources Information Center

Belova, Nadja; Eilks, Ingo; Feierabend, Timo

2015-01-01

Role-plays are a common pedagogical tool in the Social Sciences. As an imitation of societal practices, role-plays are thought to support the development of argumentation and decision-making skills among learners. However, argumentation and decision making are also goals in science education in general and in socioscientific issues-oriented…

40 CFR 78.3 - Petition for administrative review and request for evidentiary hearing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Ozone Season NOX Allowance Tracking System account, covered by the decision; or (ii) Any interested... for any CAIR Ozone Season NOX Allowance Tracking System account, covered by the decision; or (ii) Any... concise brief in support of the petition, explaining why the factual or legal issues are material and, if...

Young People's Involvement in Service Evaluation and Decision Making

ERIC Educational Resources Information Center

Hartas, Dimitra; Lindsay, Geoff

2011-01-01

This study examined young people's decision making on issues that affect their lives: bullying in different contexts (e.g., family, peer groups, school) and their involvement in evaluating the availability and effectiveness of support services (e.g., disability, care). Key aims of this study were to offer young people a platform to evaluate…

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

PubMed

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

2018-04-01

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

Engaging Families, Educators, and Communities as Educational Advocates

ERIC Educational Resources Information Center

Winton, Sue; Johnson, Lauri

2016-01-01

This special issue of "Leadership and Policy in Schools" expands knowledge about family-school-community engagement by exploring who is involved in education, in what ways, and for what purposes. This issue critically examines school-community partnerships that work to improve democratic decision-making, support public education,…

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.

Usability and feasibility of a tablet-based Decision-Support and Integrated Record-keeping (DESIRE) tool in the nurse management of hypertension in rural western Kenya.

PubMed

Vedanthan, Rajesh; Blank, Evan; Tuikong, Nelly; Kamano, Jemima; Misoi, Lawrence; Tulienge, Deborah; Hutchinson, Claire; Ascheim, Deborah D; Kimaiyo, Sylvester; Fuster, Valentin; Were, Martin C

2015-03-01

Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Usability testing consisted of "think aloud" exercises and "mock patient encounters" with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Usability and Feasibility of a Tablet-Based Decision-Support and Integrated Record-Keeping (DESIRE) Tool in the Nurse Management of Hypertension in Rural Western Kenya

PubMed Central

Vedanthan, Rajesh; Blank, Evan; Tuikong, Nelly; Kamano, Jemima; Misoi, Lawrence; Tulienge, Deborah; Hutchinson, Claire; Ascheim, Deborah D.; Kimaiyo, Sylvester; Fuster, Valentin; Were, Martin C.

2015-01-01

Background Mobile health (mHealth) applications have recently proliferated, especially in low- and middle-income countries, complementing task-redistribution strategies with clinical decision support. Relatively few studies address usability and feasibility issues that may impact success or failure of implementation, and few have been conducted for non-communicable diseases such as hypertension. Objective To conduct iterative usability and feasibility testing of a tablet-based Decision Support and Integrated Record-keeping (DESIRE) tool, a technology intended to assist rural clinicians taking care of hypertension patients at the community level in a resource-limited setting in western Kenya. Methods Usability testing consisted of “think aloud” exercises and “mock patient encounters” with five nurses, as well as one focus group discussion. Feasibility testing consisted of semi-structured interviews of five nurses and two members of the implementation team, and one focus group discussion with nurses. Content analysis was performed using both deductive codes and significant inductive codes. Critical incidents were identified and ranked according to severity. A cause-of-error analysis was used to develop corresponding design change suggestions. Results Fifty-seven critical incidents were identified in usability testing, 21 of which were unique. The cause-of-error analysis yielded 23 design change suggestions. Feasibility themes included barriers to implementation along both human and technical axes, facilitators to implementation, provider issues, patient issues and feature requests. Conclusions This participatory, iterative human-centered design process revealed previously unaddressed usability and feasibility issues affecting the implementation of the DESIRE tool in western Kenya. In addition to well-known technical issues, we highlight the importance of human factors that can impact implementation of mHealth interventions. PMID:25612791

Harnessing ecosystem models and multi-criteria decision analysis for the support of forest management.

PubMed

Wolfslehner, Bernhard; Seidl, Rupert

2010-12-01

The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.

Harnessing Ecosystem Models and Multi-Criteria Decision Analysis for the Support of Forest Management

NASA Astrophysics Data System (ADS)

Wolfslehner, Bernhard; Seidl, Rupert

2010-12-01

The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.

Middle Mississippi River decision support system: user's manual

USGS Publications Warehouse

Rohweder, Jason J.; Zigler, Steven J.; Fox, Timothy J.; Hulse, Steven N.

2005-01-01

This user's manual describes the Middle Mississippi River Decision Support System (MMRDSS) and gives detailed examples on its use. The MMRDSS provides a framework to assist decision makers regarding natural resource issues in the Middle Mississippi River floodplain. The MMRDSS is designed to provide users with a spatially explicit tool for tasks, such as inventorying existing knowledge, developing models to investigate the potential effects of management decisions, generating hypotheses to advance scientific understanding, and developing scientifically defensible studies and monitoring. The MMRDSS also includes advanced tools to assist users in evaluating differences in complexity, connectivity, and structure of aquatic habitats among river reaches. The Environmental Systems Research Institute ArcView 3.x platform was used to create and package the data and tools of the MMRDSS.

Perceived Need for a Parental Decision Aid for the HPV Vaccine: Content and Format Preferences

PubMed Central

Lechuga, Julia; Swain, Geoffrey; Weinhardt, Lance S.

2014-01-01

The human papillomavirus (HPV) is a precursor of cervical cancer. In 2006, the Federal Drug Administration licensed a vaccine to protect against four types of HPV. Three years postlicensure of the vaccine, HPV vaccination is still fraught with controversy. To date, research suggests that contrary to popular notions, parents are less concerned with controversies on moral issues and more with uncertainty regarding because long-term safety of a drug is resolved after licensure. This study was designed to understand whether mothers from diverse ethnicities perceive a need for a decision support tool. Results suggest that the design of a culturally tailored decision support tool may help guide parents through the decision-making process. PMID:21444922

Perceived need of a parental decision aid for the HPV vaccine: content and format preferences.

PubMed

Lechuga, Julia; Swain, Geoffrey; Weinhardt, Lance S

2012-03-01

The human papillomavirus (HPV) is a precursor of cervical cancer. In 2006, the Federal Drug Administration licensed a vaccine to protect against four types of HPV. Three years postlicensure of the vaccine, HPV vaccination is still fraught with controversy. To date, research suggests that contrary to popular notions, parents are less concerned with controversies on moral issues and more with uncertainty regarding because long-term safety of a drug is resolved after licensure. This study was designed to understand whether mothers from diverse ethnicities perceive a need for a decision support tool. Results suggest that the design of a culturally tailored decision support tool may help guide parents through the decision-making process.

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

PubMed

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

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

Autonomous Task Management and Decision Support Tools

NASA Technical Reports Server (NTRS)

Burian, Barbara

2017-01-01

For some time aircraft manufacturers and researchers have been pursuing mechanisms for reducing crew workload and providing better decision support to the pilots, especially during non-normal situations. Some previous attempts to develop task managers or pilot decision support tools have not resulted in robust and fully functional systems. However, the increasing sophistication of sensors and automated reasoners, and the exponential surge in the amount of digital data that is now available create a ripe environment for the development of a robust, dynamic, task manager and decision support tool that is context sensitive and integrates information from a wide array of on-board and off aircraft sourcesa tool that monitors systems and the overall flight situation, anticipates information needs, prioritizes tasks appropriately, keeps pilots well informed, and is nimble and able to adapt to changing circumstances. This presentation will discuss the many significant challenges and issues associated with the development and functionality of such a system for use on the aircraft flight deck.

“Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management

PubMed Central

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

"Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

40 CFR 209.31 - Appeal from the decision of the administrative law judge.

Code of Federal Regulations, 2013 CFR

2013-07-01

... in support of the position taken on each issue, with specific page references to the record and the... is taken from the decision of the administrative law judge, any party may file a brief with respect... of the matter in the brief, with page references, and a table of cases (alphabetically arranged...

40 CFR 209.31 - Appeal from the decision of the administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in support of the position taken on each issue, with specific page references to the record and the... is taken from the decision of the administrative law judge, any party may file a brief with respect... of the matter in the brief, with page references, and a table of cases (alphabetically arranged...

40 CFR 209.31 - Appeal from the decision of the administrative law judge.

Code of Federal Regulations, 2011 CFR

2011-07-01

... in support of the position taken on each issue, with specific page references to the record and the... is taken from the decision of the administrative law judge, any party may file a brief with respect... of the matter in the brief, with page references, and a table of cases (alphabetically arranged...

An Exploration of Closure as a Factor Influencing Group Member Satisfaction: Implications for Applications of Group Support Technology in Education.

ERIC Educational Resources Information Center

Small, Ruth V.; Venkatesh, Murali

Research that identifies factors that facilitate information processing and enhance performance without reducing group confidence and decision satisfaction may influence future development of groupwork systems. This paper contains a review of the literature on cognitive and motivational issues in both group decision-making and learning contexts…

Supreme Court Rulings on Abortion: Roe v. Wade and Selected Progeny

ERIC Educational Resources Information Center

Uerling, Donald F.

2006-01-01

Abortion is one of the most controversial and contentious issues of our time. Few topics generate as much public debate or leave as little room for political compromise. This article presents a discussion of selected United States Supreme Court decisions on abortion and the legal reasoning supporting those decisions. It should be noted initially…

49 CFR 511.25 - Summary decision and order.

Code of Federal Regulations, 2011 CFR

2011-10-01

... may move, with a supporting memorandum, for a Summary Decision and Order in its favor upon all or any of the issues in controversy. Complaint Counsel may so move at any time after thirty (30) days following issuance of a complaint, and any other party may so move at any time after issuance of a complaint...

Image-guided decision support system for pulmonary nodule classification in 3D thoracic CT images

NASA Astrophysics Data System (ADS)

Kawata, Yoshiki; Niki, Noboru; Ohmatsu, Hironobu; Kusumoto, Masahiro; Kakinuma, Ryutaro; Mori, Kiyoshi; Yamada, Kozo; Nishiyama, Hiroyuki; Eguchi, Kenji; Kaneko, Masahiro; Moriyama, Noriyuki

2004-05-01

The purpose of this study is to develop an image-guided decision support system that assists decision-making in clinical differential diagnosis of pulmonary nodules. This approach retrieves and displays nodules that exhibit morphological and internal profiles consistent to the nodule in question. It uses a three-dimensional (3-D) CT image database of pulmonary nodules for which diagnosis is known. In order to build the system, there are following issues that should be solved: 1) to categorize the nodule database with respect to morphological and internal features, 2) to quickly search nodule images similar to an indeterminate nodule from a large database, and 3) to reveal malignancy likelihood computed by using similar nodule images. Especially, the first problem influences the design of other issues. The successful categorization of nodule pattern might lead physicians to find important cues that characterize benign and malignant nodules. This paper focuses on an approach to categorize the nodule database with respect to nodule shape and CT density patterns inside nodule.

Cognitive issues in autonomous spacecraft-control operations: An investigation of software-mediated decision making in a scaled environment

NASA Astrophysics Data System (ADS)

Murphy, Elizabeth Drummond

As advances in technology are applied in complex, semi-automated domains, human controllers are distanced from the controlled process. This physical and psychological distance may both facilitate and degrade human performance. To investigate cognitive issues in spacecraft ground-control operations, the present experimental research was undertaken. The primary issue concerned the ability of operations analysts who do not monitor operations to make timely, accurate decisions when autonomous software calls for human help. Another key issue involved the potential effects of spatial-visualization ability (SVA) in environments that present data in graphical formats. Hypotheses were derived largely from previous findings and predictions in the literature. Undergraduate psychology students were assigned at random to a monitoring condition or an on-call condition in a scaled environment. The experimental task required subjects to decide on the veracity of a problem diagnosis delivered by a software process on-board a simulated spacecraft. To support decision-making, tabular and graphical data displays presented information on system status. A level of software confidence in the problem diagnosis was displayed, and subjects reported their own level of confidence in their decisions. Contrary to expectations, the performance of on-call subjects did not differ significantly from that of continuous monitors. Analysis yielded a significant interaction of sex and condition: Females in the on-call condition had the lowest mean accuracy. Results included a preference for bar charts over line graphs and faster performance with tables than with line graphs. A significant correlation was found between subjective confidence and decision accuracy. SVA was found to be predictive of accuracy but not speed; and SVA was found to be a stronger predictor of performance for males than for females. Low-SVA subjects reported that they relied more on software confidence than did medium- or high-SVA subjects. These and other findings have implications for the design of user interfaces to support human decision-making in on-call situations and to accommodate low-SVA users.

Difficult decisions: Migration from Small Island Developing States under climate change

NASA Astrophysics Data System (ADS)

Kelman, Ilan

2015-04-01

The impacts of climate change on Small Island Developing States (SIDS) are leading to discussions regarding decision-making about the potential need to migrate. Despite the situation being well-documented, with many SIDS aiming to raise the topic to prominence and to take action for themselves, limited support and interest has been forthcoming from external sources. This paper presents, analyzes, and critiques a decision-making flowchart to support actions for SIDS dealing with climate change-linked migration. The flowchart contributes to identifying the pertinent topics to consider and the potential support needed to implement decision-making. The flowchart has significant limitations and there are topics which it cannot resolve. On-the-ground considerations include who decides, finances, implements, monitors, and enforces each decision. Additionally, views within communities differ, hence mechanisms are needed for dealing with differences, while issues to address include moral and legal blame for any climate change-linked migration, the ultimate goal of the decision-making process, the wider role of migration in SIDS communities and the right to judge decision-making and decisions. The conclusions summarize the paper, emphasizing the importance of considering contexts beyond climate change and multiple SIDS voices.

Which medical and social decision topics are important after early diagnosis of Alzheimer's Disease from the perspectives of people with Alzheimer's Disease, spouses and professionals?

PubMed

Bronner, Katharina; Perneczky, Robert; McCabe, Rose; Kurz, Alexander; Hamann, Johannes

2016-03-08

The relevance of early decision making will rise with increasing availability of early detection of Alzheimer's disease (AD) using brain imaging or biomarkers. Five people with mild AD, six relatives and 13 healthcare professionals with experience in the management of AD were interviewed in a qualitative study regarding medical and social decision topics that emerge after early diagnosis of Alzheimer's disease. Medical treatment, assistance in everyday life and legal issues emerged as the main decision topics after an early diagnosis of AD. People with AD mostly got in contact with the health and social care system through the initiative of their spouses. They were usually aware of their illness and most received antidementia drugs and/or behavioural interventions. Following diagnosis people with AD received support by their spouses. Healthcare professionals were aware of the risk of excessive demand on relatives due to supporting their family member with AD. In the opinion of healthcare professionals legal issues should be arranged in time before patients lose their decisional capacity. In addition, people with AD and spouses reported various coping strategies, in particular "carry on as normal" after diagnosis but mostly are reluctant to actively plan for future stages of the disease. Due to the common desire to "carry on as usual" after a diagnosis of AD, many people with AD and spouses may miss the opportunity to discuss and decide on important medical and social topics. A structured approach e.g. a decision aid might support people with AD and spouses in their decision making process and thereby preserve persons' with AD autonomy before they lose the capacity in decision-making.

Expectations and Support for Scholarly Activity in Schools of Business.

ERIC Educational Resources Information Center

Bohrer, Paul; Dolphin, Robert, Jr.

1985-01-01

Addresses issues relating to scholarship productivity and examines these issues with consideration given to the size and the accreditation status of the business schools sampled. First, how important is scholarly activity within an institution for a variety of personnel decisions? Second, what is the relative importance of various types of…

Building and Strengthening Policy Research Capacity: Key Issues in Canadian Higher Education

ERIC Educational Resources Information Center

Jones, Glen A.

2014-01-01

Given the importance of higher education in social and economic development, governments need to build a strong higher education data and policy research infrastructure to support informed decision-making, provide policy advice, and offer a critical assessment of key trends and issues. The author discusses the decline of higher education policy…

Exploring Preservice Elementary Teachers' Critique and Adaptation of Science Curriculum Materials in Respect to Socioscientific Issues

ERIC Educational Resources Information Center

Forbes, Cory T.; Davis, Elizabeth A.

2008-01-01

The work presented here represents a preliminary effort undertaken to address the role of teachers in supporting students' learning and decision-making about socioscientific issues (SSI) by characterizing preservice elementary teachers' critique and adaptation of SSI-based science curriculum materials and identifying factors that serve to mediate…

Designing a Citizen Involvement Program: A Guidebook for Involving Citizens in the Resolution of Environmental Issues.

ERIC Educational Resources Information Center

Howell, Robert E.; And Others

A model and supportive materials are presented for design and implementation of a program for involving citizens in decision-making concerning significant environmental issues. Chapter topics include: why citizen involvement? (potential benefits of the process); theoretical basis for citizen involvement (three fundamental perspectives underlying…

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

NASA Astrophysics Data System (ADS)

Roy, Jean; Breton, Richard; Paradis, Stephane

2001-08-01

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

A Decision Support System for Drinking Water Production Integrating Health Risks Assessment

PubMed Central

Delpla, Ianis; Monteith, Donald T.; Freeman, Chris; Haftka, Joris; Hermens, Joop; Jones, Timothy G.; Baurès, Estelle; Jung, Aude-Valérie; Thomas, Olivier

2014-01-01

The issue of drinking water quality compliance in small and medium scale water services is of paramount importance in relation to the 98/83/CE European Drinking Water Directive (DWD). Additionally, concerns are being expressed over the implementation of the DWD with respect to possible impacts on water quality from forecast changes in European climate with global warming and further anticipated reductions in north European acid emissions. Consequently, we have developed a decision support system (DSS) named ARTEM-WQ (AwaReness Tool for the Evaluation and Mitigation of drinking Water Quality issues resulting from environmental changes) to support decision making by small and medium plant operators and other water stakeholders. ARTEM-WQ is based on a sequential risk analysis approach that includes consideration of catchment characteristics, climatic conditions and treatment operations. It provides a holistic evaluation of the water system, while also assessing human health risks of organic contaminants potentially present in treated waters (steroids, pharmaceuticals, pesticides, bisphenol-a, polychlorobiphenyls, polycyclic aromatic hydrocarbons, petrochemical hydrocarbons and disinfection by-products; n = 109). Moreover, the system provides recommendations for improvement while supporting decision making in its widest context. The tool has been tested on various European catchments and shows a promising potential to inform water managers of risks and appropriate mitigative actions. Further improvements should include toxicological knowledge advancement, environmental background pollutant concentrations and the assessment of the impact of distribution systems on water quality variation. PMID:25046634

"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.

Compromise decision support problems for hierarchical design involving uncertainty

NASA Astrophysics Data System (ADS)

Vadde, S.; Allen, J. K.; Mistree, F.

1994-08-01

In this paper an extension to the traditional compromise Decision Support Problem (DSP) formulation is presented. Bayesian statistics is used in the formulation to model uncertainties associated with the information being used. In an earlier paper a compromise DSP that accounts for uncertainty using fuzzy set theory was introduced. The Bayesian Decision Support Problem is described in this paper. The method for hierarchical design is demonstrated by using this formulation to design a portal frame. The results are discussed and comparisons are made with those obtained using the fuzzy DSP. Finally, the efficacy of incorporating Bayesian statistics into the traditional compromise DSP formulation is discussed and some pending research issues are described. Our emphasis in this paper is on the method rather than the results per se.

Guidance on Data Quality Assessment for Life Cycle Inventory Data

EPA Science Inventory

Data quality within Life Cycle Assessment (LCA) is a significant issue for the future support and development of LCA as a decision support tool and its wider adoption within industry. In response to current data quality standards such as the ISO 14000 series, various entities wit...

Remembering and Voting: Theory and Evidence from Amnesic Patients

PubMed Central

Coronel, Jason C.; Duff, Melissa C.; Warren, David E.; Federmeier, Kara D.; Gonsalves, Brian D.; Tranel, Daniel; Cohen, Neal J.

2013-01-01

One of the most prominent claims to emerge from the field of public opinion is that citizens can vote for candidates whose issue positions best reflect their own beliefs even when they cannot remember previously learned stances associated with the candidates. The current experiment provides a unique and powerful examination of this claim by determining whether individuals with profound amnesia, whose severe memory impairments prevent them from remembering specific issue information associated with any particular candidate, can vote for candidates whose issue positions come closest to their own political views. We report here that amnesic patients, despite not being able to remember any issue information, consistently voted for candidates with favored political positions. Thus, sound voting decisions do not require recall or recognition of previously learned associations between candidates and their issue positions. This result supports a multiple memory systems model of political decision making. PMID:24511170

Exploring morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones.

PubMed

Gammon, D; Christiansen, E K; Wynn, R

2009-07-01

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example - remote parental monitoring of adolescent blood glucose - is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents' decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families.

Implications of the Bangor Hydro decision on FERC relicensings

USGS Publications Warehouse

Pizzi, L.

1997-01-01

In the next 15 years, over 400 existing nonfederal dams will require new licenses by the Federal Energy Regulatory Commission (FERC) in order to continue operations. In many cases, state or federal agencies have a unique opportunity to condition the hydropower licenses to protect environmental values. In 1996, the Court of Appeals for the District of Columbia Circuit issued an opinion striking down a mandatory license condition imposed by the U.S. Department of the Interior in a FERC relicensing. The case, Bangor Hydro-Electric Company v.Federal Energy Regulatory Commission, is instructive for agencies regarding the procedures to be followed in imposing mandatory FERC licensing conditions in the future. After Bangor Hydro, agencies should: (1) support their decisions by substantial evidence in the FERC record, (2) request applicant studies to support agency decisions and allow public comment on the decisions as a means to test the facts and analysis, and (3) consider intervening in a case to defend the condition on appeal. Bangor Hydro also raises, but does not decide, the issue of whether the agency imposing the mandatory condition should engage in balancing the economics of the hydropower project with the public resources affected by the project.

Groundwater modelling in decision support: reflections on a unified conceptual framework

NASA Astrophysics Data System (ADS)

Doherty, John; Simmons, Craig T.

2013-11-01

Groundwater models are commonly used as basis for environmental decision-making. There has been discussion and debate in recent times regarding the issue of model simplicity and complexity. This paper contributes to this ongoing discourse. The selection of an appropriate level of model structural and parameterization complexity is not a simple matter. Although the metrics on which such selection should be based are simple, there are many competing, and often unquantifiable, considerations which must be taken into account as these metrics are applied. A unified conceptual framework is introduced and described which is intended to underpin groundwater modelling in decision support with a direct focus on matters regarding model simplicity and complexity.

Doing All the Right Things: Teacher Retention Issues

ERIC Educational Resources Information Center

Brown, Kathleen M.; Schainker, Stanley A.

2008-01-01

Teacher retention has become a national crisis. This case study describes one principal's efforts to support new teachers and reduce the turnover rate at her school. Recognizing the problem a few years ago, the principal took what she thought were a number of proactive, decisive steps to resolve the issue--she is doing all the right things.…

Self-management support for insulin therapy in type 2 diabetes.

PubMed

Funnell, Martha M; Kruger, Davida F; Spencer, Mary

2004-01-01

The purpose of this article is to describe the self-management support that can be provided by diabetes educators for type 2 diabetes patients who are transitioning from therapy with oral hypoglycemic agents to insulin. The role of the diabetes educator in patient education and self-management support during all aspects of insulin therapy is discussed. Phases during which support may be especially important include the decision-making process, initiation, and maintenance. Although some patients make the decision fairly easily, the introduction of insulin therapy is likely to raise many issues and questions for many type 2 diabetes patients. The more reluctant patients may experience psychological insulin resistance, a syndrome where insulin therapy is viewed as a threat or failure, which can affect health professionals as well. The diabetes educator can provide support and approaches to help diminish this resistance and make the transition to insulin therapy easier and more effective for patients with type 2 diabetes. Education and ongoing self-management support are needed for informed decision making and the initiation and maintenance of insulin therapy. Therefore, diabetes educators have a critical role to play during both the decision-making process and the safe transition to insulin therapy.

Quinceaneras and Quadratics: Experiences of Latinas in State-Supported Residential Schools of Science and Math

ERIC Educational Resources Information Center

Sayman, Donna M.

2013-01-01

This qualitative study sought to understand the experiences of Latinas enrolled in residential state schools of science, technology, engineering, and math (STEM). Goals of the study focused on understanding experiences and identifying factors such as decisions to enroll, barriers and supports, and issues contributing to retention. These schools…

Deep learning aided decision support for pulmonary nodules diagnosing: a review.

PubMed

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping; He, Jianxing; Liu, Bo

2018-04-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing.

An approach to improve the care of mid-life women through the implementation of a Women’s Health Assessment Tool/Clinical Decision Support toolkit

PubMed Central

Silvestrin, Terry M; Steenrod, Anna W; Coyne, Karin S; Gross, David E; Esinduy, Canan B; Kodsi, Angela B; Slifka, Gayle J; Abraham, Lucy; Araiza, Anna L; Bushmakin, Andrew G; Luo, Xuemei

2016-01-01

The objectives of this study are to describe the implementation process of the Women’s Health Assessment Tool/Clinical Decision Support toolkit and summarize patients’ and clinicians’ perceptions of the toolkit. The Women’s Health Assessment Tool/Clinical Decision Support toolkit was piloted at three clinical sites over a 4-month period in Washington State to evaluate health outcomes among mid-life women. The implementation involved a multistep process and engagement of multiple stakeholders over 18 months. Two-thirds of patients (n = 76/110) and clinicians (n = 8/12) participating in pilot completed feedback surveys; five clinicians participated in qualitative interviews. Most patients felt more prepared for their annual visit (69.7%) and that quality of care improved (68.4%) while clinicians reported streamlined patient visits and improved communication with patients. The Women’s Health Assessment Tool/Clinical Decision Support toolkit offers a unique approach to introduce and address some of the key health issues that affect mid-life women. PMID:27558508

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model.

PubMed

Damij, Nadja; Boškoski, Pavle; Bohanec, Marko; Mileva Boshkoska, Biljana

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies' business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and "what-if" scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results.

Decision support for green supply chain operations by integrating dynamic simulation and LCA indicators: diaper case study.

PubMed

Adhitya, Arief; Halim, Iskandar; Srinivasan, Rajagopalan

2011-12-01

As the issue of environmental sustainability is becoming an important business factor, companies are now looking for decision support tools to assess the fuller picture of the environmental impacts associated with their manufacturing operations and supply chain (SC) activities. Lifecycle assessment (LCA) is widely used to measure the environmental consequences assignable to a product. However, it is usually limited to a high-level snapshot of the environmental implications over the product value chain without consideration of the dynamics arising from the multitiered structure and the interactions along the SC. This paper proposes a framework for green supply chain management by integrating a SC dynamic simulation and LCA indicators to evaluate both the economic and environmental impacts of various SC decisions such as inventories, distribution network configuration, and ordering policy. The advantages of this framework are demonstrated through an industrially motivated case study involving diaper production. Three distinct scenarios are evaluated to highlight how the proposed approach enables integrated decision support for green SC design and operation.

Developing Character and Values for Global Citizens: Analysis of Pre-Service Science Teachers' Moral Reasoning on Socioscientific Issues

ERIC Educational Resources Information Center

Lee, Hyunju; Chang, Hyunsook; Choi, Kyunghee; Kim, Sung-Won; Zeidler, Dana L.

2012-01-01

Character and values are the essential driving forces that serve as general guides or points of reference for individuals to support decision-making and to act responsibly about global socioscientific issues (SSIs). Based on this assumption, we investigated to what extent pre-service science teachers (PSTs) of South Korea possess character and…

77 FR 37737 - Environmental Impact Statement for the Northeast Corridor Between Washington, DC, New York, NY...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... issuing this Notice of Intent (Notice) to advise the public of the preparation of a Tier 1 Environmental... Investment Plan (PRCIP). A PRCIP provides the data necessary to support an FRA decision to fund and implement... existing NEC. FRA is issuing this Notice to alert the public and agencies about the preparation of the Tier...

Economic analyses to support decisions about HPV vaccination in low- and middle-income countries: a consensus report and guide for analysts.

PubMed

Jit, Mark; Levin, Carol; Brisson, Marc; Levin, Ann; Resch, Stephen; Berkhof, Johannes; Kim, Jane; Hutubessy, Raymond

2013-01-30

Low- and middle-income countries need to consider economic issues such as cost-effectiveness, affordability and sustainability before introducing a program for human papillomavirus (HPV) vaccination. However, many such countries lack the technical capacity and data to conduct their own analyses. Analysts informing policy decisions should address the following questions: 1) Is an economic analysis needed? 2) Should analyses address costs, epidemiological outcomes, or both? 3) If costs are considered, what sort of analysis is needed? 4) If outcomes are considered, what sort of model should be used? 5) How complex should the analysis be? 6) How should uncertainty be captured? 7) How should model results be communicated? Selecting the appropriate analysis is essential to ensure that all the important features of the decision problem are correctly represented, but that the analyses are not more complex than necessary. This report describes the consensus of an expert group convened by the World Health Organization, prioritizing key issues to be addressed when considering economic analyses to support HPV vaccine introduction in these countries.

Decision Making Under Uncertainty and Complexity: A Model-Based Scenario Approach to Supporting Integrated Water Resources Management

NASA Astrophysics Data System (ADS)

Liu, Y.; Gupta, H.; Wagener, T.; Stewart, S.; Mahmoud, M.; Hartmann, H.; Springer, E.

2007-12-01

Some of the most challenging issues facing contemporary water resources management are those typified by complex coupled human-environmental systems with poorly characterized uncertainties. In other words, major decisions regarding water resources have to be made in the face of substantial uncertainty and complexity. It has been suggested that integrated models can be used to coherently assemble information from a broad set of domains, and can therefore serve as an effective means for tackling the complexity of environmental systems. Further, well-conceived scenarios can effectively inform decision making, particularly when high complexity and poorly characterized uncertainties make the problem intractable via traditional uncertainty analysis methods. This presentation discusses the integrated modeling framework adopted by SAHRA, an NSF Science & Technology Center, to investigate stakeholder-driven water sustainability issues within the semi-arid southwestern US. The multi-disciplinary, multi-resolution modeling framework incorporates a formal scenario approach to analyze the impacts of plausible (albeit uncertain) alternative futures to support adaptive management of water resources systems. Some of the major challenges involved in, and lessons learned from, this effort will be discussed.

Empirically supported religious and spiritual therapies.

PubMed

Hook, Joshua N; Worthington, Everett L; Davis, Don E; Jennings, David J; Gartner, Aubrey L; Hook, Jan P

2010-01-01

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues. Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality. Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort.

Structured product labeling improves detection of drug-intolerance issues.

PubMed

Schadow, Gunther

2009-01-01

This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved.

Structured Product Labeling Improves Detection of Drug-intolerance Issues

PubMed Central

Schadow, Gunther

2009-01-01

Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct intolerances. The difference between drug-intolerance issues detected or missed by either method was qualitatively analyzed. Results Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-intolerance issues on twice as many patients. Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-intolerance decision support and suggests how terminology and methods of recording drug intolerances could be improved. PMID:18952933

Implementation plan and cost analysis for Oregon's online crash reporting system.

DOT National Transportation Integrated Search

2011-07-01

Federal, state and local transportation agencies, law enforcement, the legislature, consulting firms, safety advocates and the : public use crash data to quantify emerging traffic safety issues and problems, determine priorities, support decision-mak...

The cornerstone of data warehousing for government applications

NASA Technical Reports Server (NTRS)

Kenbeek, Doug; Rothschild, Jack

1996-01-01

The purpose of this paper is to discuss data warehousing storage issues and the impact of EMC open storage technology for meeting the myriad of challenges government organizations face when building Decision Support/Data Warehouse system.

A pilot study of distributed knowledge management and clinical decision support in the cloud.

PubMed

Dixon, Brian E; Simonaitis, Linas; Goldberg, Howard S; Paterno, Marilyn D; Schaeffer, Molly; Hongsermeier, Tonya; Wright, Adam; Middleton, Blackford

2013-09-01

Implement and perform pilot testing of web-based clinical decision support services using a novel framework for creating and managing clinical knowledge in a distributed fashion using the cloud. The pilot sought to (1) develop and test connectivity to an external clinical decision support (CDS) service, (2) assess the exchange of data to and knowledge from the external CDS service, and (3) capture lessons to guide expansion to more practice sites and users. The Clinical Decision Support Consortium created a repository of shared CDS knowledge for managing hypertension, diabetes, and coronary artery disease in a community cloud hosted by Partners HealthCare. A limited data set for primary care patients at a separate health system was securely transmitted to a CDS rules engine hosted in the cloud. Preventive care reminders triggered by the limited data set were returned for display to clinician end users for review and display. During a pilot study, we (1) monitored connectivity and system performance, (2) studied the exchange of data and decision support reminders between the two health systems, and (3) captured lessons. During the six month pilot study, there were 1339 patient encounters in which information was successfully exchanged. Preventive care reminders were displayed during 57% of patient visits, most often reminding physicians to monitor blood pressure for hypertensive patients (29%) and order eye exams for patients with diabetes (28%). Lessons learned were grouped into five themes: performance, governance, semantic interoperability, ongoing adjustments, and usability. Remote, asynchronous cloud-based decision support performed reasonably well, although issues concerning governance, semantic interoperability, and usability remain key challenges for successful adoption and use of cloud-based CDS that will require collaboration between biomedical informatics and computer science disciplines. Decision support in the cloud is feasible and may be a reasonable path toward achieving better support of clinical decision-making across the widest range of health care providers. Published by Elsevier B.V.

Studying the Vendor Perspective on Clinical Decision Support

PubMed Central

Ash, Joan S.; Sittig, Dean F.; McMullen, Carmit K.; McCormack, James L.; Wright, Adam; Bunce, Arwen; Wasserman, Joseph; Mohan, Vishnu; Cohen, Deborah J.; Shapiro, Michael; Middleton, Blackford

2011-01-01

In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors’ perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a “three way conversation” among content vendors, EHR vendors, and user organizations. PMID:22195058

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

USGS Publications Warehouse

Burley, Thomas E.

2012-01-01

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

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

NASA Astrophysics Data System (ADS)

Podimata, Marianthi V.; Yannopoulos, Panayotis C.

2015-04-01

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

Development of an integrated medical supply information system

NASA Astrophysics Data System (ADS)

Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

2011-08-01

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

Social Stigma and Childbearing for Women Living With HIV/AIDS.

PubMed

Cuca, Yvette P; Rose, Carol Dawson

2016-09-01

As more women become infected with HIV, the issue of childbearing becomes increasingly salient. A more nuanced understanding of women's situations is needed to provide high-quality and relevant services and support. We examined reproductive decision making among 20 women living with HIV through in-depth interviews. These women made decisions within situations of chaos, instability, and trauma, which often limited their ability to make truly informed choices about their lives and childbearing. Despite their HIV, many of the women wanted children, but experienced stigmatization related both to their HIV and to their decisions to have children. This stigmatization came from multiple sources, including health care providers, some of whom encouraged their patients to abort pregnancies because of their HIV. Participants, however, demonstrated resistance to stigmatization, through building supportive communities and developing trusting relationships with HIV providers. These results support the need for specialized HIV care for women of childbearing age. © The Author(s) 2015.

Evaluation and purchase of an analytical flow cytometer: some of the numerous factors to consider.

PubMed

Zucker, Robert M; Fisher, Nancy C

2013-01-01

When purchasing a flow cytometer, the decision of which brand, model, specifications, and accessories may be challenging. The decisions should initially be guided by the specific applications intended for the instrument. However, many other factors need to be considered, which include hardware, software, quality assurance, support, service, and price and recommendations from colleagues. These issues are discussed to help guide the purchasing process.

NASA Remote Sensing Observations for Water Resource and Infrastructure Management

NASA Astrophysics Data System (ADS)

Granger, S. L.; Armstrong, L.; Farr, T.; Geller, G.; Heath, E.; Hyon, J.; Lavoie, S.; McDonald, K.; Realmuto, V.; Stough, T.; Szana, K.

2008-12-01

Decision support tools employed by water resource and infrastructure managers often utilize data products obtained from local sources or national/regional databases of historic surveys and observations. Incorporation of data from these sources can be laborious and time consuming as new products must be identified, cleaned and archived for each new study site. Adding remote sensing observations to the list of sources holds promise for a timely, consistent, global product to aid decision support at regional and global scales by providing global observations of geophysical parameters including soil moisture, precipitation, atmospheric temperature, derived evapotranspiration, and snow extent needed for hydrologic models and decision support tools. However, issues such as spatial and temporal resolution arise when attempting to integrate remote sensing observations into existing decision support tools. We are working to overcome these and other challenges through partnerships with water resource managers, tool developers and other stakeholders. We are developing a new data processing framework, enabled by a core GIS server, to seamlessly pull together observations from disparate sources for synthesis into information products and visualizations useful to the water resources community. A case study approach is being taken to develop the system by working closely with water infrastructure and resource managers to integrate remote observations into infrastructure, hydrologic and water resource decision tools. We present the results of a case study utilizing observations from the PALS aircraft instrument as a proxy for NASA's upcoming Soil Moisture Active Passive (SMAP) mission and an existing commercial decision support tool.

Regulatory issues with multiplicity in drug approval: Principles and controversies in a changing landscape.

PubMed

Benda, Norbert; Brandt, Andreas

2018-01-01

Recently, new draft guidelines on multiplicity issues in clinical trials have been issued by European Medicine Agency (EMA) and Food and Drug Administration (FDA), respectively. Multiplicity is an issue in clinical trials, if the probability of a false-positive decision is increased by insufficiently accounting for testing multiple hypotheses. We outline the regulatory principles related to multiplicity issues in confirmatory clinical trials intended to support a marketing authorization application in the EU, describe the reasons for an increasing complexity regarding multiple hypotheses testing and discuss the specific multiplicity issues emerging within the regulatory context and being relevant for drug approval.

Predicting rainfall beyond tomorrow

USDA-ARS?s Scientific Manuscript database

NOAA’s Climate Prediction Center issues climate precipitation forecasts that offer potential support for water resource managers and farmers and ranchers in New Mexico, but the forecasts are frequently misunderstood and not widely used in practical decision making. The objectives of this newsletter ...

HTA – Algorithm or Process?

PubMed Central

Culyer, Anthony J.

2016-01-01

Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not only "in the light of" evidence but also "on the basis of" budget impact, financial protection and equity. Health technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and are not inherent in HTA – as distinct from being common characteristics found in poorly conducted HTAs. More generally, HTA does not need "extension" since (1) ethical issues are already embedded in HTA processes, not least in their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant evidence about distributional impact and financial protection that are now starting to emerge. HTA and related techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decision-makers. What is also required is adherence by competent analysts to a standard template of good analytical practice. The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology, health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the "real" question behind the decision-maker’s brief (actual or postulated) and eliciting the social values that necessarily pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA. PMID:27694664

Decision Support Tools Evaluation Report for FAS/PECAD, Version 2.0

NASA Technical Reports Server (NTRS)

Ross, Kenton; McKellip, Rodney; Mason, Ted; Zanoni, Vicki; Morris, Keith

2004-01-01

Global agricultral intelligence is a key element of decision support eithin the U.S. Department of Agriculture (USDA). Estimeates of production and yield issued by the USDA for both foreign and domestic agriculture are primary sources of information for policy and management decision making. The USDA monitors the major global agricultural commodities through the Production Estimates and Crop Assessment Division (PECAD) of its Foreign Agricultural Service (FAS). Specifically, PECAD iintelligence focuses on global agricultural production and on conditions that affect food security. In conjunction with the USDA, NASA is evaluating the potential for products from NASA's Earth Science Enterprise (ESE) missions to add value to PECAD's decision support tools. NASA is usig a systems engineering approach to evaluate the potential enhancement of PECAD's decision support system (DSS)-first by understanding the components of the system and its input requirements, then by recommending NASA products that may be integrated as system inputs to improve the accuracy, quality, or efficiency of the DSS output. This report documents the evaluation phase of the systems engineering process and includes an examination of the system architecture, operations, and input requirements, as well as an initial assessment of specific ESE measurement systems and products that should be considered for their potential to enhance the PECAD DSS.

"Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice.

PubMed

Elwyn, Glyn; Scholl, Isabelle; Tietbohl, Caroline; Mann, Mala; Edwards, Adrian G K; Clay, Catharine; Légaré, France; van der Weijden, Trudy; Lewis, Carmen L; Wexler, Richard M; Frosch, Dominick L

2013-01-01

Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.

“Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice

PubMed Central

2013-01-01

Background Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. Methods An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. Results After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. Conclusions It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a ‘referral model’ consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the ‘barriers’ and ‘facilitators’ approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment. PMID:24625083

Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients

PubMed Central

Wills, Celia E.; Holmes‐Rovner, Margaret

2003-01-01

Abstract Objective To conduct a preliminary validation of the Satisfaction With Decision (SWD) scale with depressed primary care patients. Design  Cross‐sectional observational pilot study using a postal survey. Setting and participants  Depressed primary care patients (n = 97) who recently had made a new decision about antidepressant medication use completed surveys regarding their treatment decisions. Main variables  Measures included patient‐reported satisfaction with decision, decisional conflict, knowledge about depression and treatment, decision involvement, pain and health status, antidepressant medication efficacy, and satisfaction with health services. Results  The SWD scale had good internal consistency reliability (α = 0.85). Evidence for construct validity was confirmed via a hypothesized pattern of relationships between the SWD scale and other measures. Decision satisfaction was associated with several issues of relevance for designing patient‐centred decision support interventions: (1) knowledge about depression and treatment; (2) involvement in health‐related decisions; and (3) aiding evaluation of trade‐offs among pros and cons of treatment. Conclusions  The results of this pilot study show that the SWD scale appears to be a psychometrically sound and practical measure for research with this population. Additional research is needed on the theoretical nature of decision satisfaction and developing and testing patient‐centred decision support interventions for depression treatment. PMID:12752743

How to Measure Costs and Benefits of eHealth Interventions: An Overview of Methods and Frameworks.

PubMed

Bergmo, Trine Strand

2015-11-09

Information on the costs and benefits of eHealth interventions is needed, not only to document value for money and to support decision making in the field, but also to form the basis for developing business models and to facilitate payment systems to support large-scale services. In the absence of solid evidence of its effects, key decision makers may doubt the effectiveness, which, in turn, limits investment in, and the long-term integration of, eHealth services. However, it is not realistic to conduct economic evaluations of all eHealth applications and services in all situations, so we need to be able to generalize from those we do conduct. This implies that we have to select the most appropriate methodology and data collection strategy in order to increase the transferability across evaluations. This paper aims to contribute to the understanding of how to apply economic evaluation methodology in the eHealth field. It provides a brief overview of basic health economics principles and frameworks and discusses some methodological issues and challenges in conducting cost-effectiveness analysis of eHealth interventions. Issues regarding the identification, measurement, and valuation of costs and benefits are outlined. Furthermore, this work describes the established techniques of combining costs and benefits, presents the decision rules for identifying the preferred option, and outlines approaches to data collection strategies. Issues related to transferability and complexity are also discussed.

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model

PubMed Central

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies’ business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and “what-if” scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results. PMID:26871694

Use of multicriteria decision analysis to address conservation conflicts.

PubMed

Davies, A L; Bryce, R; Redpath, S M

2013-10-01

Conservation conflicts are increasing on a global scale and instruments for reconciling competing interests are urgently needed. Multicriteria decision analysis (MCDA) is a structured, decision-support process that can facilitate dialogue between groups with differing interests and incorporate human and environmental dimensions of conflict. MCDA is a structured and transparent method of breaking down complex problems and incorporating multiple objectives. The value of this process for addressing major challenges in conservation conflict management is that MCDA helps in setting realistic goals; entails a transparent decision-making process; and addresses mistrust, differing world views, cross-scale issues, patchy or contested information, and inflexible legislative tools. Overall we believe MCDA provides a valuable decision-support tool, particularly for increasing awareness of the effects of particular values and choices for working toward negotiated compromise, although an awareness of the effect of methodological choices and the limitations of the method is vital before applying it in conflict situations. © 2013 Society for Conservation Biology.

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

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

PubMed

Barrocas, Albert; Cohen, Michael L

2016-06-01

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team. © 2016 American Society for Parenteral and Enteral Nutrition.

Behavioral and Organizational Considerations in the Design of Information Systems and Processes for Planning and Decision Support,

DTIC Science & Technology

1981-06-01

analysis and display capability provided by management information systems to include interpretation and aggregation of information and values such as...accomplishment of these) 2. analysis of the issue d) systems analysis and modeling (determination of the structure of the decision situation, the...existingltrtie2) Surveying lsata i situation’ alternatives I altraivDsad Is this alternative -" altrnav acceptable? ANALYSIS o NOYES SHave a sufficient

Impact and Potential of Decision Research on Decision Aiding

DTIC Science & Technology

1987-12-01

series was generated by the APA Committee on Research Support (CORS). a committee reporting to APA’s major scientific policy-making body, the Board of... Scientific Affairs. CORS initiated the series to provide a forum for the discussion of behavioral research issues related to the defense mission...are interested mainly in the scientific or theoretical aspects of their work, and are usually not in the best position to understand its potential

Creating a GIS-Based Decision-Support System

NASA Technical Reports Server (NTRS)

Alvarado, Lori; Gates, Ann Q.; Gray, Bob; Reyes, Raul

1998-01-01

Tilting the Balance: Climate Variability and Water Resource Management in the Southwest, a regional conference hosted by the Pan American Center for Environmental Studies, will be held at The University of Texas at El Paso on March 2-4, 1998. The conference is supported through the US Global Change Research Program (USGCRP) established by the President in 1989, and codified by Congress in the Global Change Research Act of 1990. The NASA Mission to Planet Earth program is one of the workshops sponsors. The purpose of the regional workshops is to improve understanding of the consequences of global change. This workshop will be focused on issues along the border and the Rio Grande River and thus will bring together stakeholders from Mexico, California, Texas, New Mexico, Arizona and Colorado representing federal, state, and local governments; universities and laboratories; industry, agricultural and natural resource managers; and non-governmental organizations. This paper discusses the efforts of the NASA PACES center create a GIS-based decision-support system that can be used to facilitate discussion of the complex issues of resource management within the targeted international region.

A proposal for a computer-based framework of support for public health in the management of biological incidents: the Czech Republic experience.

PubMed

Bures, Vladimír; Otcenásková, Tereza; Cech, Pavel; Antos, Karel

2012-11-01

Biological incidents jeopardising public health require decision-making that consists of one dominant feature: complexity. Therefore, public health decision-makers necessitate appropriate support. Based on the analogy with business intelligence (BI) principles, the contextual analysis of the environment and available data resources, and conceptual modelling within systems and knowledge engineering, this paper proposes a general framework for computer-based decision support in the case of a biological incident. At the outset, the analysis of potential inputs to the framework is conducted and several resources such as demographic information, strategic documents, environmental characteristics, agent descriptors and surveillance systems are considered. Consequently, three prototypes were developed, tested and evaluated by a group of experts. Their selection was based on the overall framework scheme. Subsequently, an ontology prototype linked with an inference engine, multi-agent-based model focusing on the simulation of an environment, and expert-system prototypes were created. All prototypes proved to be utilisable support tools for decision-making in the field of public health. Nevertheless, the research revealed further issues and challenges that might be investigated by both public health focused researchers and practitioners.

Deep learning aided decision support for pulmonary nodules diagnosing: a review

PubMed Central

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping

2018-01-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing. PMID:29780633

Systems Analysis - a new paradigm and decision support tools for the water framework directive

NASA Astrophysics Data System (ADS)

Bruen, M.

2008-05-01

In the early days of Systems Analysis the focus was on providing tools for optimisation, modelling and simulation for use by experts. Now there is a recognition of the need to develop and disseminate tools to assist in making decisions, negotiating compromises and communicating preferences that can easily be used by stakeholders without the need for specialist training. The Water Framework Directive (WFD) requires public participation and thus provides a strong incentive for progress in this direction. This paper places the new paradigm in the context of the classical one and discusses some of the new approaches which can be used in the implementation of the WFD. These include multi-criteria decision support methods suitable for environmental problems, adaptive management, cognitive mapping, social learning and cooperative design and group decision-making. Concordance methods (such as ELECTRE) and the Analytical Hierarchy Process (AHP) are identified as multi-criteria methods that can be readily integrated into Decision Support Systems (DSS) that deal with complex environmental issues with very many criteria, some of which are qualitative. The expanding use of the new paradigm provides an opportunity to observe and learn from the interaction of stakeholders with the new technology and to assess its effectiveness.

Fuzzy Based Decision Support System for Condition Assessment and Rating of Bridges

NASA Astrophysics Data System (ADS)

Srinivas, Voggu; Sasmal, Saptarshi; Karusala, Ramanjaneyulu

2016-09-01

In this work, a knowledge based decision support system has been developed to efficiently handle the issues such as distress diagnosis, assessment of damages and condition rating of existing bridges towards developing an exclusive and robust Bridge Management System (BMS) for sustainable bridges. The Knowledge Based Expert System (KBES) diagnoses the distresses and finds the cause of distress in the bridge by processing the data which are heuristic and combined with site inspection results, laboratory test results etc. The coupling of symbolic and numeric type of data has been successfully implemented in the expert system to strengthen its decision making process. Finally, the condition rating of the bridge is carried out using the assessment results obtained from the KBES and the information received from the bridge inspector. A systematic procedure has been developed using fuzzy mathematics for condition rating of bridges by combining the fuzzy weighted average and resolution identity technique. The proposed methodologies and the decision support system will facilitate in developing a robust and exclusive BMS for a network of bridges across the country and allow the bridge engineers and decision makers to carry out maintenance of bridges in a rational and systematic way.

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

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

NASA Astrophysics Data System (ADS)

Neff, B. P.; Pavlick, M.

2017-12-01

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

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.

How information about other people's personal experiences can help with healthcare decision-making: a qualitative study.

PubMed

Entwistle, Vikki Ann; France, Emma F; Wyke, Sally; Jepson, Ruth; Hunt, Kate; Ziebland, Sue; Thompson, Andrew

2011-12-01

To investigate people's views of using 'general facts' and information about other people's 'personal experiences' for health-related decision-making. Sixty-two people, who between them had experience of five different focal health issues, participated in 12 focus groups and 9 interviews. Exploration of uses of the two types of information was supported by discussion of illustrative excerpts. There was less discussion of 'general facts'; participants thought it obvious that good decisions required these. Participants reported having used 'personal experiences' information to: recognise decisions that needed consideration; identify options; appraise options and make selections (including by developing and reflecting on their reasoning about possible choices); and support coping strategies. Their inclination to use 'personal experiences' information was apparently moderated by assessments of personal relevance, the motives of information providers and the 'balance' of experiences presented. People can use 'personal experiences' information in various ways to support their decision-making, and exercise some discrimination as they do. 'Personal experiences' information may help people in a number of ways in relation to decision-making. However, 'personal experiences' information does not replace the need for 'general facts' and care should be taken when it is used in resources for patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Buffelgrass-Integrated modeling of an invasive plant

USGS Publications Warehouse

Holcombe, Tracy R.

2011-01-01

Buffelgrass (Pennisetum ciliare) poses a problem in the deserts of the United States, growing in dense stands and introducing a wildfire risk in an ecosystem not adapted to fire. The Invasive Species Science Branch of the Fort Collins Science Center has worked with many partners to develop a decision support model and a data management system to address the problem. The decision support model evaluates potential strategies for resource use and allocation. The data management system is a portal where users can submit, view, and download buffelgrass data. These tools provide a case study showcasing how the FORT is working to address the urgent issue of invasive species in the United States.

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.

Deciding to adopt revised and new psychological and neuropsychological tests: an inter-organizational position paper.

PubMed

Bush, Shane S; Sweet, Jerry J; Bianchini, Kevin J; Johnson-Greene, Doug; Dean, Pamela M; Schoenberg, Mike R

2018-04-01

Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making. Ethical and professional issues were reviewed and considered. The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.

Evolutionary and Neural Computing Based Decision Support System for Disease Diagnosis from Clinical Data Sets in Medical Practice.

PubMed

Sudha, M

2017-09-27

As a recent trend, various computational intelligence and machine learning approaches have been used for mining inferences hidden in the large clinical databases to assist the clinician in strategic decision making. In any target data the irrelevant information may be detrimental, causing confusion for the mining algorithm and degrades the prediction outcome. To address this issue, this study attempts to identify an intelligent approach to assist disease diagnostic procedure using an optimal set of attributes instead of all attributes present in the clinical data set. In this proposed Application Specific Intelligent Computing (ASIC) decision support system, a rough set based genetic algorithm is employed in pre-processing phase and a back propagation neural network is applied in training and testing phase. ASIC has two phases, the first phase handles outliers, noisy data, and missing values to obtain a qualitative target data to generate appropriate attribute reduct sets from the input data using rough computing based genetic algorithm centred on a relative fitness function measure. The succeeding phase of this system involves both training and testing of back propagation neural network classifier on the selected reducts. The model performance is evaluated with widely adopted existing classifiers. The proposed ASIC system for clinical decision support has been tested with breast cancer, fertility diagnosis and heart disease data set from the University of California at Irvine (UCI) machine learning repository. The proposed system outperformed the existing approaches attaining the accuracy rate of 95.33%, 97.61%, and 93.04% for breast cancer, fertility issue and heart disease diagnosis.

49 CFR 40.407 - May a service agent ask to have a PIE reduced or terminated?

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.407 May a service... reconsideration of the decision to issue the PIE. (b) Your request must be in writing and supported with...

ENVIRONMENTAL ACCOUNTING USING EMERGY: EVALUATION OF THE STATE OF WEST VIRGINIA

EPA Science Inventory

This report was developed by energy systems ecologists from NHEERL's Atlantic Ecology Division. This research was conducted to provide methods and information to support a variety of regulatory and governance decisions that encompass environmental, economic and social issues. T...

Conference Proceedings for the Advanced Multimodal Transportation Weather Services Partnership Initiatives

DOT National Transportation Integrated Search

1999-01-01

A symposium was held at the Volpe National Transportation Systems Center on September 28, 1998 to continue an active dialogue on issues related to the use of weather informaiton to support transportation decision making, safety, and efficiency. The o...

Food Culture, Preferences and Ethics in Dysphagia Management.

PubMed

Kenny, Belinda

2015-11-01

Adults with dysphagia experience difficulties swallowing food and fluids with potentially harmful health and psychosocial consequences. Speech pathologists who manage patients with dysphagia are frequently required to address ethical issues when patients' food culture and/ or preferences are inconsistent with recommended diets. These issues incorporate complex links between food, identity and social participation. A composite case has been developed to reflect ethical issues identified by practising speech pathologists for the purposes of illustrating ethical concerns in dysphagia management. The case examines a speech pathologist's role in supporting patient autonomy when patients and carers express different goals and values. The case presents a 68-year-old man of Australian/Italian heritage with severe swallowing impairment and strong values attached to food preferences. The case is examined through application of the dysphagia algorithm, a tool for shared decision-making when patients refuse dietary modifications. Case analysis revealed the benefits and challenges of shared decision-making processes in dysphagia management. Four health professional skills and attributes were identified as synonymous with shared decision making: communication, imagination, courage and reflection. © 2015 John Wiley & Sons Ltd.

IONIO Project: Computer-mediated Decision Support System and Communication in Ocean Science

NASA Astrophysics Data System (ADS)

Oddo, Paolo; Acierno, Arianna; Cuna, Daniela; Federico, Ivan; Galati, Maria Barbara; Awad, Esam; Korres, Gerasimos; Lecci, Rita; Manzella, Giuseppe M. R.; Merico, Walter; Perivoliotis, Leonidas; Pinardi, Nadia; Shchekinova, Elena; Mannarini, Gianandrea; Vamvakaki, Chrysa; Pecci, Leda; Reseghetti, Franco

2013-04-01

A decision Support System is composed by four main steps. The first one is the definition of the problem, the issue to be covered, decisions to be taken. Different causes can provoke different problems, for each of the causes or its effects it is necessary to define a list of information and/or data that are required in order to take the better decision. The second step is the determination of sources from where information/data needed for decision-making can be obtained and who has that information. Furthermore it must be possible to evaluate the quality of the sources to see which of them can provide the best information, and identify the mode and format in which the information is presented. The third step is relying on the processing of knowledge, i.e. if the information/data are fitting for purposes. It has to be decided which parts of the information/data need to be used, what additional data or information is necessary to access, how can information be best presented to be able to understand the situation and take decisions. Finally, the decision making process is an interactive and inclusive process involving all concerned parties, whose different views must be taken into consideration. A knowledge based discussion forum is necessary to reach a consensus. A decision making process need to be examined closely and refined, and modified to meet differing needs over time. The report is presenting legal framework and knowledge base for a scientific based decision support system and a brief exploration of some of the skills that enhances the quality of decisions taken.

A study on spatial decision support systems for HIV/AIDS prevention based on COM GIS technology

NASA Astrophysics Data System (ADS)

Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli

2007-06-01

Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.

The conceptual foundation of environmental decision support.

PubMed

Reichert, Peter; Langhans, Simone D; Lienert, Judit; Schuwirth, Nele

2015-05-01

Environmental decision support intends to use the best available scientific knowledge to help decision makers find and evaluate management alternatives. The goal of this process is to achieve the best fulfillment of societal objectives. This requires a careful analysis of (i) how scientific knowledge can be represented and quantified, (ii) how societal preferences can be described and elicited, and (iii) how these concepts can best be used to support communication with authorities, politicians, and the public in environmental management. The goal of this paper is to discuss key requirements for a conceptual framework to address these issues and to suggest how these can best be met. We argue that a combination of probability theory and scenario planning with multi-attribute utility theory fulfills these requirements, and discuss adaptations and extensions of these theories to improve their application for supporting environmental decision making. With respect to (i) we suggest the use of intersubjective probabilities, if required extended to imprecise probabilities, to describe the current state of scientific knowledge. To address (ii), we emphasize the importance of value functions, in addition to utilities, to support decisions under risk. We discuss the need for testing "non-standard" value aggregation techniques, the usefulness of flexibility of value functions regarding attribute data availability, the elicitation of value functions for sub-objectives from experts, and the consideration of uncertainty in value and utility elicitation. With respect to (iii), we outline a well-structured procedure for transparent environmental decision support that is based on a clear separation of scientific prediction and societal valuation. We illustrate aspects of the suggested methodology by its application to river management in general and with a small, didactical case study on spatial river rehabilitation prioritization. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Highlights from the Future Earth Water-Energy-Food (W-E-F) Nexus Cluster Project Consultations

NASA Astrophysics Data System (ADS)

Lawford, R. G.

2017-12-01

Future Earth launched its W-E-F Nexus project in 2015. The focus of the project was to explore how improved governance and integrated information systems could support sustainability in the W-E-F Nexus. Workshops were held in four regions of the world (North America, Europe, Eastern Asia, and Southern Africa) which facilitated a better understanding of the current role of information in decision-making within the W-E-F Nexus. In each of these workshops, needs and options for improving the provision of relevant integrated data and information to support decision-making were discussed. The workshops provided distinct perspectives on W-E-F issues for each region and each sector. Regional differences arise from climate, geomorphology, natural resources and existing infrastructure as well as the economic and social policies within each country. While the needs associated with this diversity are large, it is still possible to identify unifying themes and requirements for data and information which appeared very similar in all the regions. Important themes involve developing a common rigorous definition of the Nexus, ensuring the availability of data of all types are available in the scales, frequencies, and accuracies needed to support better decision making; and promoting the gathering, analysis and use of information to break down the silos associated with the three sectors are made. Information is also needed to monitor the effects of land ownership and land management on W-E-F issues, to maximize the efficiencies that can be realized from joint planning and increased coherence in the sectoral policy approaches to address climate and environmental issues. After commenting on these opportunities the presentation will outline possible elements of a research agenda for moving the W-E-F Nexus approach forward.

Perspectives of self-direction: a systematic review of key areas contributing to service users' engagement and choice-making in self-directed disability services and supports.

PubMed

Lakhani, Ali; McDonald, Donna; Zeeman, Heidi

2018-05-01

Self-directed disability support policies aim to encourage greater choice and control for service users in terms of the health and social care they receive. The proliferation of self-directed disability support policies throughout the developed world has resulted in a growing amount of research exploring the outcomes for service users, and their families and carers. Our understanding of the issues faced by people with disabilities, particularly how they make health and social care decisions and the key areas that determine their engagement with service providers within a self-directed environment is limited. A synthesis of research is timely and can provide knowledge for service users and health and social care support providers to ensure their successful participation. A systematic review guided by the PRISMA approach explored (i) the key areas determining service users' engagement with self-directed disability services and supports, and (ii) how service users make informed decisions about providers. In October 2014 and April 2016, three databases - MEDLINE, CINAHL and Web of Science - were searched for research and review articles. Eighteen sources met the search criteria. Findings were mapped into either: key areas determining service user engagement, or service users' informed decision-making. Findings concerning key areas determining engagement fell into three themes - personal responsibility for budgeting, personalised approaches, and a cultural shift in practice and delivery among service providers. Findings about decision-making yielded two themes - supporting informed decision-making and inhibiting informed decision-making. Literature suggests that self-directed models of care may provide service users with increased control over the services that they receive. Increased control for some service users and their families requires independent external decision-making support, particularly around the domains of budgeting, planning and hiring. Future research must continue to investigate the perspectives of service users pertaining to their engagement, as their participation is central to the effectiveness of the approach. © 2016 John Wiley & Sons Ltd.

Translation and cross-cultural adaptation of a family booklet on comfort care in dementia: sensitive topics revised before implementation.

PubMed

van der Steen, Jenny T; Hertogh, Cees M P M; de Graas, Tjomme; Nakanishi, Miharu; Toscani, Franco; Arcand, Marcel

2013-02-01

Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Three themes emerged: (1) relationships among patient, physician and other professionals-the authority of the physician was more explicit in adapted versions; (2) patient rights and family position-adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services.

PubMed

Davidson, Gavin; Brophy, Lisa; Campbell, Jim; Farrell, Susan J; Gooding, Piers; O'Brien, Ann-Marie

2016-01-01

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person's wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past 30 years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Working in partnership: the application of shared decision-making to health visitor practice.

PubMed

Astbury, Ruth; Shepherd, Ashley; Cheyne, Helen

2017-01-01

To explore the processes that support shared decision-making when health visitors and parents are creating plans to improve the well-being of babies and children. Worldwide, there is a focus on promoting children's well-being to enhance the population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of 'shared decision-making' frameworks can increase patient participation, improve patient satisfaction and improve health outcomes, there is limited research linking shared decision-making with health visitor practice. A qualitative, descriptive study. The study was undertaken in two phases: in Phase 1, data were collected by audio recording two health visitor-parent decision-making conversations, in the absence of the researcher, where decisions around planning for a baby or child were being made as part of usual care, and then the participants' experiences were sought through individual questionnaires. In Phase 2, semistructured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care. Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions that were accessible for the family; engaging in decision-making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family and other professionals. Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision-making was unable to take place due to the absence of supportive processes. Health visitors are aware that planning interventions with parents can be complex. These findings indicate the value of using a shared decision-making framework to structure planning, as application of a framework identified the processes that support a collaborative approach in practice. © 2016 John Wiley & Sons Ltd.

Operator models for delivering municipal solid waste management services in developing countries: Part B: Decision support.

PubMed

Soós, Reka; Whiteman, Andrew D; Wilson, David C; Briciu, Cosmin; Nürnberger, Sofia; Oelz, Barbara; Gunsilius, Ellen; Schwehn, Ekkehard

2017-08-01

This is the second of two papers reporting the results of a major study considering 'operator models' for municipal solid waste management (MSWM) in emerging and developing countries. Part A documents the evidence base, while Part B presents a four-step decision support system for selecting an appropriate operator model in a particular local situation. Step 1 focuses on understanding local problems and framework conditions; Step 2 on formulating and prioritising local objectives; and Step 3 on assessing capacities and conditions, and thus identifying strengths and weaknesses, which underpin selection of the operator model. Step 4A addresses three generic questions, including public versus private operation, inter-municipal co-operation and integration of services. For steps 1-4A, checklists have been developed as decision support tools. Step 4B helps choose locally appropriate models from an evidence-based set of 42 common operator models ( coms); decision support tools here are a detailed catalogue of the coms, setting out advantages and disadvantages of each, and a decision-making flowchart. The decision-making process is iterative, repeating steps 2-4 as required. The advantages of a more formal process include avoiding pre-selection of a particular com known to and favoured by one decision maker, and also its assistance in identifying the possible weaknesses and aspects to consider in the selection and design of operator models. To make the best of whichever operator models are selected, key issues which need to be addressed include the capacity of the public authority as 'client', management in general and financial management in particular.

Weather information for surface transportation : a white paper on needs, issues and actions : draft (revised)

DOT National Transportation Integrated Search

1998-05-15

This White Paper focuses on the needs of surface transportation decisions for better support by weather information, integrated with other information in the ITS. Findings are included from a special team workshop and feedback from conference present...

Noncustodial Mothers: Developing Strategies of Support.

ERIC Educational Resources Information Center

Arditti, Joyce A.; Madden-Derdich, Debra A.

1993-01-01

Examined issues surrounding mothers' decisions to relinquish custody of their children and explored their postdivorce relationships with their former spouses and children. Analyzed qualitative and quantitative interview data from 13 noncustodial mothers. Subjects varied in terms of actual reasons for giving up or losing custody. Subjects perceived…

Decision-making in Coastal Management and a Collaborative Governance Framework

EPA Science Inventory

Over half of the US population lives in coastal watersheds, creating a regional pressure for coastal ecosystems to provide a broad spectrum of services while continuing to support healthy communities and economies. The National Ocean Policy, issued in 2010, and Coastal and Marin...

Evaluation and purchase of confocal microscopes: numerous factors to consider.

PubMed

Zucker, Robert M; Chua, Michael

2010-10-01

The purchase of a confocal microscope is a difficult decision. Many factors need to be considered, which include hardware, software, company, support, service, and price. These issues are discussed to help guide the purchasing process. © 2010 by John Wiley & Sons, Inc.

Dimensions of autonomy: Primary teachers' decisions about involvement in science professional development

NASA Astrophysics Data System (ADS)

Schibeci, Renato A.; Hickey, Ruth L.

2004-01-01

Professional development (PD) for primary science teachers is recognized as an important activity which can support improved science education for students. Analysis of interviews with practicing primary science teachers is used to identify the range of PD experiences of a sample of teachers from Western Australia. Teachers' reasons for attending or avoiding science-related PD are categorized as decision issues which include opportunity, compulsion, convenience, enticement, interest, recommendation, and relevance. Case studies describe the interplay of these issues, which result in teachers' attendance or avoidance of PD. A subset of the sample is used to explore teachers' views of other activities which they recognize as contributing to their science teaching, content knowledge, and pedagogy. These other activities include hobbies, partner's job, and pursuing students' interests. Legitimating teachers' own interests as a source of personally derived PD is supported as an avenue to increase the diversity of topics studied by students and to increase the level of content knowledge held by teachers.

20 CFR 30.316 - How does the FAB issue a final decision on a claim?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How does the FAB issue a final decision on a... Adjudicatory Process Hearings and Final Decisions on Claims § 30.316 How does the FAB issue a final decision on... waives any objections to all or part of the recommended decision, the FAB may issue a final decision...

To protect and to support: How citizenship and self-determination are legally constructed and managed in practice for people living with dementia in Sweden.

PubMed

Nedlund, Ann-Charlotte; Taghizadeh Larsson, Annika

2016-05-01

Since living with dementia implies increasing difficulties in taking charge of rights due to cognitive as well as communicative impairments, many people with dementia are vulnerable and in need of support in order to realize full citizenship. In Sweden, all adults right to self-determination is strongly emphasized in law, regulations, and policies. Further, and in contrast to the situation in many other countries, people living with dementia cannot be declared as incompetent of making decisions concerning social care and their right to self-determination cannot legally be taken away. The article shows that in the Swedish welfare system, the focus is more on protecting the self-determination of citizens than on supporting people in making decisions and exercising citizenship. Subsequently, this causes legally constructed zones of inclusion and exclusion. This article examines and problematizes how different institutional contexts, legal constructions, norms, and practices in Sweden affect the management of issues concerning guardianship, supported decision-making and self-determination, and outline the implications for people living with dementia. © The Author(s) 2016.

Weather monitoring and forecasting over eastern Attica (Greece) in the frame of FLIRE project

NASA Astrophysics Data System (ADS)

Kotroni, Vassiliki; Lagouvardos, Konstantinos; Chrysoulakis, Nektarios; Makropoulos, Christtos; Mimikou, Maria; Papathanasiou, Chrysoula; Poursanidis, Dimitris

2015-04-01

In the frame of FLIRE project a Decision Support System has been built with the aim to support decision making of Civil Protection Agencies and local stakeholders in the area of east Attica (Greece), in the cases of forest fires and floods. In this presentation we focus on a specific action that focuses on the provision of high resolution short-term weather forecasting data as well as of dense meteorological observations over the study area. Both weather forecasts and observations serve as an input in the Weather Information Management Tool (WIMT) of the Decision Support System. We focus on: (a) the description of the adopted strategy for setting-up the operational weather forecasting chain that provides the weather forecasts for the FLIRE project needs, (b) the presentation of the surface network station that provides real-time weather monitoring of the study area and (c) the strategy adopted for issuing smart alerts for thunderstorm forecasting based of real-time lightning observations as well as satellite observations.

A framework for ecological decision support systems: Building the right systems and building the systems right

USGS Publications Warehouse

D'Erchia, Frank; Korschgen, Carl E.; Nyquist, M.; Root, Ralph; Sojda, Richard S.; Stine, Peter

2001-01-01

Workshops in the late 1990's launched the commitment of the U.S. Geological Survey's Biological Resources Division (BRD) to develop and implement decision support systems (DSS) applications. One of the primary goals of this framework document is to provide sufficient background and information for Department of the Interior (DOI) bureau stakeholders and other clients to determine the potential for DSS development. Such an understanding can assist them in carrying out effective land planning and management practices. This document provides a definition of DSS and its characteristics and capabilities. It proceeds to describe issues related to meeting resource managers needs, such as the needs for specific applications, customer requirements, information and technology transfer, user support, and institutionalization. Using the decision process as a means to guide DSS development and determine users needs is also discussed. We conclude with information on method to evaluate DSS development efforts and recommended procedures for verification and validation. 

Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

PubMed

Kohli, R; Tan, J K; Piontek, F A; Ziege, D E; Groot, H

1999-08-01

Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

How to Measure Costs and Benefits of eHealth Interventions: An Overview of Methods and Frameworks

PubMed Central

2015-01-01

Information on the costs and benefits of eHealth interventions is needed, not only to document value for money and to support decision making in the field, but also to form the basis for developing business models and to facilitate payment systems to support large-scale services. In the absence of solid evidence of its effects, key decision makers may doubt the effectiveness, which, in turn, limits investment in, and the long-term integration of, eHealth services. However, it is not realistic to conduct economic evaluations of all eHealth applications and services in all situations, so we need to be able to generalize from those we do conduct. This implies that we have to select the most appropriate methodology and data collection strategy in order to increase the transferability across evaluations. This paper aims to contribute to the understanding of how to apply economic evaluation methodology in the eHealth field. It provides a brief overview of basic health economics principles and frameworks and discusses some methodological issues and challenges in conducting cost-effectiveness analysis of eHealth interventions. Issues regarding the identification, measurement, and valuation of costs and benefits are outlined. Furthermore, this work describes the established techniques of combining costs and benefits, presents the decision rules for identifying the preferred option, and outlines approaches to data collection strategies. Issues related to transferability and complexity are also discussed. PMID:26552360

Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda.

PubMed

Kananura, Rornald Muhumuza; Ekirapa-Kiracho, Elizabeth; Paina, Ligia; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Oo, Htet Nay Lin; Kiwanuka, Suzanne Namusoke; George, Asha; Peters, David H

2017-12-28

The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders' decision-making in eastern Uganda. The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as  key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions.

Assessing the quality of the nation's water resources

USGS Publications Warehouse

Hamilton, Pixie A.

2002-01-01

This issue of IMPACT highlights findings from the first decade of studies (1991 to 2001) by the National Water-Quality Assessment (NAWQA) Program of the U.S. Geological Survey (USGS). The articles also discuss the Program’s approaches and models designed to help understand and estimate the fate and transport of contaminants in different geographic areas and environmental settings and over different time frames. NAWQA was established by Congress in 1991 with a goal of developing long-term, consistent, and comparable science-based information on nationwide water-quality conditions. This information is used to support sound management and policy decisions by decision makers at all levels – local, state, and national – who, every day, face complex regulations and management issues related to water resources.

[Shared decision making in breast cancer. Womens' attitudes].

PubMed

Martín-Fernández, Roberto; Abt-Sacks, Analía; Perestelo-Perez, Lilisbeth; Serrano-Aguilar, Pedro

2013-01-01

The patient autonomy and the greater role for women with breast cancer in the decisions about their health are recent issues in healthcare. The objective of this work is to identify and characterize the elements that influence them in treatment decisions. A phenomenological type qualitative study. Theoretical Sampling included 70 women diagnosed with breast cancer. 45 semi structured interviews and 3 focus groups were performed between October 2009 and July 2010 in 15 regions of Spain. The analysis was based on the principles of grounded theory with the support of Atlas.ti v6.1. Patients are likely to take an active or passive role regarding decision-making depending on different variables such as their age, the information available, their self-assessment as capable agents to make decisions and the relative importance given to physical appearance. As the disease progresses, it can cause a change in women attitude, from an initially passive attitude to a more active role. The attitude of health professionals concerning shared decision-making and the information they offer determines patient participation while the family plays an essential role as a support or reinforcement of decisions made by patients. The patients' attitude regarding the decision-making of patients is very variable, becoming increasingly important the emotional status, the level of information available and the influence of the context.

Evaluation of a decision support system for pressure ulcer prevention and management: preliminary findings.

PubMed

Zielstorff, R D; Estey, G; Vickery, A; Hamilton, G; Fitzmaurice, J B; Barnett, G O

1997-01-01

A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic. A similar care unit was used as a control. In addition, the system was evaluated by experts for its instructional adequacy, and by end users for their satisfaction with the system. Preliminary results show no effect on knowledge about pressure ulcers and no effect on clinical decision making skills. The system was rated positively for instructional adequacy, and positively for user satisfaction. User interviews related to satisfaction supplemented the quantitative findings. A discussion of the issues of conducting experiments like this in today's clinical environment is included.

A Virtual Information-Action Workspace for Command and Control

NASA Astrophysics Data System (ADS)

Lintern, Gavan; Naikar, Neelam

2002-10-01

Information overload has become a critical challenge within military Command and Control. However, the problem is not so much one of too much information but of abundant information that is poorly organized and poorly represented. In addition, the capabilities to test the effects of decisions before they are implemented and to monitor the progress of events after a decision is implemented are primitive. A virtual information-action workspace could be designed to resolve these issues. The design of such a space would require a detailed understanding of the specific information needed to support decision making in Command and Control. That information can be obtained with the use of knowledge acquisition and knowledge representation tools from the field of applied cognitive psychology. In addition, it will be necessary to integrate forms for perception and action into a virtual space that will support access to the information and that will provide means for testing and implementing decisions. This paper presents a rationale for a virtual information-action workspace and outlines an approach to its design.

Evidence-based Sensor Tasking for Space Domain Awareness

NASA Astrophysics Data System (ADS)

Jaunzemis, A.; Holzinger, M.; Jah, M.

2016-09-01

Space Domain Awareness (SDA) is the actionable knowledge required to predict, avoid, deter, operate through, recover from, and/or attribute cause to the loss and/or degradation of space capabilities and services. A main purpose for SDA is to provide decision-making processes with a quantifiable and timely body of evidence of behavior(s) attributable to specific space threats and/or hazards. To fulfill the promise of SDA, it is necessary for decision makers and analysts to pose specific hypotheses that may be supported or refuted by evidence, some of which may only be collected using sensor networks. While Bayesian inference may support some of these decision making needs, it does not adequately capture ambiguity in supporting evidence; i.e., it struggles to rigorously quantify 'known unknowns' for decision makers. Over the past 40 years, evidential reasoning approaches such as Dempster Shafer theory have been developed to address problems with ambiguous bodies of evidence. This paper applies mathematical theories of evidence using Dempster Shafer expert systems to address the following critical issues: 1) How decision makers can pose critical decision criteria as rigorous, testable hypotheses, 2) How to interrogate these hypotheses to reduce ambiguity, and 3) How to task a network of sensors to gather evidence for multiple competing hypotheses. This theory is tested using a simulated sensor tasking scenario balancing search versus track responsibilities.

78 FR 26069 - Top RX Pharmacy; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

.... 1980) (upholding jury instruction that knowledge may be inferred from evidence that pharmacists... are clearly not issued for legitimate medical purposes, a pharmacist may not intentionally close his... make clear, inaction on the part of a pharmacist who fills a prescription can by, itself, support a...

LCIA framework and cross-cutting issues guidance within the UNEP/SETAC Life Cycle Initiative

EPA Science Inventory

Increasing needs for decision support and advances in scientific knowledge within life cycle assessment (LCA) led to substantial efforts to provide global guidance on environmental life cycle impact assessment (LCIA) indicators under the auspices of the UNEP-SETAC Life Cycle Init...

Indicators of Effective Policy Development & Implementation. Issue Brief #8

ERIC Educational Resources Information Center

Stonemeier, Jenny; Trader, Barb; Kaloi, Laura; Williams, Gabrielle

2016-01-01

Within the SWIFT framework, the Inclusive Policy Structure and Practice domain addresses the need for a supportive, reciprocal partnership between the school and its district or local educational agency. Therefore, intentional and effective policy decision-making processes are integral to SWIFT implementation. Such processes create opportunities…

A Right to Die?: Ethical Dilemmas of Euthanasia.

ERIC Educational Resources Information Center

Albright, Dianne E.; Hazler, Richard J.

1992-01-01

Euthanasia is considered an important social issue of the 1990s. Mental health professionals should understand the differences between voluntary, involuntary, passive, and active euthanasia; mercy killing, and assisted suicide. Encourages counselors to ethically formulate client-supportive positions to help clients face life-and-death decisions.…

Guidelines for Child Custody Evaluations in Family Law Proceedings

ERIC Educational Resources Information Center

American Psychologist, 2010

2010-01-01

Family law proceedings encompass a broad range of issues, including custody, maintenance, support, valuation, visitation, relocation, and termination of parental rights. The following guidelines address what are commonly termed child custody evaluations, involving disputes over decision making, caretaking, and access in the wake of marital or…

34 CFR 32.9 - Written decision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... stating the facts supporting the nature and origin of the debt and the hearing official's analysis... determination of the existence and the amount of the overpayment or the extreme financial hardship caused by the... decides the issue of extreme financial hardship caused by the involuntary repayment schedule only where...

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.

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

Mobile Clinical Decision Support Systems in Our Hands - Great Potential but also a Concern.

PubMed

Masic, Izet; Begic, Edin

2016-01-01

Due to the powerful computer resources as well as the availability of today's mobile devices, a special field of mobile systems for clinical decision support in medicine has been developed. The benefits of these applications (systems) are: availability of necessary hardware (mobile phones, tablets and phablets are widespread, and can be purchased at a relatively affordable price), availability of mobile applications (free or for a "small" amount of money) and also mobile applications are tailored for easy use and save time of clinicians in their daily work. In these systems lies a huge potential, and certainly a great economic benefit, so this issue must be approached multidisciplinary.

The use of misclassification costs to learn rule-based decision support models for cost-effective hospital admission strategies.

PubMed

Ambrosino, R; Buchanan, B G; Cooper, G F; Fine, M J

1995-01-01

Cost-effective health care is at the forefront of today's important health-related issues. A research team at the University of Pittsburgh has been interested in lowering the cost of medical care by attempting to define a subset of patients with community-acquire pneumonia for whom outpatient therapy is appropriate and safe. Sensitivity and specificity requirements for this domain make it difficult to use rule-based learning algorithms with standard measures of performance based on accuracy. This paper describes the use of misclassification costs to assist a rule-based machine-learning program in deriving a decision-support aid for choosing outpatient therapy for patients with community-acquired pneumonia.

Attitudes of rehabilitation medicine doctors toward medical ethics in Malaysia.

PubMed

Mazlina, M; Julia, P E

2011-06-01

Medical ethics issues encountered in rehabilitation medicine differ from those in an acute care setting due to the complex relationships among the parties involved in rehabilitative care. The study examined the attitudes of Malaysian rehabilitation doctors toward medical ethics issues commonly encountered during patient care. We surveyed 74 rehabilitation physicians and residents in Malaysia using a self-administered descriptive questionnaire. The questions covered medical ethics issues on allocation of resources, patient confidentiality, discharge planning, goal-setting, reimbursement documentation, decision-making capacity and withdrawal of life support. The overall response rate was 69 percent. More than 80 percent of respondents would disclose confidential information to their team members if it would affect the rehabilitation process. More than two-thirds of respondents would not allocate scarce rehabilitation resources if the functional outcome is marginally positive. Issues involving patients' autonomy in decision-making, both in life-threatening and non-life-threatening situations, showed mix responses. The least common response was on the issue of discharge planning, where 51 percent of respondents would send a patient back to a nursing home with suboptimal care if there were no other alternatives. The attitude of Malaysian rehabilitation doctors toward ethical issues is reflective of the level of maturity of rehabilitation medicine in Malaysia. Issues on allocation of resources, discharge planning and decision-making capacity are significantly influenced by limited rehabilitation facilities in parts of the country. The lack of influence from external factors, such as a developed health insurance system, contributes to the difference in attitude between rehabilitation doctors in Malaysia and those in developed countries.

Identifying Opportunities for Decision Support Systems in Support of Regional Resource Use Planning: An Approach Through Soft Systems Methodology.

PubMed

Zhu; Dale

2000-10-01

/ Regional resource use planning relies on key regional stakeholder groups using and having equitable access to appropriate social, economic, and environmental information and assessment tools. Decision support systems (DSS) can improve stakeholder access to such information and analysis tools. Regional resource use planning, however, is a complex process involving multiple issues, multiple assessment criteria, multiple stakeholders, and multiple values. There is a need for an approach to DSS development that can assist in understanding and modeling complex problem situations in regional resource use so that areas where DSSs could provide effective support can be identified, and the user requirements can be well established. This paper presents an approach based on the soft systems methodology for identifying DSS opportunities for regional resource use planning, taking the Central Highlands Region of Queensland, Australia, as a case study.

Risk assessment of sewer condition using artificial intelligence tools: application to the SANEST sewer system.

PubMed

Sousa, V; Matos, J P; Almeida, N; Saldanha Matos, J

2014-01-01

Operation, maintenance and rehabilitation comprise the main concerns of wastewater infrastructure asset management. Given the nature of the service provided by a wastewater system and the characteristics of the supporting infrastructure, technical issues are relevant to support asset management decisions. In particular, in densely urbanized areas served by large, complex and aging sewer networks, the sustainability of the infrastructures largely depends on the implementation of an efficient asset management system. The efficiency of such a system may be enhanced with technical decision support tools. This paper describes the role of artificial intelligence tools such as artificial neural networks and support vector machines for assisting the planning of operation and maintenance activities of wastewater infrastructures. A case study of the application of this type of tool to the wastewater infrastructures of Sistema de Saneamento da Costa do Estoril is presented.

Biotechnology patent challenged: ex-colleague seeks share of the credit.

PubMed

Budiansky, Stephen

1982-11-25

Dr. Robert Helling, supported by the University of Michigan, has decided to press a claim to co-ownership of two Cohen-Boyer genetic engineering patents assigned to Stanford and the University of California. This decision will likely delay further the issuing of the second patent, tentatively rejected by the Patent Office in part on the basis of Helling's unresolved role. It may also increase pressure for a re-examination of the first patent issued in 1980.

Soldier Perceptions of the Rapid Decision Trainer

DTIC Science & Technology

2005-05-01

utility. "* Integrated 3D spatialized sound, supporting SCORM Integration the most common sound formats including Wav and Midi . A major objective of this...34low" and "very low" ratings in a similar manner for the lowest ratings categories. Pre-LFX Questionnaire Overall training value of the RDT. Lieutenants...on school computers and has issues are similar to ActiveX, however applets issued the RDT on CD-ROM to each IOBC student installed on the client

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

PubMed

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

2012-01-01

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

A Conceptual Analytics Model for an Outcome-Driven Quality Management Framework as Part of Professional Healthcare Education.

PubMed

Hervatis, Vasilis; Loe, Alan; Barman, Linda; O'Donoghue, John; Zary, Nabil

2015-10-06

Preparing the future health care professional workforce in a changing world is a significant undertaking. Educators and other decision makers look to evidence-based knowledge to improve quality of education. Analytics, the use of data to generate insights and support decisions, have been applied successfully across numerous application domains. Health care professional education is one area where great potential is yet to be realized. Previous research of Academic and Learning analytics has mainly focused on technical issues. The focus of this study relates to its practical implementation in the setting of health care education. The aim of this study is to create a conceptual model for a deeper understanding of the synthesizing process, and transforming data into information to support educators' decision making. A deductive case study approach was applied to develop the conceptual model. The analytics loop works both in theory and in practice. The conceptual model encompasses the underlying data, the quality indicators, and decision support for educators. The model illustrates how a theory can be applied to a traditional data-driven analytics approach, and alongside the context- or need-driven analytics approach.

A Conceptual Analytics Model for an Outcome-Driven Quality Management Framework as Part of Professional Healthcare Education

PubMed Central

Loe, Alan; Barman, Linda; O'Donoghue, John; Zary, Nabil

2015-01-01

Background Preparing the future health care professional workforce in a changing world is a significant undertaking. Educators and other decision makers look to evidence-based knowledge to improve quality of education. Analytics, the use of data to generate insights and support decisions, have been applied successfully across numerous application domains. Health care professional education is one area where great potential is yet to be realized. Previous research of Academic and Learning analytics has mainly focused on technical issues. The focus of this study relates to its practical implementation in the setting of health care education. Objective The aim of this study is to create a conceptual model for a deeper understanding of the synthesizing process, and transforming data into information to support educators’ decision making. Methods A deductive case study approach was applied to develop the conceptual model. Results The analytics loop works both in theory and in practice. The conceptual model encompasses the underlying data, the quality indicators, and decision support for educators. Conclusions The model illustrates how a theory can be applied to a traditional data-driven analytics approach, and alongside the context- or need-driven analytics approach. PMID:27731840

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

PubMed

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

2016-08-01

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

Controversial Curriculum? Ask the Community!

ERIC Educational Resources Information Center

Davis, William Jeffrey

2009-01-01

Involving communities in the process of curriculum development may not be novel, but it seems lacking with regard to controversial issues such as lessons on diverse family structures, homosexuality, and other special situations. Disparity in values and convictions can lead one person to support a decision, while another person might hold an…

77 FR 47372 - New England Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

... species and area- based `extra-SASI' materials intended to support decision making related to adverse...). Recommendations from this group will be brought to the full Council for formal consideration and action, if... group for discussion, those issues may not be the subject of formal action during this meeting. Action...

14 CFR 17.33 - Adjudicative Process for contract disputes.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... 17.33 Section 17.33 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... determined by the DRO or Special Master, and in advance of the decision of the case, the parties shall make... each issue together with citations to the administrative record or other supporting materials; (3...

14 CFR 17.33 - Adjudicative Process for contract disputes.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... 17.33 Section 17.33 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... determined by the DRO or Special Master, and in advance of the decision of the case, the parties shall make... each issue together with citations to the administrative record or other supporting materials; (3...

14 CFR 17.33 - Adjudicative Process for contract disputes.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... 17.33 Section 17.33 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... determined by the DRO or Special Master, and in advance of the decision of the case, the parties shall make... each issue together with citations to the administrative record or other supporting materials; (3...

Uncertainty considerations in calibration and validation of hydrologic and water quality models

USDA-ARS?s Scientific Manuscript database

Hydrologic and water quality models (HWQMs) are increasingly used to support decisions on the state of various environmental issues and policy directions on present and future scenarios, at scales varying from watershed to continental levels. Uncertainty associated with such models may impact the ca...

Strengthening Resiliency in Coastal Watersheds: An Ecosystem Services and Ecological Integrity Decision Support System.

EPA Science Inventory

To promote and strengthen the resiliency of coastal watersheds in the face of climate change and development, ecological outcomes as well as economic, social, and environmental justice issues need to be considered. An integrated assessment framework is being developed to help wat...

A Decision Support Tool to Evaluate Sources and Sinks of Nitrogen within a Watershed Framework

EPA Science Inventory

Human transformation of the nitrogen (N) cycle is causing a number of environmental and human health problems. Federal, state and local authorities focusing on management of N loadings face both technical and non-technical challenges. One technical issue is that we need a bette...

A Distributed Information Strategy. AIR Forum 1982 Paper. Preliminary Paper.

ERIC Educational Resources Information Center

Baker, Michael E.

Planning issues and computing technology changes are reviewed and decision support systems are examined as a means of providing an appropriate information system for the university institutional research office. Examples of formative attempts to provide such systems at Carnegie-Mellon University (CMU) and other institutions are considered. The…

Constitutional Issues: Watergate and the Constitution.

ERIC Educational Resources Information Center

Gray, Leslie; Burroughs, Wynell

1987-01-01

Provides a lesson plan and primary source material for exploring whether Richard M. Nixon should have been prosecuted for obstruction of justice following his resignation from the Presidency. Contains a reproduction of the special prosecutor's memorandum that lists the factors which support or detract from a decision to prosecute Richard Nixon.…

Developing Materials for Deliberative Forums

ERIC Educational Resources Information Center

Rourke, Brad

2014-01-01

When citizens deliberate together about important issues, they can reach decisions and take action together on problems that confront them. Deliberation does not require a certain kind of guide, or framework, or language, or facilitator, but, because it can be difficult to face such choices, supporting materials can make it easier. In Developing…

Using Technology to Deliver Career Development Services: Supporting Today's Students in Higher Education

ERIC Educational Resources Information Center

Venable, Melissa A.

2010-01-01

Career services professionals are increasingly involved in decisions regarding the use of technology. This article presents a number of considerations to be explored, including the characteristics and needs of today's students, available technologies, funding requirements, and confidentiality issues. The author recommends an approach that includes…

British Columbia

ERIC Educational Resources Information Center

Walton, Gerald

2006-01-01

The province of British Columbia has a dubious history where support for lesbian, gay, bisexual, and transgendered (LGBT) issues in education is concerned. Most notable is the Surrey School Board's decision in 1997 to ban three picture books for children that depict families with two moms or two dads. The North Vancouver School Board has also…

Social Policies for Family Caregivers.

ERIC Educational Resources Information Center

Barer, Barbara M.

Demographic changes, changes in women's work roles, and changes in the nature of the family have increased the importance of identifying the effects of government policy on family cohesion and living arrangement decisions. The effect of public policy on the nation's largest source of caregivers, the family support system, is a key issue. While…

48 CFR 9904.405-60 - Illustrations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... administrative (G&A) expense. In the contractor's proposals for final Segment G&A rates (including corporate home... responsibilities on which his salary was based, no part of the official's salary would be required to be identified... the contract. The contracting officer issues a written decision which supports the auditor's position...

48 CFR 9904.405-60 - Illustrations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... administrative (G&A) expense. In the contractor's proposals for final Segment G&A rates (including corporate home... responsibilities on which his salary was based, no part of the official's salary would be required to be identified... the contract. The contracting officer issues a written decision which supports the auditor's position...

48 CFR 9904.405-60 - Illustrations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... administrative (G&A) expense. In the contractor's proposals for final Segment G&A rates (including corporate home... responsibilities on which his salary was based, no part of the official's salary would be required to be identified... the contract. The contracting officer issues a written decision which supports the auditor's position...

A Framework for the Selection of Electronic Marketplaces: A Content Analysis Approach.

ERIC Educational Resources Information Center

Stockdale, Rosemary; Standing, Craig

2002-01-01

Discussion of electronic marketplaces focuses on a content analysis of research and practitioner articles that evaluated issues that prospective participants, seeking to purchase goods and services online, need to address in their selection process. Proposes a framework to support electronic marketplace decision making that includes internal…

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.

Governing therapy choices: power/knowledge in the treatment of progressive renal failure.

PubMed

Holmes, Dave; Perron, Amélie M; Savoie, Marc

2006-12-04

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed.

Governing therapy choices: Power/Knowledge in the treatment of progressive renal failure

PubMed Central

Holmes, Dave; Perron, Amélie M; Savoie, Marc

2006-01-01

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed. PMID:17144913

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

[Passive euthanasia in clinical practice--the medical decision reflected in the legal position].

PubMed

Möller, T; Grabensee, B; Frister, H

2008-05-01

Doctors are often confronted with end-of-life decisions. When deciding on the withdrawal of medical treatment physicians have to consider the legal position. This study was done to evaluated how far doctors at the university medical center in Düsseldorf had acted in conformity with the established case law in Germany. Between April and August 2006 doctors at the university medical center in Düsseldorf filled in a standardized questionnaire about the decisions they had taken to withdraw life-support treatment. 128 of a total of 512 doctors questioned replied (25 %; 32,8 % females and 67,2 % males) . The survey showed that the judicial decision (that it is not necessary to provide treatment if life-support measures are not indicated) is largely determined by non-medical criteria. The clinical decision by doctors depended mainly on his personal opinion. Furthermore the survey showed that only a few doctors made use of the - lawful - option to withdraw medical treatment when this was not indicated. Finally the survey revealed that, in case of conflict between indication and perceived patients' wishes, the vast majority of doctors behaved in contravention of the decisions established by case law. There is the need to discuss what non-medical issues should be taken into account when determining the indication of withdrawal of life-support measures. The results also highlighted the uncertainties that exist regarding a doctor's decisions about it. Not only should legislation clarify whether "passive euthanasia" is allowed, but it would also be useful to delegate end-of-life decisions to a review board.

A public health decision support system model using reasoning methods.

PubMed

Mera, Maritza; González, Carolina; Blobel, Bernd

2015-01-01

Public health programs must be based on the real health needs of the population. However, the design of efficient and effective public health programs is subject to availability of information that can allow users to identify, at the right time, the health issues that require special attention. The objective of this paper is to propose a case-based reasoning model for the support of decision-making in public health. The model integrates a decision-making process and case-based reasoning, reusing past experiences for promptly identifying new population health priorities. A prototype implementation of the model was performed, deploying the case-based reasoning framework jColibri. The proposed model contributes to solve problems found today when designing public health programs in Colombia. Current programs are developed under uncertain environments, as the underlying analyses are carried out on the basis of outdated and unreliable data.

Framing of Uncertainty in Scientific Publications: Towards Recommendations for Decision Support

NASA Astrophysics Data System (ADS)

Guillaume, J. H. A.; Helgeson, C.; Elsawah, S.; Jakeman, A. J.; Kummu, M.

2016-12-01

Uncertainty is recognised as an essential issue in environmental decision making and decision support. As modellers, we notably use a variety of tools and techniques within an analysis, for example related to uncertainty quantification and model validation. We also address uncertainty by how we present results. For example, experienced modellers are careful to distinguish robust conclusions from those that need further work, and the precision of quantitative results is tailored to their accuracy. In doing so, the modeller frames how uncertainty should be interpreted by their audience. This is an area which extends beyond modelling to fields such as philosophy of science, semantics, discourse analysis, intercultural communication and rhetoric. We propose that framing of uncertainty deserves greater attention in the context of decision support, and that there are opportunities in this area for fundamental research, synthesis and knowledge transfer, development of teaching curricula, and significant advances in managing uncertainty in decision making. This presentation reports preliminary results of a study of framing practices. Specifically, we analyse the framing of uncertainty that is visible in the abstracts from a corpus of scientific articles. We do this through textual analysis of the content and structure of those abstracts. Each finding that appears in an abstract is classified according to the uncertainty framing approach used, using a classification scheme that was iteratively revised based on reflection and comparison amongst three coders. This analysis indicates how frequently the different framing approaches are used, and provides initial insights into relationships between frames, how the frames relate to interpretation of uncertainty, and how rhetorical devices are used by modellers to communicate uncertainty in their work. We propose initial hypotheses for how the resulting insights might influence decision support, and help advance decision making to better address uncertainty.

[Critical appraisal of organ procurement under Maastricht 3 condition].

PubMed

Puybasset, L; Bazin, J-E; Beloucif, S; Bizouarn, P; Crozier, S; Devalois, B; Eon, B; Fieux, F; Gisquet, E; Guibet-Lafaye, C; Kentish, N; Lienhart, A; Nicolas-Robin, A; Otero Lopez, M; Pelluchon, C; Roussin, F; Beydon, L

2012-05-01

The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after a decision of withdrawing life supporting therapies has been taken. This category of organ donation is performed in the USA, Canada, United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations, which formalize procedures and operations. The Sfar ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounds a note of caution regarding the applicability of this type of organ procurement in unselected patient following a decision to withdraw life supporting therapies. According to the French regulation concerning organ procurement in brain dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. It suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians. This should help preserving population trust regarding organ procurement and provide a framework to medical decision. This text has been endorsed by the Sfar. Copyright © 2012. Published by Elsevier SAS.

Incorporating Guideline Adherence and Practice Implementation Issues into the Design of Decision Support for Beta-Blocker Titration for Heart Failure.

PubMed

Smith, Michael W; Brown, Charnetta; Virani, Salim S; Weir, Charlene R; Petersen, Laura A; Kelly, Natalie; Akeroyd, Julia; Garvin, Jennifer H

2018-04-01

 The recognition of and response to undertreatment of heart failure (HF) patients can be complicated. A clinical reminder can facilitate use of guideline-concordant β-blocker titration for HF patients with depressed ejection fraction. However, the design must consider the cognitive demands on the providers and the context of the work.  This study's purpose is to develop requirements for a clinical decision support tool (a clinical reminder) by analyzing the cognitive demands of the task along with the factors in the Cabana framework of physician adherence to guidelines, the health information technology (HIT) sociotechnical framework, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework of health services implementation. It utilizes a tool that extracts information from medical records (including ejection fraction in free text reports) to identify qualifying patients at risk of undertreatment.  We conducted interviews with 17 primary care providers, 5 PharmDs, and 5 Registered Nurses across three Veterans Health Administration outpatient clinics. The interviews were based on cognitive task analysis (CTA) methods and enhanced through the inclusion of the Cabana, HIT sociotechnical, and PARIHS frameworks. The analysis of the interview data led to the development of requirements and a prototype design for a clinical reminder. We conducted a small pilot usability assessment of the clinical reminder using realistic clinical scenarios.  We identified organizational challenges (such as time pressures and underuse of pharmacists), knowledge issues regarding the guideline, and information needs regarding patient history and treatment status. We based the design of the clinical reminder on how to best address these challenges. The usability assessment indicated the tool could help the decision and titration processes.  Through the use of CTA methods enhanced with adherence, sociotechnical, and implementation frameworks, we designed a decision support tool that considers important challenges in the decision and execution of β-blocker titration for qualifying HF patients at risk of undertreatment. Schattauer GmbH Stuttgart.

Community representation in hospital decision making: a literature review.

PubMed

Murray, Zoë

2015-06-01

Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Studies spanning 1997-2012 were analysed using Donabedian' s model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in hospital governance, associated with ambiguity, organisational and consumer issues. For an inclusive agenda to real life, work must be done on understanding the representatives' role and the decision making process, adequately supporting the representational process, and developing organisational cooperation and culture regarding community representation.

A risk-based decision support framework for selection of appropriate safety measure system for underground coal mines.

PubMed

Samantra, Chitrasen; Datta, Saurav; Mahapatra, Siba Sankar

2017-03-01

In the context of underground coal mining industry, the increased economic issues regarding implementation of additional safety measure systems, along with growing public awareness to ensure high level of workers safety, have put great pressure on the managers towards finding the best solution to ensure safe as well as economically viable alternative selection. Risk-based decision support system plays an important role in finding such solutions amongst candidate alternatives with respect to multiple decision criteria. Therefore, in this paper, a unified risk-based decision-making methodology has been proposed for selecting an appropriate safety measure system in relation to an underground coal mining industry with respect to multiple risk criteria such as financial risk, operating risk, and maintenance risk. The proposed methodology uses interval-valued fuzzy set theory for modelling vagueness and subjectivity in the estimates of fuzzy risk ratings for making appropriate decision. The methodology is based on the aggregative fuzzy risk analysis and multi-criteria decision making. The selection decisions are made within the context of understanding the total integrated risk that is likely to incur while adapting the particular safety system alternative. Effectiveness of the proposed methodology has been validated through a real-time case study. The result in the context of final priority ranking is seemed fairly consistent.

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

PubMed Central

DuBenske, Lori L.; Gustafson, David H.; Shaw, Bret R.; Cleary, James F.

2011-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS—the Comprehensive Health Enhancement Support System (CHESS)—for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS. An interactive health communication system (IHCS) offers one platform for providing the information, communication, and coaching resources that cancer patients and their families need to understand the disease, find support, and develop decision-making and coping skills. One such IHCS—the Comprehensive Health Enhancement Support System (CHESS)—has evolved over the past 20 years. Based on our recent experience creating and testing a new version of CHESS—“Coping with Lung Cancer: A Network of Support”—this article outlines the issues faced in developing and implementing such a system within the cancer context. PMID:21041539

Radiation monitoring systems as a tool for assessment of accidental releases at the Chernobyl and Fukushima NPPs

NASA Astrophysics Data System (ADS)

Shershakov, Vjacheslav; Bulgakov, Vladimir

2013-04-01

The experience gained during mitigation of the consequences of the accidents at the Chernobyl and Fukushima NPPs has shown that what makes different the decision-making in case of nuclear accidents is that the greatest benefit from decision-making can be achieved in the early phase of an accident. Support to such process can be provided only by a real-time decision-making support system. In case of a nuclear accident the analysis of the situation and decision-making is not feasible without an operational radiation monitoring system, international data exchange and automated data processing, and the use of computerized decision-making support systems. With this in mind, in the framework of different international programs on the Chernobyl-related issues numerous projects were undertaken to study and develop a set of methods, algorithms and programs providing effective support to emergency response decision-making, starting from accident occurrence to decision-making regarding countermeasures to mitigate effects of radioactive contamination of the environment. The presentation focuses results of the analysis of radiation monitoring data and, on this basis, refining or, for many short-lived radionuclides, reconstructing the source term, modeling dispersion of radioactivity in the environment and assessing its impacts. The obtained results allowed adding and refining the existing estimates and in some cases reconstructing doses for the public on the territories contaminated as a result of the Chernobyl accident. The activities were implemented in two stages. In the first stage, several scenarios for dispersion of Chernobyl-related radioactivity were developed. For each scenario cesium-137 dispersion was estimated and these estimates were compared with measurement data. In the second stage, the scenario which showed the best agreement of calculations and measurements was used for modeling the dispersion of iodine-131and other short-lived radionuclides. The described approach was used for assessing the consequences at the Fukushima NPP. These results are also provided in the presentation. References 1. Kelly G.N., Ehrhardt J., Shershakov V.M.. Decision Support for Off-Site Emergency Preparedness in Europe. Radiation Protection Dosimetry, Vol. 64 Nos. 1-2, 1996, pp. 129-142. 2. Ehrhardt J., Shershakov V.M. Real-time on-line decision support systems (RODOS) for off-site emergency management following a nuclear accident. EUR 16533, 1996 3. Kelly G.N., Shershakov V.M. (Editors). Environmental contamination, radiation doses and health consequences after the ?hernobyl accident. Radiation Protection Dosimetry. Special Commemorative Issue.Vol. 64, 1996 4. Shershakov V.M. Computer information technology for support of radiation monitoring problems. OECD Proceedings of an International Workshop «Nuclear Emergency Data Management», Zurich, Switzerland, 1998, pp. 377-388 5. Pitkevich V.A., Duba V.V., Ivanov V.K., Tsyb A.F., Shershakov V.M., Golubenkov A.V., Borodin R.V., V.A., Kosykh V.S. Reconstruction of External Dose to the Inhabitants Living in the Contaminated Territory of Russia by the Results of the Accident at the Chernobyl NPP. Health Phys., Vol. 30, No. 1, pp. 54-68, 1995. 6. Shershakov V., Fesenko S., Kryshev I., Semioshkina T. Decision-Aiding Tools for Remediation Strategies. In: Radioactivity in the Environment, Volume 14, Remediation of Contaminated Environments, 2009, pp 41- 120, Elsevier Ltd.

Multicriteria decision model for retrofitting existing buildings

NASA Astrophysics Data System (ADS)

Bostenaru Dan, B.

2003-04-01

In this paper a model to decide which buildings from an urban area should be retrofitted is presented. The model has been cast into existing ones by choosing the decision rule, criterion weighting and decision support system types most suitable for the spatial problem of reducing earthquake risk in urban areas, considering existing spatial multiatributive and multiobjective decision methods and especially collaborative issues. Due to the participative character of the group decision problem "retrofitting existing buildings" the decision making model is based on interactivity. Buildings have been modeled following the criteria of spatial decision support systems. This includes identifying the corresponding spatial elements of buildings according to the information needs of actors from different sphaeres like architects, construction engineers and economists. The decision model aims to facilitate collaboration between this actors. The way of setting priorities interactivelly will be shown, by detailing the two phases: judgemental and computational, in this case site analysis, collection and evaluation of the unmodified data and converting survey data to information with computational methods using additional expert support. Buildings have been divided into spatial elements which are characteristic for the survey, present typical damages in case of an earthquake and are decisive for a better seismic behaviour in case of retrofitting. The paper describes the architectural and engineering characteristics as well as the structural damage for constuctions of different building ages on the example of building types in Bucharest, Romania in compressible and interdependent charts, based on field observation, reports from the 1977 earthquake and detailed studies made by the author together with a local engineer for the EERI Web Housing Encyclopedia. On this base criteria for setting priorities flow into the expert information contained in the system.

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions

PubMed Central

Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-01-01

Abstract Background: Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps. Aim: We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. Design: A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital. Setting/Participants: Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study. Results: Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes. Conclusions: The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians. PMID:26418215

Enhancing Decision-Making in STSE Education by Inducing Reflection and Self-Regulated Learning

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2017-02-01

Thoughtful decision-making to resolve socioscientific issues is central to science, technology, society, and environment (STSE) education. One approach for attaining this goal involves fostering students' decision-making processes. Thus, the present study explores whether the application of decision-making strategies, combined with reflections on the decision-making processes of others, enhances decision-making competence. In addition, this study examines whether this process is supported by elements of self-regulated learning, i.e., self-reflection regarding one's own performance and the setting of goals for subsequent tasks. A computer-based training program which involves the resolution of socioscientific issues related to sustainable development was developed in two versions: with and without elements of self-regulated learning. Its effects on decision-making competence were analyzed using a pre test-post test follow-up control-group design ( N = 242 high school students). Decision-making competence was assessed using an open-ended questionnaire that focused on three facets: consideration of advantages and disadvantages, metadecision aspects, and reflection on the decision-making processes of others. The findings suggest that students in both training groups incorporated aspects of metadecision into their statements more often than students in the control group. Furthermore, both training groups were more successful in reflecting on the decision-making processes of others. The students who received additional training in self-regulated learning showed greater benefits in terms of metadecision aspects and reflection, and these effects remained significant two months later. Overall, our findings demonstrate that the application of decision-making strategies, combined with reflections on the decision-making process and elements of self-regulated learning, is a fruitful approach in STSE education.

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.

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

PubMed

Vimarlund, Vivian; Davoody, Nadia; Koch, Sabine

2013-01-01

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

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

The role of emotion in decision-making: a cognitive neuroeconomic approach towards understanding sexual risk behavior.

PubMed

Gutnik, Lily A; Hakimzada, A Forogh; Yoskowitz, Nicole A; Patel, Vimla L

2006-12-01

Models of decision-making usually focus on cognitive, situational, and socio-cultural variables in accounting for human performance. However, the emotional component is rarely addressed within these models. This paper reviews evidence for the emotional aspect of decision-making and its role within a new framework of investigation, called neuroeconomics. The new approach aims to build a comprehensive theory of decision-making, through the unification of theories and methods from economics, psychology, and neuroscience. In this paper, we review these integrative research methods and their applications to issues of public health, with illustrative examples from our research on young adults' safe sex practices. This approach promises to be valuable as a comprehensively descriptive and possibly, better predictive model for construction and customization of decision support tools for health professionals and consumers.

Advancements in Risk-Informed Performance-Based Asset Management for Commercial Nuclear Power Plants

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

Liming, James K.; Ravindra, Mayasandra K.

2006-07-01

Over the past several years, ABSG Consulting Inc. (ABS Consulting) and the South Texas Project Nuclear Operating Company (STPNOC) have developed a decision support process and associated software for risk-informed, performance-based asset management (RIPBAM) of nuclear power plant facilities. RIPBAM applies probabilistic risk assessment (PRA) tools and techniques in the realm of plant physical and financial asset management. The RIPBAM process applies a tiered set of models and supporting performance measures (or metrics) that can ultimately be applied to support decisions affecting the allocation and management of plant resources (e.g., funding, staffing, scheduling, etc.). In general, the ultimate goal ofmore » the RIPBAM process is to continually support decision-making to maximize a facility's net present value (NPV) and long-term profitability for its owners. While the initial applications of RIPBAM have been for nuclear power stations, the methodology can easily be adapted to other types of power station or complex facility decision-making support. RIPBAM can also be designed to focus on performance metrics other than NPV and profitability (e.g., mission reliability, operational availability, probability of mission success per dollar invested, etc.). Recent advancements in the RIPBAM process focus on expanding the scope of previous RIPBAM applications to include not only operations, maintenance, and safety issues, but also broader risk perception components affecting plant owner (stockholder), operator, and regulator biases. Conceptually, RIPBAM is a comprehensive risk-informed cash flow model for decision support. It originated as a tool to help manage plant refueling outage scheduling, and was later expanded to include the full spectrum of operations and maintenance decision support. However, it differs from conventional business modeling tools in that it employs a systems engineering approach with broadly based probabilistic analysis of organizational 'value streams'. The scope of value stream inclusion in the process can be established by the user, but in its broadest applications, RIPBAM can be used to address how risk perceptions of plant owners and regulators are impacted by plant performance. Plant staffs can expand and refine RIPBAM models scope via a phased program of activities over time. This paper shows how the multi-metric uncertainty analysis feature of RIPBAM can apply a wide spectrum of decision-influencing factors to support decisions designed to maximize the probability of achieving, maintaining, and improving upon plant goals and objectives. In this paper, the authors show how this approach can be extremely valuable to plant owners and operators in supporting plant value-impacting decision-making processes. (authors)« less

Two-Stage Fracturing Wastewater Management in Shale Gas Development

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

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

Two-Stage Fracturing Wastewater Management in Shale Gas Development

DOE PAGES

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.; ...

2017-01-19

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

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

PubMed

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

2010-02-01

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

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

PubMed Central

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

2010-01-01

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

Making "ethical safe space" in the translation of contested knowledge: the role of community debate in defining end-of-life decision ethics.

PubMed

Kaufert, Joseph; Schwartz, Karen; Wiebe, Rhonda; Derksen, Jim; Lutfiyya, Zana M; Richert, Dean

2013-04-01

The objectives of this article are, first, to document a unique process of research knowledge translation (KT), which the authors describe as the creation of "ethical safe space," and, second, to document the narratives of forum participants and describe their interaction in a dialogue about vulnerability, the authority of physicians, and the perspective of people with disabilities on the policy. Narrative data from qualitative interviews with individual key informants and focus groups were used to identify speakers with specific expertise on policy, disability perspectives, and bioethical issues, who were invited to participate in the Forum on Ethical Safe Space. The planning workgroup adopted a model for enabling representative participation in the public forum designed to reduce the impact of physical, sensory, financial, language, and professional status barriers. Using the transcripts and keynote speakers' printed texts, primary themes and patterns of interaction were identified reflecting the alternative perspectives. Through the development of a workshop on ethical, legal, and disability-related implications of professional policy guidelines developed by the College of Physicians and Surgeons of Manitoba, we provided a qualitative analysis of the discourse involving experts and disability community members supporting alternative positions on the impact of the policy statement, and discuss ethical, legal, and disability rights issues identified in the public debate. Contested policy and ethical frameworks for making decisions about withdrawing and withholding life supporting treatment may influence both the perspectives of palliative care providers and patients referred to palliative care facilities. An innovative model for KT using a public forum that enabled stakeholders with conflicting perspectives to engage with ethical and professional policy issues asserting the physician's authority in contested decisions involving withdrawing or withholding life-supporting treatment, was a successful way to engage stakeholders supporting alternative positions on the impact of the policy statement and to discuss ethical, legal, and disability rights issues identified in the public debate. Discussion during the forum revealed several benefits of creating ethical safe space. This model of workshop allows space for participation of stakeholders, who might not otherwise be able to interact in the same forum, to articulate their perspectives and debate with other presenters and audience members. Participants at the forum spoke of the creation of ethical safe space as a starting point for more dialogue on the issues raised by the policy statement. The forum was, therefore, seen as a potential starting point for building conversation that would facilitate revising the policy with broader consultation on its legal and ethical validity.

Geospatial decision support systems for societal decision making

USGS Publications Warehouse

Bernknopf, R.L.

2005-01-01

While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the GDSS have demonstrated the benefits of utilizing science for policy decisions. Investment in science reduces decision-making uncertainty and reducing that uncertainty has economic value.

10 CFR 708.30 - What process does the Hearing Officer follow to issue an initial agency decision?

Code of Federal Regulations, 2010 CFR

2010-01-01

... initial agency decision? 708.30 Section 708.30 Energy DEPARTMENT OF ENERGY DOE CONTRACTOR EMPLOYEE PROTECTION PROGRAM Investigation, Hearing and Decision Process § 708.30 What process does the Hearing Officer follow to issue an initial agency decision? (a) The Hearing Officer will issue an initial agency decision...

43 CFR 30.266 - When is a final decision issued?

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROCEDURES Tribal Purchase of Interests Under Special Statutes § 30.266 When is a final decision issued? This... subject to the tribal purchase option, the decision must so state. (3) A copy of the probate decision... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false When is a final decision issued? 30.266...

A collaborative approach to supporting communication in the assessment of decision-making capacity.

PubMed

Zuscak, Simon John; Peisah, Carmelle; Ferguson, Alison

2016-01-01

This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals. All clinicians have an obligation to maximise client autonomy and participation in decision-making. Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient. The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder. Impairments in different aspects of auditory comprehension require different accommodations.

A novel personal health system with integrated decision support and guidance for the management of chronic liver disease.

PubMed

Kiefer, Stephan; Schäfer, Michael; Bransch, Marco; Brimmers, Peter; Bartolomé, Diego; Baños, Janie; Orr, James; Jones, Dave; Jara, Maximilian; Stockmann, Martin

2014-01-01

A personal health system platform for the management of patients with chronic liver disease that incorporates a novel approach to integrate decision support and guidance through care pathways for patients and their doctors is presented in this paper. The personal health system incorporates an integrated decision support engine that guides patients and doctors through the management of the disease by issuing tasks and providing recommendations to both the care team and the patient and by controlling the execution of a Care Flow Plan based on the results of tasks and the monitored health status of the patient. This Care Flow Plan represents a formal, business process based model of disease management designed off-line by domain experts on the basis of clinical guidelines, knowledge of care pathways and an organisational model for integrated, patient-centred care. In this way, remote monitoring and treatment are dynamically adapted to the patient's actual condition and clinical symptoms and allow flexible delivery of care with close integration of specialists, therapists and care-givers.

Urban Climate Resilience - Connecting climate models with decision support cyberinfrastructure using open standards

NASA Astrophysics Data System (ADS)

Bermudez, L. E.; Percivall, G.; Idol, T. A.

2015-12-01

Experts in climate modeling, remote sensing of the Earth, and cyber infrastructure must work together in order to make climate predictions available to decision makers. Such experts and decision makers worked together in the Open Geospatial Consortium's (OGC) Testbed 11 to address a scenario of population displacement by coastal inundation due to the predicted sea level rise. In a Policy Fact Sheet "Harnessing Climate Data to Boost Ecosystem & Water Resilience", issued by White House Office of Science and Technology (OSTP) in December 2014, OGC committed to increase access to climate change information using open standards. In July 2015, the OGC Testbed 11 Urban Climate Resilience activity delivered on that commitment with open standards based support for climate-change preparedness. Using open standards such as the OGC Web Coverage Service and Web Processing Service and the NetCDF and GMLJP2 encoding standards, Testbed 11 deployed an interoperable high-resolution flood model to bring climate model outputs together with global change assessment models and other remote sensing data for decision support. Methods to confirm model predictions and to allow "what-if-scenarios" included in-situ sensor webs and crowdsourcing. A scenario was in two locations: San Francisco Bay Area and Mozambique. The scenarios demonstrated interoperation and capabilities of open geospatial specifications in supporting data services and processing services. The resultant High Resolution Flood Information System addressed access and control of simulation models and high-resolution data in an open, worldwide, collaborative Web environment. The scenarios examined the feasibility and capability of existing OGC geospatial Web service specifications in supporting the on-demand, dynamic serving of flood information from models with forecasting capacity. Results of this testbed included identification of standards and best practices that help researchers and cities deal with climate-related issues. Results of the testbeds will now be deployed in pilot applications. The testbed also identified areas of additional development needed to help identify scientific investments and cyberinfrastructure approaches needed to improve the application of climate science research results to urban climate resilence.

Informed Decision-Making in the Context of Prenatal Chromosomal Microarray.

PubMed

Baker, Jessica; Shuman, Cheryl; Chitayat, David; Wasim, Syed; Okun, Nan; Keunen, Johannes; Hofstedter, Renee; Silver, Rachel

2018-03-07

The introduction of chromosomal microarray (CMA) into the prenatal setting has involved considerable deliberation due to the wide range of possible outcomes (e.g., copy number variants of uncertain clinical significance). Such issues are typically discussed in pre-test counseling for pregnant women to support informed decision-making regarding prenatal testing options. This research study aimed to assess the level of informed decision-making with respect to prenatal CMA and the factor(s) influencing decision-making to accept CMA for the selected prenatal testing procedure (i.e., chorionic villus sampling or amniocentesis). We employed a questionnaire that was adapted from a three-dimensional measure previously used to assess informed decision-making with respect to prenatal screening for Down syndrome and neural tube defects. This measure classifies an informed decision as one that is knowledgeable, value-consistent, and deliberated. Our questionnaire also included an optional open-ended question, soliciting factors that may have influenced the participants' decision to accept prenatal CMA; these responses were analyzed qualitatively. Data analysis on 106 participants indicated that 49% made an informed decision (i.e., meeting all three criteria of knowledgeable, deliberated, and value-consistent). Analysis of 59 responses to the open-ended question showed that "the more information the better" emerged as the dominant factor influencing both informed and uninformed participants' decisions to accept prenatal CMA. Despite learning about the key issues in pre-test genetic counseling, our study classified a significant portion of women as making uninformed decisions due to insufficient knowledge, lack of deliberation, value-inconsistency, or a combination of these three measures. Future efforts should focus on developing educational approaches and counseling strategies to effectively increase the rate of informed decision-making among women offered prenatal CMA.

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...

Whistleblowing: what influences nurses' decisions on whether to report poor practice?

PubMed

Gallagher, Ann

Several recent high profile examples demonstrate that nurses fear and have reason to fear the consequences of reporting poor practice. This article examines the ethical issues surrounding whistleblowing, discussing in detail the reasons for and against reporting concerns about poor practice, and how nurses can be supported to do this.

38 CFR 17.904 - Review and appeal process.

Code of Federal Regulations, 2010 CFR

2010-07-01

... submitted in writing (by facsimile, mail, or hand delivery) within one year of the date of the initial..., including any relevant supporting documentation, a benefits advisor will issue a written determination (with... dissatisfied, within 90 days of the date of the decision he or she may submit in writing (by facsimile, mail...

Using Data: Innovative Ways To Improve Results for Students with Disabilities.

ERIC Educational Resources Information Center

Research Connections in Special Education, 2003

2003-01-01

This issue presents two articles on the use of data to improve results for students with disabilities. The first paper examines how researchers supported by the Office of Special Education Programs are discovering innovative uses of scientifically derived information in instructional and administrative decision making as well as strategies for…

Australia State of the Environment 2011--A Resource for Science Teachers

ERIC Educational Resources Information Center

Marsack, Peter; Shepherd, Lee-Anne; Bartlett, Anni

2013-01-01

Australia State of the Environment 2011 (SoE 2011) is a comprehensive review of the Australian environment, providing an independent and authoritative snapshot of the state of our continent. The report presents relevant and useful information to the public and decision makers to improve understanding of environmental issues and support better…

77 FR 24698 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Environmental Protection Agency (EPA) to support the decision making process for an industrial chemical under the Toxic Substances Control Act (TSCA) (15 U.S.C. 2601). Under TSCA, EPA has the authority to issue... exposure to chemical substances and mixtures. Drugs, cosmetics, foods, food additives, pesticides, and...

Issues of Spatial and Temporal Scale in Modeling the Effects of Field Operatiions on Soil Properties

USDA-ARS?s Scientific Manuscript database

Tillage is an important procedure for modifying the soil environment in order to enhance crop growth and conserve soil and water resources. Process-based models of crop production are widely used in decision support, but few explicitly simulate tillage. The Cropping Systems Model (CSM) was modified ...

Performance Evaluation of Indian Technical Institutions Using PROMETHEE-GAIA Approach

ERIC Educational Resources Information Center

Ranjan, Rajeev; Chakraborty, Shankar

2015-01-01

It has now become an important issue to evaluate the performance of technical institutions to develop better research and enrich the existing teaching processes. The results of such performance appraisal would serve as a reference point for decisions to choose a particular institution, hire manpower, and provide financial support for the…

The Presidency: A Question of Power. American Government Issues Series, Number 1.

ERIC Educational Resources Information Center

Hargrove, Erwin C.; Hoopes, Roy

An historical analysis of the use and abuse of power in the Presidency is provided in this supplementary student material. The content includes an analysis of the historical roots of presidential power, popular support, cooperation and conflict with Congress, the international role of the presidency, presidential decision making, the relationship…

Eight Issues for Learning Scientists about Education and the Economy

ERIC Educational Resources Information Center

Roschelle, Jeremy; Bakia, Marianne; Toyama, Yukie; Patton, Charles

2011-01-01

Linking research to a compelling societal interest can build financial commitments to research, bring increased attention to findings, and grow support for scaling up impacts. Among many compelling societal interests that learning scientists can cite--such as increasing the quality of life, preparing citizens to make decisions in a complex world,…

Implementing Wireless Mobile Instructional Labs: Planning Issues and Case Study

ERIC Educational Resources Information Center

McKimmy, Paul B.

2005-01-01

In April 2002, the Technology Advisory Committee of the University of Hawaii-Manoa College of Education (COE) prioritized the upgrade of existing instructional computer labs. Following several weeks of research and discussion, a decision was made to support wireless and mobile technologies during the upgrade. In June 2002, the first of three…

Understanding Innovation: Youth-Adult Partnerships in Decision Making

ERIC Educational Resources Information Center

Zeldin, Shepherd; Petrokubi, Julie

2006-01-01

In the United States, the concept of youth-adult partnership remains innovative. The notion that youth and adults can collaborate on issues of importance runs counter to prevailing societal norms, public policies, structures and standards of practice. There is not much cultural or policy support for managers seeking to integrate youth-adult…

17 CFR 10.102 - Review of initial decisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the appeal with respect to the issues presented, and the reasons therefor, and citations to supporting... answering brief generally shall follow the same style as prescribed for the appeal brief but may omit a... reference citations to the record contained in its brief or in any other document. If an appellee deems it...

The Continuum: A Teaching Strategy for Science and Society Issues.

ERIC Educational Resources Information Center

Hendrix, Jon R.

1993-01-01

Describes a decision-making lesson where students rank genetic defects and syndromes from least to most severe. Students are then asked to draw a line in the continuum where they would not feel obligated to support the life, or in the case of an in utero life, maintain the pregnancy. (PR)

Systems analysis - a new paradigm and decision support tools for the water framework directive

NASA Astrophysics Data System (ADS)

Bruen, M.

2007-06-01

In the early days of Systems Analysis the focus was on providing tools for optimisation, modelling and simulation for use by experts. Now there is a recognition of the need to develop and disseminate tools to assist in making decisions, negotiating compromises and communicating preferences that can easily be used by stakeholders without the need for specialist training. The Water Framework Directive (WFD) requires public participation and thus provides a strong incentive for progress in this direction. This paper places the new paradigm in the context of the classical one and discusses some of the new approaches which can be used in the implementation of the WFD. These include multi-criteria decision support methods suitable for environmental problems, adaptive management, cognitive mapping, social learning and cooperative design and group decision-making. Concordance methods (such as ELECTRE) and the Analytical Hierarchy Process (AHP) are identified as multi-criteria methods that can be readily integrated into Decision Support Systems (DSS) that deal with complex environmental issues with very many criteria, some of which are qualitative. The expanding use of the new paradigm provides an opportunity to observe and learn from the interaction of stakeholders with the new technology and to assess its effectiveness. This is best done by trained sociologists fully integrated into the processes. The WINCOMS research project is an example applied to the implementation of the WFD in Ireland.

Interactive decision support in hepatic surgery

PubMed Central

Dugas, Martin; Schauer, Rolf; Volk, Andreas; Rau, Horst

2002-01-01

Background Hepatic surgery is characterized by complicated operations with a significant peri- and postoperative risk for the patient. We developed a web-based, high-granular research database for comprehensive documentation of all relevant variables to evaluate new surgical techniques. Methods To integrate this research system into the clinical setting, we designed an interactive decision support component. The objective is to provide relevant information for the surgeon and the patient to assess preoperatively the risk of a specific surgical procedure. Based on five established predictors of patient outcomes, the risk assessment tool searches for similar cases in the database and aggregates the information to estimate the risk for an individual patient. Results The physician can verify the analysis and exclude manually non-matching cases according to his expertise. The analysis is visualized by means of a Kaplan-Meier plot. To evaluate the decision support component we analyzed data on 165 patients diagnosed with hepatocellular carcinoma (period 1996–2000). The similarity search provides a two-peak distribution indicating there are groups of similar patients and singular cases which are quite different to the average. The results of the risk estimation are consistent with the observed survival data, but must be interpreted with caution because of the limited number of matching reference cases. Conclusion Critical issues for the decision support system are clinical integration, a transparent and reliable knowledge base and user feedback. PMID:12003639

25 CFR 162.598 - When will BIA issue a decision on an appeal from a WSR leasing decision?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false When will BIA issue a decision on an appeal from a WSR leasing decision? 162.598 Section 162.598 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR..., and Enforcement § 162.598 When will BIA issue a decision on an appeal from a WSR leasing decision? BIA...

25 CFR 162.598 - When will BIA issue a decision on an appeal from a WSR leasing decision?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false When will BIA issue a decision on an appeal from a WSR leasing decision? 162.598 Section 162.598 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR..., and Enforcement § 162.598 When will BIA issue a decision on an appeal from a WSR leasing decision? BIA...

Decision Support Tool Evaluation Report for General NOAA Oil Modeling Environment(GNOME) Version 2.0

NASA Technical Reports Server (NTRS)

Spruce, Joseph P.; Hall, Callie; Zanoni, Vicki; Blonski, Slawomir; D'Sa, Eurico; Estep, Lee; Holland, Donald; Moore, Roxzana F.; Pagnutti, Mary; Terrie, Gregory

2004-01-01

NASA's Earth Science Applications Directorate evaluated the potential of NASA remote sensing data and modeling products to enhance the General NOAA Oil Modeling Environment (GNOME) decision support tool. NOAA's Office of Response and Restoration (OR&R) Hazardous Materials (HAZMAT) Response Division is interested in enhancing GNOME with near-realtime (NRT) NASA remote sensing products on oceanic winds and ocean circulation. The NASA SeaWinds sea surface wind and Jason-1 sea surface height NRT products have potential, as do sea surface temperature and reflectance products from the Moderate Resolution Imaging Spectroradiometer and sea surface reflectance products from Landsat and the Advanced Spaceborne Thermal Emission and Reflectance Radiometer. HAZMAT is also interested in the Advanced Circulation model and the Ocean General Circulation Model. Certain issues must be considered, including lack of data continuity, marginal data redundancy, and data formatting problems. Spatial resolution is an issue for near-shore GNOME applications. Additional work will be needed to incorporate NASA inputs into GNOME, including verification and validation of data products, algorithms, models, and NRT data.

Human Decision Processes: Implications for SSA Support Tools

NASA Astrophysics Data System (ADS)

Picciano, P.

2013-09-01

Despite significant advances in computing power and artificial intelligence (AI), few critical decisions are made without a human decision maker in the loop. Space Situational Awareness (SSA) missions are both critical and complex, typically adhering to the human-in-the-loop (HITL) model. The collection of human operators injects a needed diversity of expert knowledge, experience, and authority required to successfully fulfill SSA tasking. A wealth of literature on human decision making exists citing myriad empirical studies and offering a varied set of prescriptive and descriptive models of judgment and decision making (Hastie & Dawes, 2001; Baron, 2000). Many findings have been proven sufficiently robust to allow information architects or system/interface designers to take action to improve decision processes. For the purpose of discussion, these concepts are bifurcated in two groups: 1) vulnerabilities to mitigate, and 2) capabilities to augment. These vulnerabilities and capabilities refer specifically to the decision process and should not be confused with a shortcoming or skill of a specific human operator. Thus the framing of questions and orders, the automated tools with which to collaborate, priming and contextual data, and the delivery of information all play a critical role in human judgment and choice. Evaluating the merits of any decision can be elusive; in order to constrain this discussion, ‘rational choice' will tend toward the economic model characteristics such as maximizing utility and selection consistency (e.g., if A preferred to B, and B preferred to C, than A should be preferred to C). Simple decision models often encourage one to list the pros and cons of a decision, perhaps use a weighting schema, but one way or another weigh the future benefit (or harm) of making a selection. The result (sought by the rationalist models) should drive toward higher utility. Despite notable differences in researchers' theses (to be discussed in the full paper), one opinion shared is that the rational, economic, deliberate listing/evaluation of all options is NOT representative of how many decision are made. A framework gaining interest lately describes two systems predominantly at work: intuition and reasoning (Kahneman, 2003). Intuition is fast, automatic, and parallel contrasted with the more effortful, deliberative, and sequential reasoning. One of the issues of contention is that considerable research is stacked supporting both sides claiming that intuition is: • A hallmark of expertise responsible for rapid, optimal decisions in the face of adversity • A vulnerability where biases serve as decision traps leading to wrong choices Using seminal studies from a range of domains and tasking, potential solutions for SSA decision support will be offered. Important issues such as managing uncertainty, framing inquiries, and information architecture, and contextual cues will be discussed. The purpose is to provide awareness of the human limitations and capabilities in complex decision making so engineers and designers can consider such factors in their development of SSA tools.

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

PubMed

Cecchi, Catherine

2008-01-01

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

The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems.

PubMed

Howard, B J; Beresford, N A; Nisbet, A; Cox, G; Oughton, D H; Hunt, J; Alvarez, B; Andersson, K G; Liland, A; Voigt, G

2005-01-01

The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

Automated integration of wireless biosignal collection devices for patient-centred decision-making in point-of-care systems

PubMed Central

Menychtas, Andreas; Tsanakas, Panayiotis

2016-01-01

The proper acquisition of biosignals data from various biosensor devices and their remote accessibility are still issues that prevent the wide adoption of point-of-care systems in the routine of monitoring chronic patients. This Letter presents an advanced framework for enabling patient monitoring that utilises a cloud computing infrastructure for data management and analysis. The framework introduces also a local mechanism for uniform biosignals collection from wearables and biosignal sensors, and decision support modules, in order to enable prompt and essential decisions. A prototype smartphone application and the related cloud modules have been implemented for demonstrating the value of the proposed framework. Initial results regarding the performance of the system and the effectiveness in data management and decision-making have been quite encouraging. PMID:27222731

Automated integration of wireless biosignal collection devices for patient-centred decision-making in point-of-care systems.

PubMed

Menychtas, Andreas; Tsanakas, Panayiotis; Maglogiannis, Ilias

2016-03-01

The proper acquisition of biosignals data from various biosensor devices and their remote accessibility are still issues that prevent the wide adoption of point-of-care systems in the routine of monitoring chronic patients. This Letter presents an advanced framework for enabling patient monitoring that utilises a cloud computing infrastructure for data management and analysis. The framework introduces also a local mechanism for uniform biosignals collection from wearables and biosignal sensors, and decision support modules, in order to enable prompt and essential decisions. A prototype smartphone application and the related cloud modules have been implemented for demonstrating the value of the proposed framework. Initial results regarding the performance of the system and the effectiveness in data management and decision-making have been quite encouraging.

Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men.

PubMed

Berry, Donna L; Halpenny, Barbara; Bosco, Jaclyn L F; Bruyere, John; Sanda, Martin G

2015-07-24

The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer. P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized. Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid. Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.

Canonical Duality Theory and Algorithms for Solving Some Challenging Problems in Global Optimization and Decision Science

DTIC Science & Technology

2015-09-24

algorithms for solving real- world problems. Within the past five years, 2 books, 5 journal special issues, and about 60 papers have been published...Four international conferences have been organized, including the 3rd World Congress of Global Optimization. A unified methodology and algorithm have...been developed with real- world applications. This grant has been used to support and co-support three post-doctors, three PhD students, one part

A new ball game: the United Nations Convention on the Rights of Persons with Disabilities and assumptions in care for people with dementia.

PubMed

Smith, Anita; Sullivan, Danny

2012-09-01

The United Nations Convention on the Rights of Persons with Disabilities is a powerful international instrument which imposes significant responsibilities on signatories. This column discusses changes in the definition of legal capacity which will have significant impacts on decision-making related to people with dementia. Various restrictions and limitations on personal freedoms are discussed in light of the Convention. The main focus is on challenges to existing paradigms of substitute decision-making, which are in wide use through a guardianship model. Under Art 12 of the Convention, moves to supported decision-making will result in significant changes in ensuring the rights of people with dementia. There are challenges ahead in implementing supported decision-making schemes, not only due to tension with existing practices and legislation, but also the difficulty of developing and resourcing workable schemes. This is particularly so with advanced dementia, which is acknowledged as a pressing issue for Australia due to effective health care, an ageing population and changing expectations.

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy.

PubMed

Sereno, Sara; Leal, Isabel; Maroco, João

2013-07-01

This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

A knowledge engineering framework towards clinical support for adverse drug event prevention: the PSIP approach.

PubMed

Koutkias, Vassilis; Stalidis, George; Chouvarda, Ioanna; Lazou, Katerina; Kilintzis, Vassilis; Maglaveras, Nicos

2009-01-01

Adverse Drug Events (ADEs) are currently considered as a major public health issue, endangering patients' safety and causing significant healthcare costs. Several research efforts are currently concentrating on the reduction of preventable ADEs by employing Information Technology (IT) solutions, which aim to provide healthcare professionals and patients with relevant knowledge and decision support tools. In this context, we present a knowledge engineering approach towards the construction of a Knowledge-based System (KBS) regarded as the core part of a CDSS (Clinical Decision Support System) for ADE prevention, all developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication). In the current paper, we present the knowledge sources considered in PSIP and the implications they pose to knowledge engineering, the methodological approach followed, as well as the components defining the knowledge engineering framework based on relevant state-of-the-art technologies and representation formalisms.

Evaluation of RxNorm for Medication Clinical Decision Support.

PubMed

Freimuth, Robert R; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G

2014-01-01

We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS.

Evaluation of RxNorm for Medication Clinical Decision Support

PubMed Central

Freimuth, Robert R.; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G.

2014-01-01

We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS. PMID:25954360

Design and evaluation of a disaster preparedness logistics tool.

PubMed

Neches, Robert; Ryutov, Tatyana; Kichkaylo, Tatiana; Burke, Rita V; Claudius, Ilene A; Upperman, Jeffrey S

2009-01-01

The purpose of this article is to describe the development and testing of the Pediatric Emergency Decision Support System (PEDSS), a dynamic tool for pediatric victim disaster planning. This is a descriptive article outlining an innovative automated approach to pediatric decision support and disaster planning. Disaster Resource Centers and umbrella hospitals in Los Angeles County. The authors use a model set of hypothetical patients for our pediatric disaster planning approach. The authors developed the PEDSS software to accomplish two goals: (a) core that supports user interaction and data management requirements (e.g., accessing demographic information about a healthcare facility's catchment area) and (b) set of modules each addressing a critical disaster preparation issue. The authors believe the PEDSS tool will help hospital disaster response personnel produce and maintain disaster response plans that apply best practice pediatric recommendations to their particular local conditions and requirements.

Knowledge transfer and exchange processes for environmental health issues in Canadian Aboriginal communities.

PubMed

Jack, Susan M; Brooks, Sandy; Furgal, Chris M; Dobbins, Maureen

2010-02-01

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information.

Knowledge Transfer and Exchange Processes for Environmental Health Issues in Canadian Aboriginal Communities

PubMed Central

Jack, Susan M.; Brooks, Sandy; Furgal, Chris M.; Dobbins, Maureen

2010-01-01

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information. PMID:20616996

Child health in the workplace: the Supreme Court in Hammer v. Dagenhart (1918).

PubMed

Berger, L R; Johansson, S R

1980-01-01

Exploitation of children in the labor force at the beginning of this century gave rise to a national campaign leading to congressional passage of the Keating-Owen Act in 1916. The act prohibited from interstate commerce goods produced in factories or mines that employed children who either were under fourteen years of age or who were under sixteen years of age and worked more than eight hours a day. Despite its popular support, the Act was declared unconstitutional by the Supreme Court in Hammer v. Dagenhart (1918). The Court's decision involved several major issues: interpretation of the Fifth and Fourteenth Amendments to the Constitution, freedom of contract, police power of the states, and the interstate commerce clause. Review of previous Court decisions suggests that the justices were on less than solid legal ground in reaching their decision. Examination of the historical context of the decision, however, suggests other factors that may have played a more important role than judicial precedents. The debate prompted by Hammer v. Dagenhart has much relevance to such current issues as young agricultural workers, sex discrimination in industry, and the powers of the federal government vis-a-vis states and individual citizens.

10 CFR 708.34 - What is the process for issuing an appeal decision?

Code of Federal Regulations, 2010 CFR

2010-01-01

... appeal decision to all parties and to the Head of Field Element or EC Director having jurisdiction over... 10 Energy 4 2010-01-01 2010-01-01 false What is the process for issuing an appeal decision? 708.34..., Hearing and Decision Process § 708.34 What is the process for issuing an appeal decision? (a) If there is...

Hospital efficiency and transaction costs: a stochastic frontier approach.

PubMed

Ludwig, Martijn; Groot, Wim; Van Merode, Frits

2009-07-01

The make-or-buy decision of organizations is an important issue in the transaction cost theory, but is usually not analyzed from an efficiency perspective. Hospitals frequently have to decide whether to outsource or not. The main question we address is: Is the make-or-buy decision affected by the efficiency of hospitals? A one-stage stochastic cost frontier equation is estimated for Dutch hospitals. The make-or-buy decisions of ten different hospital services are used as explanatory variables to explain efficiency of hospitals. It is found that for most services the make-or-buy decision is not related to efficiency. Kitchen services are an important exception to this. Large hospitals tend to outsource less, which is supported by efficiency reasons. For most hospital services, outsourcing does not significantly affect the efficiency of hospitals. The focus on the make-or-buy decision may therefore be less important than often assumed.

Incorporating uncertainty in watershed management decision-making: A mercury TMDL case study

USGS Publications Warehouse

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

2005-01-01

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

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

PubMed

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

2013-01-01

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

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

Sacchi, L.; Lanzola, G.; Viani, N.

2015-01-01

Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857

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

Approaches and incentives to implement integrated pest management that addresses regional and environmental issues.

PubMed

Brewer, Michael J; Goodell, Peter B

2012-01-01

Agricultural, environmental, and social and policy interests have influenced integrated pest management (IPM) from its inception. The first 50 years of IPM paid special attention to field-based management and market-driven decision making. Concurrently, IPM strategies became available that were best applied both within and beyond the bounds of individual fields and that also provided environmental benefits. This generated an incentives dilemma for farmers: selecting IPM activities for individual fields on the basis of market-based economics versus selecting IPM activities best applied regionally that have longer-term benefits, including environmental benefits, that accrue to the broader community as well as the farmer. Over the past several decades, public-supported incentives, such as financial incentives available to farmers from conservation programs for farms, have begun to be employed to encourage use of conservation techniques, including strategies with IPM relevance. Combining private investments with public support may effectively address the incentives dilemma when advanced IPM strategies are used regionally and provide public goods such as those benefiting resource conservation. This review focuses on adaptation of IPM to these broader issues, on transitions of IPM from primarily individual field-based decision making to coordinated community decision making, and on the form of partnerships needed to gain long-lasting regional and environmental benefits. Copyright © 2012 by Annual Reviews. All rights reserved.

Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

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

Issue a Boil-Water Advisory or Wait for Definitive Information? A Decision Analysis

PubMed Central

Wagner, Michael M.; Wallstrom, Garrick L.; Onisko, Agnieszka

2005-01-01

Objective Study the decision to issue a boil-water advisory in response to a spike in sales of diarrhea remedies or wait 72 hours for the results of definitive testing of water and people. Methods Decision analysis. Results In the base-case analysis, the optimal decision is test-and-wait. If the cost of issuing a boil-water advisory is less than 13.92 cents per person per day, the optimal decision is to issue the boil-water advisory immediately. Conclusions Decisions based on surveillance data that are suggestive but not conclusive about the existence of a disease outbreak can be modeled. PMID:16779145

Success matters: Recasting the relationship among geophysical, biological, and behavioral scientists to support decision making on major environmental challenges

NASA Astrophysics Data System (ADS)

Knopman, Debra S.

2006-03-01

Coping with global change, providing clean water for growing populations, and disposing of nuclear waste are some of the most difficult public policy challenges of our time. Unknowns in the physical sciences are one source of the difficulty. Real difficulties in meeting these challenges also arise in the behavioral sciences. A potentially rich vein of transdisciplinary research is to integrate the psychology of decision making, known as "judgment and decision making," or JDM, with the development of technical information and decision support tools for complex, long-term environmental problems. Practitioners of JDM conduct research on how individuals and groups respond to uncertainty and ambiguity, hedge against risks, anchor decisions to the status quo, compare relative risks and rewards of alternative strategies, and cope with other classes of decisions. Practitioners use a variety of stimuli, chance devices, hypothetical and real choices involving small stakes, scenarios, and questionnaires to measure (directly and indirectly) preferences under varying conditions. These kinds of experiments can help guide choices about the level of complexity required for different types of decision-making processes, the value of new data collection efforts, and the ways in which uncertainty in model outcomes can be cast to minimize decision-making paralysis. They can also provide a scientific basis for interacting with decision makers throughout the model development process, designing better ways of eliciting and combining opinions and of communicating information relevant to public policy issues with the goal of improving the value of the scientific contribution to the social decision.

Using Constructivist Career Development to Improve Career Decision Self-Efficacy in TRiO Students

ERIC Educational Resources Information Center

Grier-Reed, Tabitha; Ganuza, Zoila

2012-01-01

Although more high school graduates are attending college, many are not graduating (The Bill and Melinda Gates Foundation, 2004). First-generation, low-income, and underrepresented students are especially at risk for falling through the cracks. To help address this issue, programs such as TRiO Student Support Services (SSS) assist…

Effect of Content Knowledge on Angoff-Style Standard Setting Judgments

ERIC Educational Resources Information Center

Margolis, Melissa J.; Mee, Janet; Clauser, Brian E.; Winward, Marcia; Clauser, Jerome C.

2016-01-01

Evidence to support the credibility of standard setting procedures is a critical part of the validity argument for decisions made based on tests that are used for classification. One area in which there has been limited empirical study is the impact of standard setting judge selection on the resulting cut score. One important issue related to…

Benefits a Community College Can Realize by Providing Older Adult Programs: A Trustee's Viewpoint.

ERIC Educational Resources Information Center

Hartstein, Ray

Board members of community colleges need to carefully consider and actively support feasible programs for older people with a firm commitment to fiscal and programmatic decisions assuring lifelong learning opportunities and public service activities. Trustees must be aware of and understand problems and issues of older adults, secure data for…

Using Generalizability Theory as a Framework for Informing Measurement Issues in Middle School Settings

ERIC Educational Resources Information Center

Ing, Marsha; Shih, Jeffrey C.

2013-01-01

There are situations within middle school settings where measurements of students and teachers are used for high-stakes decisions. For example, student performance is used as an indicator of teacher quality or determines student eligibility for particular types of support services. Given the high-stakes nature of these types of assessments,…

75 FR 10305 - Environmental Impact Statement and Habitat Conservation Plan for the Incidental Take of Seven...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... Statement (EIS) to evaluate the impacts of, and alternatives to, the proposed issuance of an Endangered... alternatives and issues to be addressed in the draft EIS must be received by close of business on June 3, 2010... gather the information necessary to determine impacts and alternatives to support a decision regarding...

Using Memes and Memetic Processes to Explain Social and Conceptual Influences on Student Understanding about Complex Socio-Scientific Issues

ERIC Educational Resources Information Center

Yoon, Susan

2008-01-01

This study investigated seventh grade learners' decision making about genetic engineering concepts and applications. A social network analyses supported by technology tracked changes in student understanding with a focus on social and conceptual influences. Results indicated that several social and conceptual mechanisms potentially affected how…

Gilligan Revisited: Methodological Issues in the Study of Gender and Moral Development.

ERIC Educational Resources Information Center

Dickey, Barbara; And Others

A study examined Carol Gilligan's theory of moral reasoning, seeking evidence to either support or deny the claim that individuals primarily use one of two different sets of sex-related constructs to arrive at decisions when faced with moral dilemmas. Subjects, 20 young lawyers and psychologists (equally divided as to men and women), were…

Storytelling to support watershed research on emerging issues

Treesearch

Phillip Hellman

2016-01-01

Projections of budget deficits by the Congressional Budget Office imply ever-increasing pressure on federal spending for all purposes, including long-term watershed research. This presentation will argue that, since federal funding is ultimately a political decision, those responsible for maintaining long-term watershed research programs should not try to provide ...

Indirect Costs Reimbursement in the U.S.A.: Facts and Fiction.

ERIC Educational Resources Information Center

Sylvain, Christian

2000-01-01

This brief clarifies the U.S. system for indirect cost reimbursements to universities for research. In Canada the system of research support derives from historical decisions on federal-provincial roles, and the responsibilities and mechanisms for funding indirect costs is less than clear. When this issue is raised, comparisons with the U.S.…

Exploring Respondent Issues in the Collection of Ethnic/Racial Demographics for College Students

ERIC Educational Resources Information Center

Mrozek, Lawrence James

2011-01-01

With the Department of Education's Integrated Postsecondary Education Data System (IPEDS) requirements to report ethnicity and race in a specific manner, there has been discussion about the effectiveness of the terms that colleges and universities are required to use. Most of the research to support the category and option decisions by IPEDS were…

The Effect of Using Socio-Scientific Issues Approach in Teaching Environmental Issues on Improving the Students' Ability of Making Appropriate Decisions towards These Issues

ERIC Educational Resources Information Center

Zo'bi, Abdallah Salim

2014-01-01

This study aimed to identify nature of students' decisions patterns towards environmental issues and the possibility to improve these decisions during teaching process using Socio-Scientific Issues Approach. And to achieve this, the researcher prepared and developed tools of the study represented by a test of open questions focused on…

Optimization-based decision support to assist in logistics planning for hospital evacuations.

PubMed

Glick, Roger; Bish, Douglas R; Agca, Esra

2013-01-01

The evacuation of the hospital is a very complex process and evacuation planning is an important part of a hospital's emergency management plan. There are numerous factors that affect the evacuation plan including the nature of threat, availability of resources and staff the characteristics of the evacuee population, and risk to patients and staff. The safety and health of patients is of fundamental importance, but safely moving patients to alternative care facilities while under threat is a very challenging task. This article describes the logistical issues and complexities involved in planning and execution of hospital evacuations. Furthermore, this article provides examples of how optimization-based decision support tools can help evacuation planners to better plan for complex evacuations by providing real-world solutions to various evacuation scenarios.

A Clinical Decision Support System for Breast Cancer Patients

NASA Astrophysics Data System (ADS)

Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

Decision making in the neonatal intensive care environment.

PubMed

Rivers, R P

1996-04-01

Consideration as to whether withdrawal of intensive care support might be a more appropriate line of action than to continue with full intensive care has become a part of the life and death decision making process undertaken in neonatal intensive care units. After outlining the moral objectives of delivery of health care, the arguments for taking quality of life and its various components into account during these deliberations are presented. The circumstances in which the appropriateness of continuing care should be considered are highlighted and the care options presented. The crucial importance of allowing time for parents to come to terms with the situation is emphasised as is the need for giving clear guidelines to junior staff over resuscitation issues. Finally, an environment for providing optimal family support during the process of withdrawal is suggested.

Caregiving and, Decision-Making For Seniors: How You Can Help

MedlinePlus

... Issue Past Issues Feature: Senior Living Caregiving and Decision-Making For Seniors: How You Can Help Past Issues / ... key resources and suggestions for effective care and decision-making for seniors. —The Editors To Find Out More ...

75 FR 33673 - Tart Cherries Grown in the States of Michigan, New York, Pennsylvania, Oregon, Utah, Washington...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... Recommended Decision issued on May 7, 2009 and published in the May 12, 2009, issue of the Federal Register (74 FR 22112), and a Secretary's Decision and Referendum Order issued on January 6, 2010, and... Decision and Opportunity to File Written Exceptions thereto. This Recommended Decision was published in the...

Team Meetings within Clinical Domains - Exploring the Use of Routines and Technical Support for Communication

NASA Astrophysics Data System (ADS)

Groth, Kristina; Lantz, Ann; Sallnäs, Eva-Lotta; Frykholm, Oscar; Green, Anders

Today, it is common that a team of clinicians, from different disciplines, instead of one single doctor, care for a patient. This is especially true when it concerns more complicated diseases in highly specialised health care. Going from one doctor to a team of doctors raises new dimensions/problems/issues when deciding about the diagnosis and how to treat the patient. Instead of one person deciding, based on the information given from others, a group of people need to agree on a decision. How do the participants during such decision meetings argue for their experience and skill? What kind of technologies are available and how do they support the communication in the meeting? Måseide (2006), for example, focuses on how different forms of evidence influence and regulate the judgements and decisions of medical practitioners during such meetings. Groth et al. (2008), for example, focuses on the technology used during such meetings, with a focus on audio, video, and images.

System for decision analysis support on complex waste management issues

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

Shropshire, D.E.

1997-10-01

A software system called the Waste Flow Analysis has been developed and applied to complex environmental management processes for the United States Department of Energy (US DOE). The system can evaluate proposed methods of waste retrieval, treatment, storage, transportation, and disposal. Analysts can evaluate various scenarios to see the impacts to waste slows and schedules, costs, and health and safety risks. Decision analysis capabilities have been integrated into the system to help identify preferred alternatives based on a specific objectives may be to maximize the waste moved to final disposition during a given time period, minimize health risks, minimize costs,more » or combinations of objectives. The decision analysis capabilities can support evaluation of large and complex problems rapidly, and under conditions of variable uncertainty. The system is being used to evaluate environmental management strategies to safely disposition wastes in the next ten years and reduce the environmental legacy resulting from nuclear material production over the past forty years.« less

In search of tools to aid logical thinking and communicating about medical decision making.

PubMed

Hunink, M G

2001-01-01

To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults.

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

NASA Astrophysics Data System (ADS)

Emery, Katherine Beth

People worldwide are faced with making decisions daily. While many decisions are quick (e.g., what clothes to wear), others, such as those about environmental issues (e.g., overfishing), require more thought and have less immediate outcomes. How one makes such decisions depends on how one interprets, evaluates, and uses evidence. The central objective of this thesis was to investigate environmental science literacy in general, and specifically, to understand how evidence and other factors impact decision-making. I conducted three main studies: First, I provide an example of how decision-making practices affect environmental systems and services through a descriptive case study of Atlantic bluefin tuna overfishing. I reviewed the scientific, historical and cultural factors contributing to a paradox of marine preservation in the Mediterranean and highlighted the need for education and informed decision-making about such social and ecological issues. This study motivated me to investigate how people make decisions about environmental issues. Second, I interviewed middle school students to understand how they describe and evaluate evidence hypothetically and in practice about environmental issues---a key component of environmental literacy. Students discussed how they would evaluate evidence and then were then given a packet containing multiple excerpts of information from conflicting stakeholders about an environmental issue and asked how they would make voting or purchasing decisions about these issues. Findings showed that students' ideas about evaluating evidence (e.g., by scientific and non-scientific criteria) match their practices in part. This study was unique in that it investigated how students evaluate evidence that (1) contradicts other evidence and (2), conflicts with the student's prior positions. Finally, I investigated whether middle school students used evidence when making decisions about socioscientific issues. I hypothesized that holding a strong opinion would decrease the likelihood of changing decisions when presented with additional information. Findings indicated that most students do not change their stance after reading additional evidence. Students were more likely to change their decisions about issues that they cared least about than about issues that they cared most about. Implications for science teaching and learning are discussed.

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.

Controlling equine influenza: policy networks and decision-making during the 2007 Australian equine influenza outbreak.

PubMed

Schemann, K; Gillespie, J A; Toribio, J-A L M L; Ward, M P; Dhand, N K

2014-10-01

Rapid, evidence-based decision-making is critical during a disease outbreak response; however, compliance by stakeholders is necessary to ensure that such decisions are effective - especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 individuals representing 12 industry and government organizations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response were seen as positive, and 75-100% of individuals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 46-75% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases (EADs) and response systems will improve stakeholder participation in emergency disease management and preparedness for future EAD incursions. © 2012 Blackwell Verlag GmbH.

A decision modeling for phasor measurement unit location selection in smart grid systems

NASA Astrophysics Data System (ADS)

Lee, Seung Yup

As a key technology for enhancing the smart grid system, Phasor Measurement Unit (PMU) provides synchronized phasor measurements of voltages and currents of wide-area electric power grid. With various benefits from its application, one of the critical issues in utilizing PMUs is the optimal site selection of units. The main aim of this research is to develop a decision support system, which can be used in resource allocation task for smart grid system analysis. As an effort to suggest a robust decision model and standardize the decision modeling process, a harmonized modeling framework, which considers operational circumstances of component, is proposed in connection with a deterministic approach utilizing integer programming. With the results obtained from the optimal PMU placement problem, the advantages and potential that the harmonized modeling process possesses are assessed and discussed.

Processing of intended and unintended strategic issues and integration into the strategic agenda.

PubMed

Ridder, Hans-Gerd; Schrader, Jan Simon

2017-11-01

Strategic change is needed in hospitals due to external and internal pressures. However, research on strategic change, as a combination of management and medical expertise in hospitals, remains scarce. We analyze how intended strategic issues are processed into deliberate strategies and how unintended strategic issues are processed into emergent strategies in the management of strategy formation in hospitals. This study empirically investigates the integration of medical and management expertise in strategy formation. The longitudinal character of the case study enabled us to track patterns of intended and unintended strategic issues over 2 years. We triangulated data from interviews, observations, and documents. In accordance with the quality standards of qualitative research procedures, we analyzed the data by pattern matching and provided analytical generalization regarding strategy formation in hospitals. Our findings suggest that strategic issues are particularly successful within the strategy formation process if interest groups are concerned with the strategic issue, prospective profits are estimated, and relevant decisions makers are involved early on. Structure and interaction processes require clear criteria and transparent procedures for effective strategy formation. There is systematic neglect of medical expertise in processes of generating strategies. Our study reveals that the decentralized structure of medical centers is an adequate template for both the operationalization of intended strategic issues and the development of unintended strategic issues. However, tasks, roles, responsibility, resources, and administrative support are necessary for effective management of strategy formation. Similarly, criteria, procedures, and decision-making are prerequisites for effective strategy formation.

A clinical information systems strategy for a large integrated delivery network.

PubMed Central

Kuperman, G. J.; Spurr, C.; Flammini, S.; Bates, D.; Glaser, J.

2000-01-01

Integrated delivery networks (IDNs) are an emerging class of health care institutions. IDNs are formed from the affiliation of individual health care institutions and are intended to be more efficient in the current fiscal health care environment. To realize efficiencies and support their strategic visions, IDNs rely critically on excellent information technology (IT). Because of its importance to the mission of the IDN, strategic decisions about IT are made by the top leadership of the IDN. At Partners HealthCare System, a large IDN in Boston, MA, a clinical information systems strategy has been created to support the Partners clinical vision. In this paper, we discuss the Partners' structure, clinical vision, and current IT initiatives in place to address the clinical vision. The initiatives are: a clinical data repository, inpatient process support, electronic medical records, a portal strategy, referral applications, knowledge resources, support for product lines, patient computing, confidentiality, and clinical decision support. We address several of the issues encountered in trying to bring excellent information technology to a large IDN. PMID:11079921

Backlash or a Positive Response?: Public Opinion of LGB Issues After Obergefell v. Hodges.

PubMed

Kazyak, Emily; Stange, Mathew

2018-01-10

Following Obergefell v. Hodges, same-sex marriage remains controversial and anti-LGBT state legislation has been passed, which raises questions about whether the Supreme Court's ruling may have created a backlash. We use data from two waves of a general population survey of Nebraskans conducted before and after the decision to answer three questions. First, we test three theories of how the court decision influenced public opinion. We find that support for same-sex marriage was significantly higher following the ruling, suggesting that there was not a backlash to it. Second, we assess whether people perceive that the court accurately reflects the public's opinion. We find that people who favor same-sex marriage are more likely to think that the ruling refects public opinion very well; those who oppose same-sex marriage are more likely to think that the ruling does not at all reflect public opinion. Third, we examine the association between discussing gay rights and support for same-sex marriage, finding that those who talk about LGB issues very often are more likely to favor same-sex marriage. We discuss the implications of these findings in relation to two of the themes of this special issue: the influence of marriage equality on Americans' understandings of marriage and the impact of marriage equality on future LGBT activism.

Assessing the influence of knowledge translation platforms on health system policy processes to achieve the health millennium development goals in Cameroon and Uganda: a comparative case study.

PubMed

Ongolo-Zogo, Pierre; Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

2018-05-01

There is a scarcity of empirical data on the influence of initiatives supporting evidence-informed health system policy-making (EIHSP), such as the knowledge translation platforms (KTPs) operating in Africa. To assess whether and how two KTPs housed in government-affiliated institutions in Cameroon and Uganda have influenced: (1) health system policy-making processes and decisions aiming at supporting achievement of the health millennium development goals (MDGs); and (2) the general climate for EIHSP. We conducted an embedded comparative case study of four policy processes in which Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda were involved between 2009 and 2011. We combined a documentary review and semi structured interviews of 54 stakeholders. A framework-guided thematic analysis, inspired by scholarship in health policy analysis and knowledge utilization was used. EVIPNet Cameroon and REACH-PI Uganda have had direct influence on health system policy decisions. The coproduction of evidence briefs combined with tacit knowledge gathered during inclusive evidence-informed stakeholder dialogues helped to reframe health system problems, unveil sources of conflicts, open grounds for consensus and align viable and affordable options for achieving the health MDGs thus leading to decisions. New policy issue networks have emerged. The KTPs indirectly influenced health policy processes by changing how interests interact with one another and by introducing safe-harbour deliberations and intersected with contextual ideational factors by improving access to policy-relevant evidence. KTPs were perceived as change agents with positive impact on the understanding, acceptance and adoption of EIHSP because of their complementary work in relation to capacity building, rapid evidence syntheses and clearinghouse of policy-relevant evidence. This embedded case study illustrates how two KTPs influenced policy decisions through pathways involving policy issue networks, interest groups interaction and evidence-supported ideas and how they influenced the general climate for EIHSP.

Assessing the influence of knowledge translation platforms on health system policy processes to achieve the health millennium development goals in Cameroon and Uganda: a comparative case study

PubMed Central

Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

2018-01-01

Abstract There is a scarcity of empirical data on the influence of initiatives supporting evidence-informed health system policy-making (EIHSP), such as the knowledge translation platforms (KTPs) operating in Africa. To assess whether and how two KTPs housed in government-affiliated institutions in Cameroon and Uganda have influenced: (1) health system policy-making processes and decisions aiming at supporting achievement of the health millennium development goals (MDGs); and (2) the general climate for EIHSP. We conducted an embedded comparative case study of four policy processes in which Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda were involved between 2009 and 2011. We combined a documentary review and semi structured interviews of 54 stakeholders. A framework-guided thematic analysis, inspired by scholarship in health policy analysis and knowledge utilization was used. EVIPNet Cameroon and REACH-PI Uganda have had direct influence on health system policy decisions. The coproduction of evidence briefs combined with tacit knowledge gathered during inclusive evidence-informed stakeholder dialogues helped to reframe health system problems, unveil sources of conflicts, open grounds for consensus and align viable and affordable options for achieving the health MDGs thus leading to decisions. New policy issue networks have emerged. The KTPs indirectly influenced health policy processes by changing how interests interact with one another and by introducing safe-harbour deliberations and intersected with contextual ideational factors by improving access to policy-relevant evidence. KTPs were perceived as change agents with positive impact on the understanding, acceptance and adoption of EIHSP because of their complementary work in relation to capacity building, rapid evidence syntheses and clearinghouse of policy-relevant evidence. This embedded case study illustrates how two KTPs influenced policy decisions through pathways involving policy issue networks, interest groups interaction and evidence-supported ideas and how they influenced the general climate for EIHSP. PMID:29506146

Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience.

PubMed

Fleisher, Linda; Wen, Kuang Yi; Miller, Suzanne M; Diefenbach, Michael; Stanton, Annette L; Ropka, Mary; Morra, Marion; Raich, Peter C

2015-11-01

Cancer patients and survivors are assuming active roles in decision-making and digital patient support tools are widely used to facilitate patient engagement. As part of Cancer Information Service Research Consortium's randomized controlled trials focused on the efficacy of eHealth interventions to promote informed treatment decision-making for newly diagnosed prostate and breast cancer patients, and post-treatment breast cancer, we conducted a rigorous process evaluation to examine the actual use of and perceived benefits of two complementary communication channels -- print and eHealth interventions. The three Virtual Cancer Information Service (V-CIS) interventions were developed through a rigorous developmental process, guided by self-regulatory theory, informed decision-making frameworks, and health communications best practices. Control arm participants received NCI print materials; experimental arm participants received the additional V-CIS patient support tool. Actual usage data from the web-based V-CIS was also obtained and reported. Print materials were highly used by all groups. About 60% of the experimental group reported using the V-CIS. Those who did use the V-CIS rated it highly on improvements in knowledge, patient-provider communication and decision-making. The findings show that how patients actually use eHealth interventions either singularly or within the context of other communication channels is complex. Integrating rigorous best practices and theoretical foundations is essential and multiple communication approaches should be considered to support patient preferences.

78 FR 77101 - Certain New Pneumatic Off-the-Road Tires From the People's Republic of China: Final Results of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... Decision Memorandum and electronic versions of the Issues and Decision Memorandum are identical in content. Analysis of Comments Received All issues raised in this review are addressed in the Issues and Decision...

EVA Suit Studies: Human Forward Contamination Project

NASA Technical Reports Server (NTRS)

Rucker, Michelle

2017-01-01

Background: NASA Strategic Knowledge Gap B5: Forward Contamination for Mars. Issue: we have knowledge gaps!: Whether / how microbes are released from crewed pressure systems. Why do we care?: Informs Mars operational concepts - How to protect the science; Informs architecture decisions - How “open” Environmental Control and Life Support (ECLS) systems are; Informs landing site selection decisions - How close we can land / operate to where life may be present. Project goal: get some data to fill in these gaps: Data will help determine whether we’re ready to go to Mars, or if we need to change our systems or operational designs.

GAIA - A New Approach To Decision Making on Climate Disruption Issues

NASA Astrophysics Data System (ADS)

Paxton, L. J.; Weiss, M.; Schaefer, R. K.; Swartz, W. H.; Nix, M.; Strong, S. B.; Fountain, G. H.; Babin, S. M.; Pikas, C. K.; Parker, C. L.; Global Assimilation of InformationAction

2011-12-01

GAIA - the Global Assimilation of Information for Action program - provides a broadly extensible framework for enabling the development of a deeper understanding of the issues associated with climate disruption. The key notion of GAIA is that the global climate problem is so complex that a "system engineering" approach is needed in order to make it understandable. The key tenet of system engineering is to focus on requirements and to develop a cost-effective process for satisfying those requirements. To demonstrate this approach we focused first on the impact of climate disruption on public health. GAIA is described in some detail on our website (http://gaia.jhuapl.edu). Climate disruption is not just a scientific problem; one of the key issues that our community has is that of translating scientific results into knowledge that can be used to make informed decisions. In order to support decision makers we have to understand their issues and how to communicate with them. In this talk, we describe how we have built a community of interest that combines subject matter experts from diverse communities (public health, climate change, government, public policy, industry, etc) with policy makers and representatives from industry to develop, on a "level playing field", an understanding of each other's points of view and issues. The first application of this technology was the development of a workshop on Climate, Climate Change and Public Health held April 12-14, 2011. This paper describes our approach to going beyond the workshop environment to continue to engage the decision maker's community in a variety of ways that translate abstract scientific data into actionable information. Key ideas we will discuss include the development of social media, simulations of global/national/local environments affected by climate disruption, and visualizations of the monetary and health impacts of choosing not to address mitigation or adaptation to climate disruption.

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy

PubMed Central

Sereno, Sara; Leal, Isabel; Maroco, João

2013-01-01

Background This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. Methods In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. Results The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Conclusion Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions. PMID:24163799

Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation.

PubMed

Dale, Craig M; Sinuff, Tasnim; Morrison, Laurie J; Golan, Eyal; Scales, Damon C

2016-07-01

Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management. We conducted qualitative interviews with intensive care unit (ICU) physicians and nurses following withdrawal of life support in comatose patients with OHCA treated with targeted temperature management. The study was carried out across 18 academic and community hospitals participating in a multicenter, stepped-wedge, cluster-randomized controlled trial designed to improve quality-of-care processes for patients after OHCA in Ontario, Canada. We used a focused thematic analysis to capture barriers to guideline-concordant neurological prognostication and used these barriers to identify potentially modifiable issues. The core thematic finding was a high emotional burden of ICU family-team communication in which strong feelings inhibited information transfer and delayed decision making following OHCA. Four subthemes describing sources of communication strain were identified: (1) requests from family members to provide early outcome predictions, (2) incomplete family comprehension of critical care, (3) family requests for early withdrawal of life support based on their understanding of patients' preferences and values, and (4) family-team communication gaps related to prognostic uncertainty. Participants worried that gaps in timely and clear prognostic information contributed to surrogates' perceptions of a poor outcome and to inappropriately early decisions to withdraw life support. Family-team communication difficulties may be an underestimated factor leading to early withdrawal of life support in ICUs for individuals who initially survive OHCA.

The Role of Integrated Modelling and Assessment for Decision-Making: Lessons from Water Allocation Issues in Australia

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Guillaume, J. H. A.; El Sawah, S.; Hamilton, S.

2014-12-01

Integrated modelling and assessment (IMA) is best regarded as a process that can support environmental decision-making when issues are strongly contested and uncertainties pervasive. To be most useful, the process must be multi-dimensional and phased. Principally, it must be tailored to the problem context to encompass diverse issues of concern, management settings and stakeholders. This in turn requires the integration of multiple processes and components of natural and human systems and their corresponding spatial and temporal scales. Modellers therefore need to be able to integrate multiple disciplines, methods, models, tools and data, and many sources and types of uncertainty. These dimensions are incorporated into iteration between the various phases of the IMA process, including scoping, problem framing and formulation, assessing options and communicating findings. Two case studies in Australia are employed to share the lessons of how integration can be achieved in these IMA phases using a mix of stakeholder participation processes and modelling tools. One case study aims to improve the relevance of modelling by incorporating stakeholder's views of irrigated viticulture and water management decision making. It used a novel methodology with the acronym ICTAM, consisting of Interviews to elicit mental models, Cognitive maps to represent and analyse individual and group mental models, Time-sequence diagrams to chronologically structure the decision making process, an All-encompassing conceptual model, and computational Models of stakeholder decision making. The second case uses a hydro-economic river network model to examine basin-wide impacts of water allocation cuts and adoption of farm innovations. The knowledge exchange approach used in each case was designed to integrate data and knowledge bearing in mind the contextual dimensions of the problem at hand, and the specific contributions that environmental modelling was thought to be able to make.

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 decision-support tool to inform Australian strategies for preventing suicide and suicidal behaviour.

PubMed

Page, Andrew; Atkinson, Jo-An; Heffernan, Mark; McDonnell, Geoff; Hickie, Ian

2017-04-27

Dynamic simulation modelling is increasingly being recognised as a valuable decision-support tool to help guide investments and actions to address complex public health issues such as suicide. In particular, participatory system dynamics (SD) modelling provides a useful tool for asking high-level 'what if' questions, and testing the likely impacts of different combinations of policies and interventions at an aggregate level before they are implemented in the real world. We developed an SD model for suicide prevention in Australia, and investigated the hypothesised impacts over the next 10 years (2015-2025) of a combination of current intervention strategies proposed for population interventions in Australia: 1) general practitioner (GP) training, 2) coordinated aftercare in those who have attempted suicide, 3) school-based mental health literacy programs, 4) brief-contact interventions in hospital settings, and 5) psychosocial treatment approaches. Findings suggest that the largest reductions in suicide were associated with GP training (6%) and coordinated aftercare approaches (4%), with total reductions of 12% for all interventions combined. This paper highlights the value of dynamic modelling methods for managing complexity and uncertainty, and demonstrates their potential use as a decision-support tool for policy makers and program planners for community suicide prevention actions.

Interpreting support vector machine models for multivariate group wise analysis in neuroimaging

PubMed Central

Gaonkar, Bilwaj; Shinohara, Russell T; Davatzikos, Christos

2015-01-01

Machine learning based classification algorithms like support vector machines (SVMs) have shown great promise for turning a high dimensional neuroimaging data into clinically useful decision criteria. However, tracing imaging based patterns that contribute significantly to classifier decisions remains an open problem. This is an issue of critical importance in imaging studies seeking to determine which anatomical or physiological imaging features contribute to the classifier’s decision, thereby allowing users to critically evaluate the findings of such machine learning methods and to understand disease mechanisms. The majority of published work addresses the question of statistical inference for support vector classification using permutation tests based on SVM weight vectors. Such permutation testing ignores the SVM margin, which is critical in SVM theory. In this work we emphasize the use of a statistic that explicitly accounts for the SVM margin and show that the null distributions associated with this statistic are asymptotically normal. Further, our experiments show that this statistic is a lot less conservative as compared to weight based permutation tests and yet specific enough to tease out multivariate patterns in the data. Thus, we can better understand the multivariate patterns that the SVM uses for neuroimaging based classification. PMID:26210913

Compatibility and consistency in display-control systems - Implications for aircraft decision aid design

NASA Technical Reports Server (NTRS)

Andre, Anthony D.; Wickens, Christopher D.

1992-01-01

In this study we contrast display-control movement relations defined in terms of stimulus-response (physical) compatibility with those defined by stimulus-cognitive compatibility, and we relate these findings to the issue of command versus status levels of decision aid support. A second issue addressed is the cost of inconsistency across multiple display-control mappings. Subjects performed a flight control task while responding to one to four analog indicators, formatted as either command or status displays. The results suggest that there is an advantage for the status format when subjects are required to verbally report the state of the indicator(s), but no advantage was found for either format when subjects were required to manually correct the indicated state. The data point to the importance of display-control consistency and suggest that it may even outweigh that of compatibility.

Successful integration efforts in water quality from the integrated Ocean Observing System Regional Associations and the National Water Quality Monitoring Network

USGS Publications Warehouse

Ragsdale, R.; Vowinkel, E.; Porter, D.; Hamilton, P.; Morrison, R.; Kohut, J.; Connell, B.; Kelsey, H.; Trowbridge, P.

2011-01-01

The Integrated Ocean Observing System (IOOS??) Regional Associations and Interagency Partners hosted a water quality workshop in January 2010 to discuss issues of nutrient enrichment and dissolved oxygen depletion (hypoxia), harmful algal blooms (HABs), and beach water quality. In 2007, the National Water Quality Monitoring Council piloted demonstration projects as part of the National Water Quality Monitoring Network (Network) for U.S. Coastal Waters and their Tributaries in three IOOS Regional Associations, and these projects are ongoing. Examples of integrated science-based solutions to water quality issues of major concern from the IOOS regions and Network demonstration projects are explored in this article. These examples illustrate instances where management decisions have benefited from decision-support tools that make use of interoperable data. Gaps, challenges, and outcomes are identified, and a proposal is made for future work toward a multiregional water quality project for beach water quality.

Water quality success stories: Integrated assessments from the IOOS regional associations and national water quality monitoring network

USGS Publications Warehouse

Ragsdale, Rob; Vowinkel, Eric; Porter, Dwayne; Hamilton, Pixie; Morrison, Ru; Kohut, Josh; Connell, Bob; Kelsey, Heath; Trowbridge, Phil

2011-01-01

The Integrated Ocean Observing System (IOOS®) Regional Associations and Interagency Partners hosted a water quality workshop in January 2010 to discuss issues of nutrient enrichment and dissolved oxygen depletion (hypoxia), harmful algal blooms (HABs), and beach water quality. In 2007, the National Water Quality Monitoring Council piloted demonstration projects as part of the National Water Quality Monitoring Network (Network) for U.S. Coastal Waters and their Tributaries in three IOOS Regional Associations, and these projects are ongoing. Examples of integrated science-based solutions to water quality issues of major concern from the IOOS regions and Network demonstration projects are explored in this article. These examples illustrate instances where management decisions have benefited from decision-support tools that make use of interoperable data. Gaps, challenges, and outcomes are identified, and a proposal is made for future work toward a multiregional water quality project for beach water quality.

Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

PubMed Central

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

2011-01-01

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

Use of an Online Clinical Process Support System as an Aid to Identification and Management of Developmental and Mental Health Problems.

PubMed

Howard, Barbara J; Sturner, Raymond

2017-12-01

To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening. An online clinical process support system (CHADIS) shows promise in addressing these issues. Use of a comprehensive panel of online pre-visit screens; linked decision support to provide moment-of-care training; and post-visit activities and resources for patient-specific education, monitoring and care coordination is an efficient way to make the entire process of screening and follow up care feasible in primary care. CHADIS fulfills these requirements and provides Maintenance of Certification credit to physicians as well as added income for screening efforts.

High-speed civil transport issues and technology program

NASA Technical Reports Server (NTRS)

Hewett, Marle D.

1992-01-01

A strawman program plan is presented, consisting of technology developments and demonstrations required to support the construction of a high-speed civil transport. The plan includes a compilation of technology issues related to the development of a transport. The issues represent technical areas in which research and development are required to allow airframe manufacturers to pursue an HSCT development. The vast majority of technical issues presented require flight demonstrated and validated solutions before a transport development will be undertaken by the industry. The author believes that NASA is the agency best suited to address flight demonstration issues in a concentrated effort. The new Integrated Test Facility at NASA Dryden Flight Research Facility is considered ideally suited to the task of supporting ground validations of proof-of-concept and prototype system demonstrations before night demonstrations. An elaborate ground hardware-in-the-loop (iron bird) simulation supported in this facility provides a viable alternative to developing an expensive fill-scale prototype transport technology demonstrator. Drygen's SR-71 assets, modified appropriately, are a suitable test-bed for supporting flight demonstrations and validations of certain transport technology solutions. A subscale, manned or unmanned flight demonstrator is suitable for flight validation of transport technology solutions, if appropriate structural similarity relationships can be established. The author contends that developing a full-scale prototype transport technology demonstrator is the best alternative to ensuring that a positive decision to develop a transport is reached by the United States aerospace industry.

Tools to support evidence-informed public health decision making

PubMed Central

2014-01-01

Background Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. Methods As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Results Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the ‘actionable message(s)’ from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making. Conclusion Tools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools’ application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice. PMID:25034534

Tools to support evidence-informed public health decision making.

PubMed

Yost, Jennifer; Dobbins, Maureen; Traynor, Robyn; DeCorby, Kara; Workentine, Stephanie; Greco, Lori

2014-07-18

Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the 'actionable message(s)' from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making. Tools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools' application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice.

Legal and Policy Issues for LGBT Patients with Cancer or at Elevated Risk of Cancer.

PubMed

Cahill, Sean R

2018-02-01

To understand the major legal and policy issues for lesbian, gay, bisexual and transgender (LGBT) cancer patients. LGBT health policy research. Major policy issues include discrimination, lack of cultural competency and clinically appropriate care, insurance coverage, family recognition, and sexual orientation and gender identity data collection. Nurses play a major role in providing affirming and competent care to LGBT cancer patients. Using correct names and pronouns with transgender patients, and collecting sexual orientation and gender identity data can send an affirming message to LGBT patients, as well as inform decision support and preventive screenings, and improve treatment outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

75 FR 82069 - In the Matter of Certain Underground Cable and Pipe Locators; Notice of Commission Decision Not...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

... to review initial determinations (``IDs'') (Order Nos. 5 and 6) terminating the investigation based... underground cable and pipe locators that infringe certain claims of U.S. Patent No. 6,268,731. The complaint... response in support of the motions to terminate. On December 1, 2010, the ALJ issued Order Nos. 5 and 6...

When Districts Support and Integrate Social and Emotional Learning (SEL): Findings from an Ongoing Evaluation of Districtwide Implementation of SEL

ERIC Educational Resources Information Center

Kendziora, Kimberly; Yoder, Nick

2016-01-01

The Issue: Students need more than just academic knowledge to succeed in college, careers, and personal and public life. They need to understand their own skills and abilities, manage their emotions and behavior, communicate effectively, negotiate conflict, care about others, and make responsible decisions. Social and emotional skills undergird…

Optimizing spatial and temporal treatments to maintain effective fire and non-fire fuels treatments at landscape scales

Treesearch

J. Greg Jones; Woodam Chung; Carl Seielstad; Janet Sullivan; Kurt Krueger

2010-01-01

There is a recognized need to apply and maintain fuel treatments to reduce catastrophic wildland fires. A number of models and decision support systems have been developed for addressing different aspects of fuel treatments while considering other important resource management issues and constraints. Although these models address diverse aspects of the fuel treatment-...

"Whatever Is Comfortable:" Secondary Physical Educators' Curricular Decision Making: Issues of Knowledge and Gendered Performativity

ERIC Educational Resources Information Center

Ferry, Matthew; McCaughtry, Nate

2015-01-01

Throughout history there have been debates as to what content knowledge (CK) is of most value for physical education (PE). Much recent conversation has circulated around the hope that time spent in PE supports students' regular participation in physical activity (PA). Researchers' use of the term PA, however, often stresses the similarities while…

Trends and Issues in Technology Education Research in Taiwan: A Co-Word Analysis of 1994-2013 Graduate Theses

ERIC Educational Resources Information Center

Lee, Lung-Sheng; Fang, Yu-Shen

2015-01-01

In Taiwan, the Technology Education for 1-12 graders is comprised of two courses--Living Technology (LT) and Information Technology (IT). With its ever-changing feature, Technology Education needs on-going research to support its decisions and actions. The education-related academic programs in universities regularly concern about the development…

"Should We Kill the Grey Squirrels?" A Study Exploring Students' Justifications and Decision-Making

ERIC Educational Resources Information Center

Evagorou, Maria; Jimenez-Aleixandre, Maria Pilar; Osborne, Jonathan

2012-01-01

A problem that is still unexplored in the field of socioscientific issues (SSI) and that was explored in this study is how different students decide upon a SSI they are discussing, how their justifications change during the instruction and how they use (or not) the evidence from the learning environment to support their justifications. For the…

Slicing the Apple: Need Amidst Affluence in New York City, 2002. Volume I: Technical Report [and] Volume II: Appendicies [and] Summary Report.

ERIC Educational Resources Information Center

2002

This report provides a broad overview of significant issues and trends affecting human services in New York City. Written for decision makers, policymakers, service providers, and financial supporters, the first volume includes (1) "Introduction" (the social temperature of New York City); (2) "Who are New Yorkers?" (population…

The Watershed and River Systems Management Program: Decision Support for Water- and Environmental-Resource Management

NASA Astrophysics Data System (ADS)

Leavesley, G.; Markstrom, S.; Frevert, D.; Fulp, T.; Zagona, E.; Viger, R.

2004-12-01

Increasing demands for limited fresh-water supplies, and increasing complexity of water-management issues, present the water-resource manager with the difficult task of achieving an equitable balance of water allocation among a diverse group of water users. The Watershed and River System Management Program (WARSMP) is a cooperative effort between the U.S. Geological Survey (USGS) and the Bureau of Reclamation (BOR) to develop and deploy a database-centered, decision-support system (DSS) to address these multi-objective, resource-management problems. The decision-support system couples the USGS Modular Modeling System (MMS) with the BOR RiverWare tools using a shared relational database. MMS is an integrated system of computer software that provides a research and operational framework to support the development and integration of a wide variety of hydrologic and ecosystem models, and their application to water- and ecosystem-resource management. RiverWare is an object-oriented reservoir and river-system modeling framework developed to provide tools for evaluating and applying water-allocation and management strategies. The modeling capabilities of MMS and Riverware include simulating watershed runoff, reservoir inflows, and the impacts of resource-management decisions on municipal, agricultural, and industrial water users, environmental concerns, power generation, and recreational interests. Forecasts of future climatic conditions are a key component in the application of MMS models to resource-management decisions. Forecast methods applied in MMS include a modified version of the National Weather Service's Extended Streamflow Prediction Program (ESP) and statistical downscaling from atmospheric models. The WARSMP DSS is currently operational in the Gunnison River Basin, Colorado; Yakima River Basin, Washington; Rio Grande Basin in Colorado and New Mexico; and Truckee River Basin in California and Nevada.

A web based spatial decision supporting system for land management and soil conservation

NASA Astrophysics Data System (ADS)

Terribile, F.; Agrillo, A.; Bonfante, A.; Buscemi, G.; Colandrea, M.; D'Antonio, A.; De Mascellis, R.; De Michele, C.; Langella, G.; Manna, P.; Marotta, L.; Mileti, F. A.; Minieri, L.; Orefice, N.; Valentini, S.; Vingiani, S.; Basile, A.

2015-02-01

Today it is evident that there are many contrasting demands on our landscape (e.g. food security, more sustainable agriculture, higher income in rural areas, etc.) but also many land degradation problems. It has been proved that providing operational answers to these demands and problems is extremely difficult. Here we aim to demonstrate that a Spatial Decision Support System based on geospatial cyber-infrastructure (GCI) can embody all of the above, so producing a smart system for supporting decision making for agriculture, forestry and urban planning with respect to the landscape. In this paper, we discuss methods and results of a special kind of GCI architecture, one that is highly focused on soil and land conservation (SOILCONSWEB-LIFE+ project). The system allows us to obtain dynamic, multidisciplinary, multiscale, and multifunctional answers to agriculture, forestry and urban planning issues through the web. The system has been applied to and tested in an area of about 20 000 ha in the South of Italy, within the framework of a European LIFE+ project. The paper reports - as a case study - results from two different applications dealing with agriculture (olive growth tool) and environmental protection (soil capability to protect groundwater). Developed with the help of end users, the system is starting to be adopted by local communities. The system indirectly explores a change of paradigm for soil and landscape scientists. Indeed, the potential benefit is shown of overcoming current disciplinary fragmentation over landscape issues by offering - through a smart web based system - truly integrated geospatial knowledge that may be directly and freely used by any end user (http://www.landconsultingweb.eu). This may help bridge the last much important divide between scientists working on the landscape and end users.

Factors of accepting pain management decision support systems by nurse anesthetists

PubMed Central

2013-01-01

Background Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective. Methods A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool. Results The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists’ perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists’ perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R2=.487) and perceived usefulness (β=.443, p<.001, R2=.646) significantly affected nurse anesthetists’ PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated. Conclusions The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development. PMID:23360305

Analysis of ETMS Data Quality for Traffic Flow Management Decisions

NASA Technical Reports Server (NTRS)

Chatterji, Gano B.; Sridhar, Banavar; Kim, Douglas

2003-01-01

The data needed for air traffic flow management decision support tools is provided by the Enhanced Traffic Management System (ETMS). This includes both the tools that are in current use and the ones being developed for future deployment. Since the quality of decision support provided by all these tools will be influenced by the quality of the input ETMS data, an assessment of ETMS data quality is needed. Motivated by this desire, ETMS data quality is examined in this paper in terms of the unavailability of flight plans, deviation from the filed flight plans, departure delays, altitude errors and track data drops. Although many of these data quality issues are not new, little is known about their extent. A goal of this paper is to document the magnitude of data quality issues supported by numerical analysis of ETMS data. Guided by this goal, ETMS data for a 24-hour period were processed to determine the number of aircraft with missing flight plan messages at any given instant of time. Results are presented for aircraft above 18,000 feet altitude and also at all altitudes. Since deviation from filed flight plan is also a major cause of trajectory-modeling errors, statistics of deviations are presented. Errors in proposed departure times and ETMS-generated vertical profiles are also shown. A method for conditioning the vertical profiles for improving demand prediction accuracy is described. Graphs of actual sector counts obtained using these vertical profiles are compared with those obtained using the Host data for sectors in the Fort Worth Center to demonstrate the benefit of preprocessing. Finally, results are presented to quantify the extent of data drops. A method for propagating track positions during ETMS data drops is also described.

A Web-based spatial decision supporting system for land management and soil conservation

NASA Astrophysics Data System (ADS)

Terribile, F.; Agrillo, A.; Bonfante, A.; Buscemi, G.; Colandrea, M.; D'Antonio, A.; De Mascellis, R.; De Michele, C.; Langella, G.; Manna, P.; Marotta, L.; Mileti, F. A.; Minieri, L.; Orefice, N.; Valentini, S.; Vingiani, S.; Basile, A.

2015-07-01

Today it is evident that there are many contrasting demands on our landscape (e.g. food security, more sustainable agriculture, higher income in rural areas, etc.) as well as many land degradation problems. It has been proved that providing operational answers to these demands and problems is extremely difficult. Here we aim to demonstrate that a spatial decision support system based on geospatial cyberinfrastructure (GCI) can address all of the above, so producing a smart system for supporting decision making for agriculture, forestry, and urban planning with respect to the landscape. In this paper, we discuss methods and results of a special kind of GCI architecture, one that is highly focused on land management and soil conservation. The system allows us to obtain dynamic, multidisciplinary, multiscale, and multifunctional answers to agriculture, forestry, and urban planning issues through the Web. The system has been applied to and tested in an area of about 20 000 ha in the south of Italy, within the framework of a European LIFE+ project (SOILCONSWEB). The paper reports - as a case study - results from two different applications dealing with agriculture (olive growth tool) and environmental protection (soil capability to protect groundwater). Developed with the help of end users, the system is starting to be adopted by local communities. The system indirectly explores a change of paradigm for soil and landscape scientists. Indeed, the potential benefit is shown of overcoming current disciplinary fragmentation over landscape issues by offering - through a smart Web-based system - truly integrated geospatial knowledge that may be directly and freely used by any end user (www.landconsultingweb.eu). This may help bridge the last very important divide between scientists working on the landscape and end users.

Manager`s views of public involvement

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

Branch, K.M.; Heerwagen, J.; Bradbury, J.

1995-12-01

Four issues commonly form the framework for debates about the acceptability of proposed projects or technologies--the substantive decision or technological choice; the treatment of the community by the proponent organization; the way the decision-making process has been structured and managed; and the status of institutional safeguards and protection. One of the clear messages of cultural theory is that differences in perspectives are a normal and inevitable part of society, and that attempts to resolve differences by persuasion are not likely to work. These findings are useful when considering the goals and possibilities of public involvement as a decision-making tool, andmore » when designing or evaluating public involvement training programs for managers. The research reported here examines the viewpoints and concerns of managers and decision-makers about the four issues identified above, with particular emphasis on their perspectives and concerns about opening decision-making processes to the public and about managers` roles and responsibilities for structuring and managing open decision-making processes. Implications of these findings for public involvement training for managers is also discussed. The data presented in this paper were obtained from face-to-face interviews with managers and decision-makers with experience managing a variety of hazardous waste management decision-making processes. We conducted these interviews in the course of four separate research projects: needs assessments to support the design and development of a public involvement training program for managers; a study of community residents` and managers` perspectives on the chemical stockpile disposal program; an evaluation of the effectiveness of public involvement training for managers in the Department of Energy; and a study to develop indicators of the benefits and costs of public involvement.« less

Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions

PubMed Central

Brooks, Alan; Ba-Nguz, Antoinette

2012-01-01

Traditionally it has taken years or decades for new public health interventions targeting diseases found in developing countries to be accessible to those most in need. One reason for the delay has been insufficient anticipation of the eventual processes and evidence required for decision making by countries. This paper describes research into the anticipated processes and data needed to inform decision making on malaria vaccines, the most advanced of which is still in phase 3 trials. From 2006 to 2008, a series of country consultations in Africa led to the development of a guide to assist countries in preparing their malaria vaccine decision-making frameworks. The guide builds upon the World Health Organization’s Vaccine Introduction Guidelines. It identifies the processes and data for decisions, when they would be needed relative to the development timelines of the intervention, and where they will come from. Policy development will be supported by data (e.g. malaria disease burden; roles of other malaria interventions; malaria vaccine impact; economic and financial issues; malaria vaccine efficacy, quality and safety) as will implementation decisions (e.g. programmatic issues and socio-cultural environment). This generic guide can now be applied to any future malaria vaccine. The paper discusses the opportunities and challenges to early planning for country decision-making—from the potential for timely, evidence-informed decisions to the risks of over-promising around an intervention still under development. Careful and well-structured planning by countries is an important way to ensure that new interventions do not remain unused for years or decades after they become available. PMID:22513733

Legal decision-making by people with aphasia: critical incidents for speech pathologists.

PubMed

Ferguson, Alison; Duffield, Gemma; Worrall, Linda

2010-01-01

The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist. The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations. The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software. The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication. The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area. 2010 Royal College of Speech & Language Therapists.

Life support technology investment strategies for flight programs: An application of decision analysis

NASA Technical Reports Server (NTRS)

Schlater, Nelson J.; Simonds, Charles H.; Ballin, Mark G.

1993-01-01

Applied research and technology development (R&TD) is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Given the increased awareness of limitations in resources, effective R&TD today needs a method for up-front assessment of competing technologies to help guide technology investment decisions. Such an assessment approach must account for uncertainties in system performance parameters, mission requirements and architectures, and internal and external events influencing a development program. The methodology known as decision analysis has the potential to address these issues. It was evaluated by performing a case study assessment of alternative carbon dioxide removal technologies for NASA"s proposed First Lunar Outpost program. An approach was developed that accounts for the uncertainties in each technology's cost and performance parameters as well as programmatic uncertainties such as mission architecture. Life cycle cost savings relative to a baseline, adjusted for the cost of money, was used as a figure of merit to evaluate each of the alternative carbon dioxide removal technology candidates. The methodology was found to provide a consistent decision-making strategy for the develpoment of new life support technology. The case study results provided insight that was not possible from more traditional analysis approaches.

Life support technology investment strategies for flight programs: An application of decision analysis

NASA Technical Reports Server (NTRS)

Schlater, Nelson J.; Simonds, Charles H.; Ballin, Mark G.

1993-01-01

Applied research and technology development (R&TD) is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Given the increased awareness of limitations in resources, effective R&TD today needs a method for up-front assessment of competing technologies to help guide technology investment decisions. Such an assessment approach must account for uncertainties in system performance parameters, mission requirements and architectures, and internal and external events influencing a development program. The methodology known as decision analysis has the potential to address these issues. It was evaluated by performing a case study assessment of alternative carbon dioxide removal technologies for NASA's proposed First Lunar Outpost program. An approach was developed that accounts for the uncertainties in each technology's cost and performance parameters as well as programmatic uncertainties such as mission architecture. Life cycle cost savings relative to a baseline, adjusted for the cost of money, was used as a figure of merit to evaluate each of the alternative carbon dioxide removal technology candidates. The methodology was found to provide a consistent decision-making strategy for development of new life support technology. The case study results provided insight that was not possible from more traditional analysis approaches.

Development by Design in Colombia: Making Mitigation Decisions Consistent with Conservation Outcomes

PubMed Central

Saenz, Shirley; Walschburger, Tomas; González, Juan Carlos; León, Jorge; McKenney, Bruce; Kiesecker, Joseph

2013-01-01

Mitigation policy and regulatory frameworks are consistent in their strong support for the mitigation hierarchy of: (1) avoiding impacts, (2) minimizing impacts, and then (3) offsetting/compensating for residual impacts. While mitigation frameworks require developers to avoid, minimize and restore biodiversity on-site before considering an offset for residual impacts, there is a lack of quantitative guidance for this decision-making process. What are the criteria for requiring impacts be avoided altogether? Here we examine how conservation planning can guide the application of the mitigation hierarchy to address this issue. In support of the Colombian government's aim to improve siting and mitigation practices for planned development, we examined five pilot projects in landscapes expected to experience significant increases in mining, petroleum and/or infrastructure development. By blending landscape-level conservation planning with application of the mitigation hierarchy, we can proactively identify where proposed development and conservation priorities would be in conflict and where impacts should be avoided. The approach we outline here has been adopted by the Colombian Ministry of Environment and Sustainable Development to guide licensing decisions, avoid piecemeal licensing, and promote mitigation decisions that maintain landscape condition. PMID:24339972

Development by design in Colombia: making mitigation decisions consistent with conservation outcomes.

PubMed

Saenz, Shirley; Walschburger, Tomas; González, Juan Carlos; León, Jorge; McKenney, Bruce; Kiesecker, Joseph

2013-01-01

Mitigation policy and regulatory frameworks are consistent in their strong support for the mitigation hierarchy of: (1) avoiding impacts, (2) minimizing impacts, and then (3) offsetting/compensating for residual impacts. While mitigation frameworks require developers to avoid, minimize and restore biodiversity on-site before considering an offset for residual impacts, there is a lack of quantitative guidance for this decision-making process. What are the criteria for requiring impacts be avoided altogether? Here we examine how conservation planning can guide the application of the mitigation hierarchy to address this issue. In support of the Colombian government's aim to improve siting and mitigation practices for planned development, we examined five pilot projects in landscapes expected to experience significant increases in mining, petroleum and/or infrastructure development. By blending landscape-level conservation planning with application of the mitigation hierarchy, we can proactively identify where proposed development and conservation priorities would be in conflict and where impacts should be avoided. The approach we outline here has been adopted by the Colombian Ministry of Environment and Sustainable Development to guide licensing decisions, avoid piecemeal licensing, and promote mitigation decisions that maintain landscape condition.

Estimating the potential water reuse based on fuzzy reasoning.

PubMed

Almeida, Giovana; Vieira, José; Marques, Alfeu Sá; Kiperstok, Asher; Cardoso, Alberto

2013-10-15

Studies worldwide suggest that the risk of water shortage in regions affected by climate change is growing. Decision support tools can help governments to identify future water supply problems in order to plan mitigation measures. Treated wastewater is considered a suitable alternative water resource and it is used for non-potable applications in many dry regions around the world. This work describes a decision support system (DSS) that was developed to identify current water reuse potential and the variables that determine the reclamation level. The DSS uses fuzzy inference system (FIS) as a tool and multi-criteria decision making is the conceptual approach behind the DSS. It was observed that water reuse level seems to be related to environmental factors such as drought, water exploitation index, water use, population density and the wastewater treatment rate, among others. A dataset was built to analyze these features through water reuse potential with a FIS that considered 155 regions and 183 cities. Despite some inexact fit between the classification and simulation data for agricultural and urban water reuse potential it was found that the FIS was suitable to identify the water reuse trend. Information on the water reuse potential is important because it issues a warning about future water supply needs based on climate change scenarios, which helps to support decision making with a view to tackling water shortage. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Space Shuttle Disaster: Ethical Issues in Organizational Decision-Making.

ERIC Educational Resources Information Center

Kramer, Ronald C.; Jaksa, James A.

Arguing that the issue of organizational decision making and bureaucratic responsibility in the use of technologies with potential for creating social harm should concern everyone, this paper explores the ethical issues raised by organizational decisions concerning the launch of the space shuttle "Challenger." The paper first describes a…

Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis.

PubMed

Baptista, Sofia; Teles Sampaio, Elvira; Heleno, Bruno; Azevedo, Luís Filipe; Martins, Carlos

2018-06-26

Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict. This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids. We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR). Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD -7.07%; 95% CI -9.44 to -4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD -0.50; 95% CI -0.88 to -0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25). According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men. ©Sofia Baptista, Elvira Teles Sampaio, Bruno Heleno, Luís Filipe Azevedo, Carlos Martins. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

Improving accountability in vaccine decision-making.

PubMed

Timmis, James Kenneth; Black, Steven; Rappuoli, Rino

2017-11-01

Healthcare decisions, in particular those affecting entire populations, should be evidence-based and taken by decision-makers sharing broad alignment with affected stakeholders. However, criteria, priorities and procedures for decision-making are sometimes non-transparent, frequently vary considerably across equivalent decision-bodies, do not always consider the broader benefits of new health-measures, and therefore do not necessarily adequately represent the relevant stakeholder-spectrum. Areas covered: To address these issues in the context of the evaluation of new vaccines, we have proposed a first baseline set of core evaluation criteria, primarily selected by members of the vaccine research community, and suggested their implementation in vaccine evaluation procedures. In this communication, we review the consequences and utility of stakeholder-centered core considerations to increase transparency in and accountability of decision-making procedures, in general, and of the benefits gained by their inclusion in Multi-Criteria-Decision-Analysis tools, exemplified by SMART Vaccines, specifically. Expert commentary: To increase effectiveness and comparability of health decision outcomes, decision procedures should be properly standardized across equivalent (national) decision bodies. To this end, including stakeholder-centered criteria in decision procedures would significantly increase their transparency and accountability, support international capacity building to improve health, and reduce societal costs and inequity resulting from suboptimal health decision-making.

On decentralized design: Rationale, dynamics, and effects on decision-making

NASA Astrophysics Data System (ADS)

Chanron, Vincent

The focus of this dissertation is the design of complex systems, including engineering systems such as cars, airplanes, and satellites. Companies who design these systems are under constant pressure to design better products that meet customer expectations, and competition forces them to develop them faster. One of the responses of the industry to these conflicting challenges has been the decentralization of the design responsibilities. The current lack of understanding of the dynamics of decentralized design processes is the main motivation for this research, and places value on the descriptive base. It identifies the main reasons and the true benefits for companies to decentralize the design of their products. It also demonstrates the limitations of this approach by listing the relevant issues and problems created by the decentralization of decisions. Based on these observations, a game-theoretic approach to decentralized design is proposed to model the decisions made during the design process. The dynamics are modeled using mathematical formulations inspired from control theory. Building upon this formalism, the issue of convergence in decentralized design is analyzed: the equilibrium points of the design space are identified and convergent and divergent patterns are recognized. This rigorous investigation of the design process provides motivation and support for proposing new approaches to decentralized design problems. Two methods are developed, which aim at improving the design process in two ways: decreasing the product development time, and increasing the optimality of the final design. The frame of these methods are inspired by eigenstructure decomposition and set-based design, respectively. The value of the research detailed within this dissertation is in the proposed methods which are built upon the sound mathematical formalism developed. The contribution of this work is two fold: rigorous investigation of the design process, and practical support to decision-making in decentralized environments.

Retention and attrition factors for female certified athletic trainers in the National Collegiate Athletic Association Division I Football Bowl Subdivision setting.

PubMed

Goodman, Ashley; Mensch, James M; Jay, Michelle; French, Karen E; Mitchell, Murray F; Fritz, Stacy L

2010-01-01

Organizational effectiveness and the continuity of patient care can be affected by certain levels of attrition. However, little is known about the retention and attrition of female certified athletic trainers (ATs) in certain settings. To gain insight and understanding into the factors and circumstances affecting female ATs' decisions to persist in or leave the National Collegiate Athletic Association Division I Football Bowl Subdivision (NCAA D-I FBS) setting. Qualitative study. The 12 NCAA D-I FBS institutions within the Southeastern Conference. A total of 23 women who were current full-time ATs (n = 12) or former full-time ATs (n = 11) at Southeastern Conference institutions participated. Data were collected via in-depth, semistructured interviews, transcribed verbatim, and analyzed via a grounded theory approach. Peer review and member checking methods were performed to establish trustworthiness. The decision to persist involved 4 main factors: (1) increased autonomy, (2) increased social support, (3) enjoyment of job/fitting the NCAA D-I mold, and (4) kinship responsibility. Two subfactors of persistence, the NCAA D-I atmosphere and positive athlete dynamics, emerged under the main factor of enjoyment of job/fitting the NCAA D-I mold. The decision to leave included 3 main factors: (1) life balance issues, (2) role conflict and role overload, and (3) kinship responsibility. Two subfactors of leaving, supervisory/coach conflict and decreased autonomy, emerged under the main factor of role conflict and role overload. A female AT's decision to persist in or leave the NCAA D-I FBS setting can involve several factors. In order to retain capable ATs long term in the NCAA D-I setting, an individual's attributes and obligations, the setting's cultural issues, and an organization's social support paradigm should be considered.

A Framework to Design the Computational Load Distribution of Wireless Sensor Networks in Power Consumption Constrained Environments

PubMed Central

Sánchez-Álvarez, David; Rodríguez-Pérez, Francisco-Javier

2018-01-01

In this paper, we present a work based on the computational load distribution among the homogeneous nodes and the Hub/Sink of Wireless Sensor Networks (WSNs). The main contribution of the paper is an early decision support framework helping WSN designers to take decisions about computational load distribution for those WSNs where power consumption is a key issue (when we refer to “framework” in this work, we are considering it as a support tool to make decisions where the executive judgment can be included along with the set of mathematical tools of the WSN designer; this work shows the need to include the load distribution as an integral component of the WSN system for making early decisions regarding energy consumption). The framework takes advantage of the idea that balancing sensors nodes and Hub/Sink computational load can lead to improved energy consumption for the whole or at least the battery-powered nodes of the WSN. The approach is not trivial and it takes into account related issues such as the required data distribution, nodes, and Hub/Sink connectivity and availability due to their connectivity features and duty-cycle. For a practical demonstration, the proposed framework is applied to an agriculture case study, a sector very relevant in our region. In this kind of rural context, distances, low costs due to vegetable selling prices and the lack of continuous power supplies may lead to viable or inviable sensing solutions for the farmers. The proposed framework systematize and facilitates WSN designers the required complex calculations taking into account the most relevant variables regarding power consumption, avoiding full/partial/prototype implementations, and measurements of different computational load distribution potential solutions for a specific WSN. PMID:29570645

Beyond Precision: Issues of Morality and Decision Making in Minimizing Collateral Casualties

DTIC Science & Technology

2003-04-28

possible contributions from moral judgment and decision making . As Fuller himself said, laws “can create the conditions essential for a rational ...BEYOND PRECISION: Issues of Morality and Decision Making in Minimizing Collateral Casualties Program in Arms Control, Disarmament, and...28 APR 2003 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Beyond Precision: Issues of Morality and Decision Making in

21 CFR 1.405 - When does FDA have to issue a decision on an appeal?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false When does FDA have to issue a decision on an... Consumption What Is the Appeal Process for A Detention Order? § 1.405 When does FDA have to issue a decision... final decision within the 5-calendar day period after the appeal is filed. If FDA either fails to...

21 CFR 1.405 - When does FDA have to issue a decision on an appeal?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 1 2011-04-01 2011-04-01 false When does FDA have to issue a decision on an... Consumption What Is the Appeal Process for A Detention Order? § 1.405 When does FDA have to issue a decision... final decision within the 5-calendar day period after the appeal is filed. If FDA either fails to...

21 CFR 1.405 - When does FDA have to issue a decision on an appeal?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 1 2014-04-01 2014-04-01 false When does FDA have to issue a decision on an... Consumption What Is the Appeal Process for A Detention Order? § 1.405 When does FDA have to issue a decision... final decision within the 5-calendar day period after the appeal is filed. If FDA either fails to...

21 CFR 1.405 - When does FDA have to issue a decision on an appeal?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false When does FDA have to issue a decision on an... Consumption What Is the Appeal Process for A Detention Order? § 1.405 When does FDA have to issue a decision... final decision within the 5-calendar day period after the appeal is filed. If FDA either fails to...

21 CFR 1.405 - When does FDA have to issue a decision on an appeal?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false When does FDA have to issue a decision on an... Consumption What Is the Appeal Process for A Detention Order? § 1.405 When does FDA have to issue a decision... final decision within the 5-calendar day period after the appeal is filed. If FDA either fails to...

To delegate or not to delegate: A review of control frameworks for autonomous cars.

PubMed

Richards, Dale; Stedmon, Alex

2016-03-01

There have been significant advances in technology and automated systems that will eventually see the use of autonomous cars as commonplace on our roads. Various systems are already available that provide the driver with different levels of decision support. This paper highlights the key human factors issues associated with the interaction between the user and an autonomous system, including assistive decision support and the delegation of authority to the automobile. The level of support offered to the driver can range from traditional automated assistance, to system generated guidance that offers advice for the driver to act upon, and even more direct action that is initiated by the system itself without driver intervention. In many of these instances the role of the driver is slowly moving towards a supervisory role within a complex system rather than one of direct control of the vehicle. Different paradigms of interaction are considered and focus is placed on the partnership that takes place between the driver and the vehicle. Drawing on the wealth of knowledge that exists within the aviation domain and research literature that examines technology partnerships within the cockpit, this paper considers important factors that will assist the automotive community to understand the underlying issues of the human and their interaction within complex systems. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Improving medical decisions for incapacitated persons: does focusing on "accurate predictions" lead to an inaccurate picture?

PubMed

Kim, Scott Y H

2014-04-01

The Patient Preference Predictor (PPP) proposal places a high priority on the accuracy of predicting patients' preferences and finds the performance of surrogates inadequate. However, the quest to develop a highly accurate, individualized statistical model has significant obstacles. First, it will be impossible to validate the PPP beyond the limit imposed by 60%-80% reliability of people's preferences for future medical decisions--a figure no better than the known average accuracy of surrogates. Second, evidence supports the view that a sizable minority of persons may not even have preferences to predict. Third, many, perhaps most, people express their autonomy just as much by entrusting their loved ones to exercise their judgment than by desiring to specifically control future decisions. Surrogate decision making faces none of these issues and, in fact, it may be more efficient, accurate, and authoritative than is commonly assumed.

Modeling the customer in electronic commerce.

PubMed

Helander, M G; Khalid, H M

2000-12-01

This paper reviews interface design of web pages for e-commerce. Different tasks in e-commerce are contrasted. A systems model is used to illustrate the information flow between three subsystems in e-commerce: store environment, customer, and web technology. A customer makes several decisions: to enter the store, to navigate, to purchase, to pay, and to keep the merchandize. This artificial environment must be designed so that it can support customer decision-making. To retain customers it must be pleasing and fun, and create a task with natural flow. Customers have different needs, competence and motivation, which affect decision-making. It may therefore be important to customize the design of the e-store environment. Future ergonomics research will have to investigate perceptual aspects, such as presentation of merchandize, and cognitive issues, such as product search and navigation, as well as decision making while considering various economic parameters. Five theories on e-commerce research are presented.

29 CFR 18.41 - Summary decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Summary decision. 18.41 Section 18.41 Labor Office of the... ADMINISTRATIVE LAW JUDGES General § 18.41 Summary decision. (a) No genuine issue of material fact. (1) Where no.... Any final decision issued as a summary decision shall conform to the requirements for all final...

Critical appraisal of organ procurement under Maastricht 3 condition.

PubMed

Puybasset, L; Bazin, J-E; Beloucif, S; Bizouarn, P; Crozier, S; Devalois, B; Eon, B; Fieux, F; Gisquet, E; Guibet-Lafaye, C; Kentish, N; Lienhart, A; Nicolas-Robin, A; Otero Lopez, M; Pelluchon, C; Roussin, F; Beydon, L

2014-02-01

The ethics committee of the French Society of Anesthesia and Intensive Care (Sfar) has been requested by the French Biomedical Agency to consider the issue of organ donation in patients after the decision to withdraw life-supportive therapies has been taken. This type of organ donation is performed in the USA, Canada, the United Kingdom, the Netherlands and Belgium. The three former countries have published recommendations formalizing procedures and operations. The French Society of Anesthesia and Intensive Care (Société française d'anesthésie et de reanimation [Sfar]) ethics committee has considered this issue and envisioned the different aspects of the whole process. Consequently, it sounded a note of caution regarding the applicability of this type of organ procurement in unselected patients following a decision to withdraw life-supportive therapies. According to French regulations concerning organ procurement in brain-dead patients, the committee stresses the need to restrict this specific way of procurement to severely brain-injured patients, once confirmatory investigations predicting a catastrophic prognosis have been performed. This suggests that the nature of the confirmatory investigation required should be formalized by the French Biomedical Agency on behalf of the French parliamentarians, which should help preserve population trust regarding organ procurement and provide a framework for medical decision. This text has been endorsed by the Sfar. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China.

PubMed

Ling, Dong-Lan; Yu, Hong-Jing; Guo, Hui-Ling

2017-01-01

Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Treating each family individually to explore the family's beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.

Decision analysis framing study; in-valley drainage management strategies for the western San Joaquin Valley, California

USGS Publications Warehouse

Presser, Theresa S.; Jenni, Karen E.; Nieman, Timothy; Coleman, James

2010-01-01

Constraints on drainage management in the western San Joaquin Valley and implications of proposed approaches to management were recently evaluated by the U.S. Geological Survey (USGS). The USGS found that a significant amount of data for relevant technical issues was available and that a structured, analytical decision support tool could help optimize combinations of specific in-valley drainage management strategies, address uncertainties, and document underlying data analysis for future use. To follow-up on USGS's technical analysis and to help define a scientific basis for decisionmaking in implementing in-valley drainage management strategies, this report describes the first step (that is, a framing study) in a Decision Analysis process. In general, a Decision Analysis process includes four steps: (1) problem framing to establish the scope of the decision problem(s) and a set of fundamental objectives to evaluate potential solutions, (2) generation of strategies to address identified decision problem(s), (3) identification of uncertainties and their relationships, and (4) construction of a decision support model. Participation in such a systematic approach can help to promote consensus and to build a record of qualified supporting data for planning and implementation. In December 2008, a Decision Analysis framing study was initiated with a series of meetings designed to obtain preliminary input from key stakeholder groups on the scope of decisions relevant to drainage management that were of interest to them, and on the fundamental objectives each group considered relevant to those decisions. Two key findings of this framing study are: (1) participating stakeholders have many drainage management objectives in common; and (2) understanding the links between drainage management and water management is necessary both for sound science-based decisionmaking and for resolving stakeholder differences about the value of proposed drainage management solutions. Citing ongoing legal processes associated with drainage management in the western San Joaquin Valley, the U.S. Bureau of Reclamation (USBR) withdrew from the Decision Analysis process early in the proceedings. Without the involvement of the USBR, the USGS discontinued further development of this study.

[The health care system requires individuals to take more personal responsibility].

PubMed

Schaefer, Corinna; Weißbach, Lothar

2012-01-01

In the health care context, the phrase "personal responsibility" is frequently used as a euphemism for restricting publicly funded health care services. The concept of responsibility, however, primarily comprises the individual's own autonomous choices in consideration of their possible implications. In order to be able to act responsibly in respect to health care issues, the individual must rely on objective information about the possible consequences of his or her decision. The current profit-oriented competitive medical care environment prevents the distribution of objective information. A mutually supportive community benefits from its members acting responsibly, since citizens are capable of supporting themselves before they avail themselves of community support. This requires the State to respect the individual and his or her autonomous decision-making. If the community established rules as to what is considered a healthy lifestyle or even required people to adopt one, it would, to a large part, take away the citizens' autonomy and thus prevent them to assume responsibility. Copyright © 2012. Published by Elsevier GmbH.

Artificial intelligent decision support for low-cost launch vehicle integrated mission operations

NASA Astrophysics Data System (ADS)

Szatkowski, Gerard P.; Schultz, Roger

1988-11-01

The feasibility, benefits, and risks associated with Artificial Intelligence (AI) Expert Systems applied to low cost space expendable launch vehicle systems are reviewed. This study is in support of the joint USAF/NASA effort to define the next generation of a heavy-lift Advanced Launch System (ALS) which will provide economical and routine access to space. The significant technical goals of the ALS program include: a 10 fold reduction in cost per pound to orbit, launch processing in under 3 weeks, and higher reliability and safety standards than current expendables. Knowledge-based system techniques are being explored for the purpose of automating decision support processes in onboard and ground systems for pre-launch checkout and in-flight operations. Issues such as: satisfying real-time requirements, providing safety validation, hardware and Data Base Management System (DBMS) interfacing, system synergistic effects, human interfaces, and ease of maintainability, have an effect on the viability of expert systems as a useful tool.

Artificial intelligent decision support for low-cost launch vehicle integrated mission operations

NASA Technical Reports Server (NTRS)

Szatkowski, Gerard P.; Schultz, Roger

1988-01-01

The feasibility, benefits, and risks associated with Artificial Intelligence (AI) Expert Systems applied to low cost space expendable launch vehicle systems are reviewed. This study is in support of the joint USAF/NASA effort to define the next generation of a heavy-lift Advanced Launch System (ALS) which will provide economical and routine access to space. The significant technical goals of the ALS program include: a 10 fold reduction in cost per pound to orbit, launch processing in under 3 weeks, and higher reliability and safety standards than current expendables. Knowledge-based system techniques are being explored for the purpose of automating decision support processes in onboard and ground systems for pre-launch checkout and in-flight operations. Issues such as: satisfying real-time requirements, providing safety validation, hardware and Data Base Management System (DBMS) interfacing, system synergistic effects, human interfaces, and ease of maintainability, have an effect on the viability of expert systems as a useful tool.

Are insurance companies liable under the Americans with Disabilities Act?

PubMed

Manning, J S

2000-03-01

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

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.

How Students' Values Are Intertwined with Decisions in a Socio-Scientific Issue

ERIC Educational Resources Information Center

Paraskeva-Hadjichambi, Demetra; Hadjichambis, Andreas Ch.; Korfiatis, Konstantinos

2015-01-01

The present study incorporated a scaffolding decision making procedure on an authentic environmental socio-scientific issue and investigated how students' decisions are intertwined with their values. Computer-based activities provided necessary information and allowed for the consideration of multiple aspects of the issue, the study of the effects…

Human factors in spacecraft design

NASA Technical Reports Server (NTRS)

Harrison, Albert A.; Connors, Mary M.

1990-01-01

This paper describes some of the salient implications of evolving mission parameters for spacecraft design. Among the requirements for future spacecraft are new, higher standards of living, increased support of human productivity, and greater accommodation of physical and cultural variability. Design issues include volumetric allowances, architecture and layouts, closed life support systems, health maintenance systems, recreational facilities, automation, privacy, and decor. An understanding of behavioral responses to design elements is a precondition for critical design decisions. Human factors research results must be taken into account early in the course of the design process.

[Nurses' support in smoking cessation therapy in Japan].

PubMed

Taniguchi, Chie

2013-03-01

Smoking cessation therapy (SCT) was introduced in 2006 in Japan. The patients who wish to stop smoking and receive SCT routinely undergo counseling and advice provided by trained nurse. This paper introduces rationale, methods and contents of the nurses counseling and advice by differentiating physicians' roles in the SCT. We show these supports performed at Nagoya Medical Center, which is one of the famous hospital for the SCT in Japan. Three key issues for the nurses' approach: encouragement of self-decision, promoting self-efficacy and yielding positive thinking are discussed in this paper.

Ethical aspects of care in the newborn surgical patient.

PubMed

Hazebroek, Frans W J; Tibboel, Dick; Wijnen, Rene M H

2014-10-01

This article places focus on three main subjects that are all related to the ethical aspects of care of newborns undergoing major surgical interventions. The first concerns the communication between the surgeon, as a representative of the treatment team, and the parents. The second is the way to handle new developments in neonatal surgery. The third issue covers several aspects of the ethical decision-making process with regard to forgoing life support in surgical neonates. These issues will be discussed on the basis of two clinical case reports. Copyright © 2014 Elsevier Inc. All rights reserved.

[Woman's participation in the decision process of the pregnancy and puerperal cycle: nursing care integrative review].

PubMed

Busanello, Josefine; Lunardi Filho, Wilson Danilo; Kerber, Nalú Pereira da Costa; Lunardi, Valéria Lerch; dos Santos, Silvana Sidnei

2011-12-01

This is an integrative review that aims to identify the contribution of nursing care for woman's participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Saúde) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right.

Development of a Spanish-Language Hospice Video.

PubMed

Chung, Kyusuk; Augustin, Frankline; Esparza, Salvador

2017-09-01

The nation faces a persistent issue of delayed access to hospice care. Even though hospice enrollment is considered to be one of the most difficult medical decisions, physician clinics and hospitals lack tools for helping patients/families faced with making decisions about enrollment. Health-care literature lacks discussion of development of decision-making aids in the context of hospice decisions for minority ethnic groups, even though those groups have decisional needs that may differ from those of non-Hispanic whites. To fill the gap, we developed a video of a Latino hospice patient with footages showing how the patient was being taken care of by her family with support from a hospice disciplinary team. A primary objective of this article is to describe how focus groups, existing decision aids, and individual interviews were used to develop and improve a Spanish-language hospice educational video targeting Latino subgroups with linguistic, cultural, and educational barriers. These steps may provide guidelines for developing and revising health-related videos targeting other minority ethnic groups.

Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support.

PubMed

Kennedy, Tara J T; Regehr, Glenn; Baker, G Ross; Lingard, Lorelei

2009-02-09

To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor. Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods. Three teaching hospitals in an urban setting in Canada. 124 members of teaching teams on general internal medicine wards and in the emergency department, comprising 31 attending physicians, 57 junior and senior residents, 28 medical students, and eight nurses. Purposeful sampling to saturation was conducted. Trainees' decisions about whether or not to seek clinical support were influenced by three issues: the clinical question (clinical importance, scope of practice), supervisor factors (availability, approachability), and trainee factors (skill, desire for independence, evaluation). Trainees perceived that requesting frequent/inappropriate support threatened their credibility and used rhetorical strategies to preserve credibility. These strategies included building a case for the importance of requests, saving requests for opportune moments, making a plan before requesting support, and targeting requests to specific team members. Trainees consider not only clinical implications but also professional credibility when requesting support from clinical supervisors. Exposing the complexity of this process provides the opportunity to make changes to training programmes to promote timely supervision and provides a framework for further exploration of the impact of clinical training on quality of care of patients.

[Suspension of Respiratory Support in Patients with Amyotrophic Lateral Sclerosis].

PubMed

Silberberg, Agustín A; Robetto, Josefina; Achával, Mora

2018-01-01

Decision making in advanced Amyotrophic Lateral Sclerosis (ALS) patients keeps on being a controversial issue. The aim of this work is to discuss ethical implications of withdrawing respiratory support treatment in patients with ALS. Through a bibliographic search on Pubmed database (2010-2016) we investigated whether or not the use of Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV) would increase survival and quality of life. We included 38 review articles. From these papers, results and ethical implications of initiating and mainly withdrawing respiratory support were analyzed. Survival time increased with NIV and with MV. Quality of life, above all according to physiological criteria, improved with NIV but regarding MV it remained controversial. Implementation and future withdrawal of MV seemed open to medical and ethical discussion. From a perspective of the intrinsic dignity of every human being, whatever its quality of life was, and knowing that no effective therapies for the underlying disease are available, the decision to remove MV in a patient with advanced ALS requires: knowledge of the will of the patient and, above all, evaluating whether this respiratory support measure is becoming objectively disproportionate.

The National Aeronautics and Space Administration's Earth Science Applications Program: Exploring Partnerships to Enhance Decision Making in Public Health Practice

NASA Technical Reports Server (NTRS)

Vann, Timi S.; Venezia, Robert A.

2002-01-01

The National Aeronautics and Space Administration (NASA), Earth Science Enterprise is engaged in applications of NASA Earth science and remote sensing technologies for public health. Efforts are focused on establishing partnerships with those agencies and organizations that have responsibility for protecting the Nation's Health. The program's goal is the integration of NASA's advanced data and technology for enhanced decision support in the areas of disease surveillance and environmental health. A focused applications program, based on understanding partner issues and requirements, has the potential to significantly contribute to more informed decision making in public health practice. This paper intends to provide background information on NASA's investment in public health and is a call for partnership with the larger practice community.

Methodological individualism in experimental games: not so easily dismissed.

PubMed

Krueger, Joachim I

2008-06-01

Orthodox game theory and social preference models cannot explain why people cooperate in many experimental games or how they manage to coordinate their choices. The theory of evidential decision making provides a solution, based on the idea that people tend to project their own choices onto others, whatever these choices might be. Evidential decision making preserves methodological individualism, and it works without recourse to social preferences. Rejecting methodological individualism, team reasoning is a thinly disguised resurgence of the group mind fallacy, and the experiments reported by Colman et al. [Colman, A. M., Pulford, B. D., & Rose, J. (this issue). Collective rationality in interactive decisions: Evidence for team reasoning. Acta Psychologica, doi:10.1016/j.actpsy.2007.08.003.] do not offer evidence that uniquely supports team reasoning.

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

PubMed

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

2017-12-01

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

Risk communication, geoethics and decision science issues in Japan's disaster management system

NASA Astrophysics Data System (ADS)

Sugimoto, M.

2014-12-01

Issues in Japan's disaster management system were revealed by the 2011 Tohoku earthquake and tsunami, and by the Fukushima Dai-ichi nuclear power station accident. Many important decisions were based on scientific data, but appear not to have sufficiently considered the uncertainties of the data and the societal aspects of the problems. The issues that arose show the need for scientists to appropriately deal with risk communication and geoethics and issues. This paper discusses necessity of　education for risk communication, geoethics and decisions science in school before students become sicentific decision makers in future.

Pharmacogenomic knowledge representation, reasoning and genome-based clinical decision support based on OWL 2 DL ontologies.

PubMed

Samwald, Matthias; Miñarro Giménez, Jose Antonio; Boyce, Richard D; Freimuth, Robert R; Adlassnig, Klaus-Peter; Dumontier, Michel

2015-02-22

Every year, hundreds of thousands of patients experience treatment failure or adverse drug reactions (ADRs), many of which could be prevented by pharmacogenomic testing. However, the primary knowledge needed for clinical pharmacogenomics is currently dispersed over disparate data structures and captured in unstructured or semi-structured formalizations. This is a source of potential ambiguity and complexity, making it difficult to create reliable information technology systems for enabling clinical pharmacogenomics. We developed Web Ontology Language (OWL) ontologies and automated reasoning methodologies to meet the following goals: 1) provide a simple and concise formalism for representing pharmacogenomic knowledge, 2) finde errors and insufficient definitions in pharmacogenomic knowledge bases, 3) automatically assign alleles and phenotypes to patients, 4) match patients to clinically appropriate pharmacogenomic guidelines and clinical decision support messages and 5) facilitate the detection of inconsistencies and overlaps between pharmacogenomic treatment guidelines from different sources. We evaluated different reasoning systems and test our approach with a large collection of publicly available genetic profiles. Our methodology proved to be a novel and useful choice for representing, analyzing and using pharmacogenomic data. The Genomic Clinical Decision Support (Genomic CDS) ontology represents 336 SNPs with 707 variants; 665 haplotypes related to 43 genes; 22 rules related to drug-response phenotypes; and 308 clinical decision support rules. OWL reasoning identified CDS rules with overlapping target populations but differing treatment recommendations. Only a modest number of clinical decision support rules were triggered for a collection of 943 public genetic profiles. We found significant performance differences across available OWL reasoners. The ontology-based framework we developed can be used to represent, organize and reason over the growing wealth of pharmacogenomic knowledge, as well as to identify errors, inconsistencies and insufficient definitions in source data sets or individual patient data. Our study highlights both advantages and potential practical issues with such an ontology-based approach.

A National Crop Progress Monitoring and Decision Support System Based on NASA Earth Science Results

NASA Astrophysics Data System (ADS)

di, L.; Yang, Z.

2009-12-01

Timely and accurate information on weekly crop progress and development is essential to a dynamic agricultural industry in the U. S. and the world. By law, the National Agricultural Statistics Service (NASS) of the U. S. Department of Agriculture’s (USDA) is responsible for monitoring and assessing U.S. agricultural production. Currently NASS compiles and issues weekly state and national crop progress and development reports based on reports from knowledgeable state and county agricultural officials and farmers. Such survey-based reports are subjectively estimated for an entire county, lack spatial coverage, and are labor intensive. There has been limited use of remote sensing data to assess crop conditions. NASS produces weekly 1-km resolution un-calibrated AVHRR-based NDVI static images to represent national vegetation conditions but there is no quantitative crop progress information. This presentation discusses the early result for developing a National Crop Progress Monitoring and Decision Support System. The system will overcome the shortcomings of the existing systems by integrating NASA satellite and model-based land surface and weather products, NASS’ wealth of internal crop progress and condition data and Cropland Data Layers (CDL), and the Farm Service Agency’s (FSA) Common Land Units (CLU). The system, using service-oriented architecture and web service technologies, will automatically produce and disseminate quantitative national crop progress maps and associated decision support data at 250-m resolution, as well as summary reports to support NASS and worldwide users in their decision-making. It will provide overall and specific crop progress for individual crops from the state level down to CLU field level to meet different users’ needs on all known croplands. This will greatly enhance the effectiveness and accuracy of the NASS aggregated crop condition data and charts of and provides objective and scientific evidence and guidance for the adjustment of NASS survey data. This presentation will discuss the architecture, Earth observation data, and the crop progress model used in the decision support system.

Evidence and Options for Informed Decision-Making to Achive Arctic Sustainability

NASA Astrophysics Data System (ADS)

Berkman, P. A.

2017-12-01

This presentation will consider the development of evidence and options for informed decision-making that will need to operate across generations to achieve Arctic sustainability (Figure). Context of these Arctic decisions is global, recognizing that we live in an interconnected civilization on a planetary scale, as revealed unambiguously with evidence from the `world' wars in the first half of the 20thcentury. First, for clarification, data and evidence are not the same. Data is generated from information and observations to answer specific questions, posed with methods from the natural and social sciences as well as indigenous knowledge. These data reveal patterns and trends in our societies and natural world, underscoring the evidence for decisions to address impacts, issues and resources within, across and beyond the boundaries of nations - recognizing that nations still are the principal jurisdictional unit. However, for this decision-support process to be effective, options (without advocacy) - which can be used or ignored explicitly - must be generated from the evidence, taking into consideration stakeholder perspectives and governance records in a manner that will contribute to informed decision-making. The resulting decisions will involve built elements that require capitalization and technology as well as governance mechanisms coming from diverse jurisdictional authorities. The innovation required is to balance economic prosperity, environmental protection and societal well-being. These three pillars of sustainability further involve stability, balancing urgencies of the moment and of future generations, recognizing that children born today will be alive in the 22nd century. Consequently, options for informed decisions must operate across a continuum of urgencies from security time scales to sustainability time scales. This decision-support process is holistic (international, interdisciplinary and inclusive), reflecting the applications of science diplomacy to balance national interests and common interests for the benefit of all on Earth.

Treatment decision-making processes in the systemic treatment of ovarian cancer: review of the scientific evidence.

PubMed

Luketina, Hrvoje; Fotopoulou, Christina; Luketina, Ruzica-Rosalia; Pilger, Adak; Sehouli, Jalid

2012-09-01

The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer. The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC. The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician's personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organisations also seem to play a significant role in the treatment decision-making process. This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.

“Do your homework…and then hope for the best”: the challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making

PubMed Central

2013-01-01

Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Conclusions Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad. PMID:24053385

"Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

PubMed

Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik

2013-09-22

Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism. Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad.

Modeling forest planning trade-offs on the Colorado Front Range using MAGIS, an optimization, spatial decision support system

Treesearch

Edward B. Butler

2005-01-01

The fires of 2000 and 2002 catalyzed a national mandate for fuel treatment programs to facilitate wildfire mitigation, yet the issues that need to be considered when planning large landscape projects are daunting, often ending in gridlock due to planning conflicts. Hazardous fuels maps help little when planning for integrated, system-wide ecological objectives and fail...

JPRS Report Environmental Issues

DTIC Science & Technology

1990-11-21

Janeiro O GLOBO 4 NovJ 8 Malaysian Commentary Scores EC Plan To Ban Tropical Hardwood Imports [Kuala Lumpur International 6 Nov] 8 Danish Support...Sought in Defending Malaysian Timber Policies [Kuala Lumpur International 7 NovJ 9 German-Indian Arabian Sea Atmospheric Project Findings Announced...an appeal against Judge Wanderley’s decision, thereby allowing the U.S. submarine to remain in Brazilian waters. Malaysian Commentary Scores EC Plan

Acceptance and barriers pertaining to a general practice decision support system for multiple clinical conditions: A mixed methods evaluation.

PubMed

Arts, Derk L; Medlock, Stephanie K; van Weert, Henk C P M; Wyatt, Jeremy C; Abu-Hanna, Ameen

2018-01-01

Many studies have investigated the use of clinical decision support systems as a means to improve care, but have thus far failed to show significant effects on patient-related outcomes. We developed a clinical decision support system that attempted to address issues that were identified in these studies. The system was implemented in Dutch general practice and was designed to be both unobtrusive and to respond in real time. Despite our efforts, usage of the system was low. In the current study we perform a mixed methods evaluation to identify remediable barriers which led to disappointing usage rates for our system. A mixed methods evaluation employing an online questionnaire and focus group. The focus group was organized to clarify free text comments and receive more detailed feedback from general practitioners. Topics consisted of items based on results from the survey and additional open questions. The response rate for the questionnaire was 94%. Results from the questionnaire and focus group can be summarized as follows: The system was perceived as interruptive, despite its design. Participants felt that there were too many recommendations and that the relevance of the recommendations varied. Demographic based recommendations (e.g. age) were often irrelevant, while specific risk-based recommendations (e.g. diagnosis) were more relevant. The other main barrier to use was lack of time during the patient visit. These results are likely to be useful to other researchers who are attempting to address the problems of interruption and alert fatigue in decision support.

The neural processing of moral sensitivity to issues of justice and care.

PubMed

Robertson, Diana; Snarey, John; Ousley, Opal; Harenski, Keith; DuBois Bowman, F; Gilkey, Rick; Kilts, Clinton

2007-03-02

The empirical and theoretical consideration of ethical decision making has focused on the process of moral judgment; however, a precondition to judgment is moral sensitivity, the ability to detect and evaluate moral issues [Rest, J. R. (1984). The major components of morality. In W. Kurtines & J. Gewirtz (Eds.), Morality, moral behaviour, and moral development (pp. 24-38). New York, NY: Wiley]. Using functional magnetic resonance imaging (fMRI) and contextually standardized, real life moral issues, we demonstrate that sensitivity to moral issues is associated with activation of the polar medial prefrontal cortex, dorsal posterior cingulate cortex, and posterior superior temporal sulcus (STS). These activations suggest that moral sensitivity is related to access to knowledge unique to one's self, supported by autobiographical memory retrieval and social perspective taking. We also assessed whether sensitivity to rule-based or "justice" moral issues versus social situational or "care" moral issues is associated with dissociable neural processing events. Sensitivity to justice issues was associated with greater activation of the left intraparietal sulcus, whereas sensitivity to care issues was associated with greater activation of the ventral posterior cingulate cortex, ventromedial and dorsolateral prefrontal cortex, and thalamus. These results suggest a role for access to self histories and identities and social perspectives in sensitivity to moral issues, provide neural representations of the subcomponent process of moral sensitivity originally proposed by Rest, and support differing neural information processing for the interpretive recognition of justice and care moral issues.

10 CFR 780.34 - Criteria for decision to issue a license.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Criteria for decision to issue a license. 780.34 Section 780.34 Energy DEPARTMENT OF ENERGY PATENT COMPENSATION BOARD REGULATIONS Application for a License Pursuant to Section 153b(2) of the Atomic Energy Act of 1954 § 780.34 Criteria for decision to issue a...

10 CFR 780.34 - Criteria for decision to issue a license.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Criteria for decision to issue a license. 780.34 Section 780.34 Energy DEPARTMENT OF ENERGY PATENT COMPENSATION BOARD REGULATIONS Application for a License Pursuant to Section 153b(2) of the Atomic Energy Act of 1954 § 780.34 Criteria for decision to issue a...

10 CFR 780.34 - Criteria for decision to issue a license.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Criteria for decision to issue a license. 780.34 Section 780.34 Energy DEPARTMENT OF ENERGY PATENT COMPENSATION BOARD REGULATIONS Application for a License Pursuant to Section 153b(2) of the Atomic Energy Act of 1954 § 780.34 Criteria for decision to issue a...

10 CFR 780.34 - Criteria for decision to issue a license.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Criteria for decision to issue a license. 780.34 Section 780.34 Energy DEPARTMENT OF ENERGY PATENT COMPENSATION BOARD REGULATIONS Application for a License Pursuant to Section 153b(2) of the Atomic Energy Act of 1954 § 780.34 Criteria for decision to issue a...

10 CFR 780.34 - Criteria for decision to issue a license.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Criteria for decision to issue a license. 780.34 Section 780.34 Energy DEPARTMENT OF ENERGY PATENT COMPENSATION BOARD REGULATIONS Application for a License Pursuant to Section 153b(2) of the Atomic Energy Act of 1954 § 780.34 Criteria for decision to issue a...

Students' Reasoning Processes in Making Decisions about an Authentic, Local Socio-Scientific Issue: Bat Conservation

ERIC Educational Resources Information Center

Lee, Yeung Chung; Grace, Marcus

2010-01-01

Education for scientific literacy entails the development of scientific knowledge and the ability to apply this knowledge and value judgments to decisions about real-life issues. This paper reports an attempt to involve secondary level biology students in making decisions about an authentic socio-scientific issue--that of bat conservation--through…

EPA Growing DASEES (Decision Analysis For A Sustainable Environment, Economy & Society) - To Aid In Making Decisions On Complex Environmental Issues

EPA Science Inventory

Having a framework and tools to help sort through complicated environmental issues in an objective way would be useful to communities and risk managers, and all the stakeholders affected by these issues. This is one need that DASEES (Decision Analysis for a Sustainable En...

Computerization of guidelines: a knowledge specification method to convert text to detailed decision tree for electronic implementation.

PubMed

Aguirre-Junco, Angel-Ricardo; Colombet, Isabelle; Zunino, Sylvain; Jaulent, Marie-Christine; Leneveut, Laurence; Chatellier, Gilles

2004-01-01

The initial step for the computerization of guidelines is the knowledge specification from the prose text of guidelines. We describe a method of knowledge specification based on a structured and systematic analysis of text allowing detailed specification of a decision tree. We use decision tables to validate the decision algorithm and decision trees to specify and represent this algorithm, along with elementary messages of recommendation. Edition tools are also necessary to facilitate the process of validation and workflow between expert physicians who will validate the specified knowledge and computer scientist who will encode the specified knowledge in a guide-line model. Applied to eleven different guidelines issued by an official agency, the method allows a quick and valid computerization and integration in a larger decision support system called EsPeR (Personalized Estimate of Risks). The quality of the text guidelines is however still to be developed further. The method used for computerization could help to define a framework usable at the initial step of guideline development in order to produce guidelines ready for electronic implementation.

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.

Decision-making process related to treatment and management in Korean women with breast cancer: Finding the right individualized healthcare trajectory.

PubMed

Kim, Kkotbong; Yang, Jinhyang

2017-06-01

After being diagnosed with breast cancer, women must make a number of decisions about their treatment and management. When the decision-making process among breast cancer patients is ineffective, it results in harm to their health. Little is known about the decision-making process of breast cancer patients during the entire course of treatment and management. We investigated women with breast cancer to explore the decision-making processes related to treatment and management. Eleven women participated, all of whom were receiving treatment or management in Korea. The average participant age was 43.5years. For data collection and analysis, a grounded theory methodology was used. Through constant comparative analyses, a core category emerged that we referred to as "finding the right individualized healthcare trajectory." The decision-making process occurred in four phases: turmoil, exploration, balance, and control. The turmoil phase included weighing the credibility of information and lowering the anxiety level. The exploration phase included assessing the expertise/promptness of medical treatment and evaluating the effectiveness of follow-up management. The balance phase included performing analyses from multiple angles and rediscovering value as a human being. The control phase included constructing an individualized management system and following prescribed and other management options. It is important to provide patients with accurate information related to the treatment and management of breast cancer so that they can make effective decisions. Healthcare providers should engage with patients on issues related to their disease, understand the burden placed on patients because of issues related to their sex, and ensure that the patient has a sufficient support system. The results of this study can be used to develop phase-specific, patient-centered, and tailored interventions for breast cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing an Environmental Decision Support System for Stream Management: the STREAMES Experience

NASA Astrophysics Data System (ADS)

Riera, J.; Argerich, A.; Comas, J.; Llorens, E.; Martí, E.; Godé, L.; Pargament, D.; Puig, M.; Sabater, F.

2005-05-01

Transferring research knowledge to stream managers is crucial for scientifically sound management. Environmental decision support systems are advocated as an effective means to accomplish this. STREAMES (STream REAach Management: an Expert System) is a decision tree based EDSS prototype developed within the context of an European project as a tool to assist water managers in the diagnosis of problems, detection of causes, and selection of management strategies for coping with stream degradation issues related mostly to excess nutrient availability. STREAMES was developed by a team of scientists, water managers, and experts in knowledge engineering. Although the tool focuses on management at the stream reach scale, it also incorporates a mass-balance catchment nutrient emission model and a simple GIS module. We will briefly present the prototype and share our experience in its development. Emphasis will be placed on the process of knowledge acquisition, the design process, the pitfalls and benefits of the communication between scientists and managers, and the potential for future development of STREAMES, particularly in the context of the EU Water Framework Directive.

Lessons for health care rationing from the case of child B.

PubMed

Price, D

1996-01-20

More details have emerged about the child B leukaemia case with the publication of the All England Law Report on the Appeal Court decision. At the time the view was widely held that the controversy might have been avoided if the responsible health authority had consulted the public. The law report reveals, however, that the courts adopted a moral language widely at variance with that of the patient's doctor. The courts were concerned to support a utilitarian decision procedure based on calculations of the greatest overall good; the doctor was concerned with the best interests of a sick child. The doctor-patient relationship may be damaged when public consideration transforms the issue in this way. Also, the Appeal Court supported a decision which claimed to have "weighed" opposing evaluations, but it excused the health authority from describing how that weighing took place. One of the main criticisms of the utilitarian approach, however, is that weighing of this type is extremely difficult to justify. By its ruling the court has made legal challenge on the grounds of inadequate consultation virtually impossible to substantiate.

Lessons for health care rationing from the case of child B.

PubMed Central

Price, D.

1996-01-01

More details have emerged about the child B leukaemia case with the publication of the All England Law Report on the Appeal Court decision. At the time the view was widely held that the controversy might have been avoided if the responsible health authority had consulted the public. The law report reveals, however, that the courts adopted a moral language widely at variance with that of the patient's doctor. The courts were concerned to support a utilitarian decision procedure based on calculations of the greatest overall good; the doctor was concerned with the best interests of a sick child. The doctor-patient relationship may be damaged when public consideration transforms the issue in this way. Also, the Appeal Court supported a decision which claimed to have "weighed" opposing evaluations, but it excused the health authority from describing how that weighing took place. One of the main criticisms of the utilitarian approach, however, is that weighing of this type is extremely difficult to justify. By its ruling the court has made legal challenge on the grounds of inadequate consultation virtually impossible to substantiate. Images p168-a PMID:8563539

A spatial decision support system (SDSS) for sustainable tourism planning in Cameron Highlands, Malaysia

NASA Astrophysics Data System (ADS)

Aminu, M.; Matori, A. N.; Yusof, K. W.

2014-02-01

The study describes a methodological approach based on an integrated use of Geographic Information System (GIS) and Analytic Network Process (ANP) of Multi Criteria Evaluation (MCE) to determine nature conservation and tourism development priorities among the highland areas. A set of criteria and indicators were defined to evaluate the highlands biodiversity conservation and tourism development. Pair wise comparison technique was used in order to support solution of a decision problem by evaluating possible alternatives from different perspectives. After the weights have been derived from the pairwise comparison technique, the next step was to compute the unweighted supermatrix, weighted supermatrix and the limit matrix. The limit matrix was normalized to obtain the priorities and the results transferred into GIS environment. Elements evaluated and ranked were represented by criterion maps. Map layers reflecting the opinion of different experts involved were summed using the weighted overlay approach of GIS. Subsequently sustainable tourism development scenarios were generated. The generation of scenarios highlighted the critical issues of the decision problem because it allows one to gradually narrow down a problem.

30 CFR 44.41 - Summary decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Summary decision. 44.41 Section 44.41 Mineral... REQUIREMENTS RULES OF PRACTICE FOR PETITIONS FOR MODIFICATION OF MANDATORY SAFETY STANDARDS Summary Decisions § 44.41 Summary decision. (a) No genuine issue of material fact. (1) Where no genuine issue of a...

A Possible Approach for Addressing Neglected Human Factors Issues of Systems Engineering

NASA Technical Reports Server (NTRS)

Johnson, Christopher W.; Holloway, C. Michael

2011-01-01

The increasing complexity of safety-critical applications has led to the introduction of decision support tools in the transportation and process industries. Automation has also been introduced to support operator intervention in safety-critical applications. These innovations help reduce overall operator workload, and filter application data to maximize the finite cognitive and perceptual resources of system operators. However, these benefits do not come without a cost. Increased computational support for the end-users of safety-critical applications leads to increased reliance on engineers to monitor and maintain automated systems and decision support tools. This paper argues that by focussing on the end-users of complex applications, previous research has tended to neglect the demands that are being placed on systems engineers. The argument is illustrated through discussing three recent accidents. The paper concludes by presenting a possible strategy for building and using highly automated systems based on increased attention by management and regulators, improvements in competency and training for technical staff, sustained support for engineering team resource management, and the development of incident reporting systems for infrastructure failures. This paper represents preliminary work, about which we seek comments and suggestions.

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

NASA Technical Reports Server (NTRS)

Tavana, Madjid; Lee, Seunghee

1996-01-01

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

Development of a robust space power system decision model

NASA Astrophysics Data System (ADS)

Chew, Gilbert; Pelaccio, Dennis G.; Jacobs, Mark; Stancati, Michael; Cataldo, Robert

2001-02-01

NASA continues to evaluate power systems to support human exploration of the Moon and Mars. The system(s) would address all power needs of surface bases and on-board power for space transfer vehicles. Prior studies have examined both solar and nuclear-based alternatives with respect to individual issues such as sizing or cost. What has not been addressed is a comprehensive look at the risks and benefits of the options that could serve as the analytical framework to support a system choice that best serves the needs of the exploration program. This paper describes the SAIC developed Space Power System Decision Model, which uses a formal Two-step Analytical Hierarchy Process (TAHP) methodology that is used in the decision-making process to clearly distinguish candidate power systems in terms of benefits, safety, and risk. TAHP is a decision making process based on the Analytical Hierarchy Process, which employs a hierarchic approach of structuring decision factors by weights, and relatively ranks system design options on a consistent basis. This decision process also includes a level of data gathering and organization that produces a consistent, well-documented assessment, from which the capability of each power system option to meet top-level goals can be prioritized. The model defined on this effort focuses on the comparative assessment candidate power system options for Mars surface application(s). This paper describes the principles of this approach, the assessment criteria and weighting procedures, and the tools to capture and assess the expert knowledge associated with space power system evaluation. .

Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and case studies.

PubMed

Haby, Michelle M; Chapman, Evelina; Clark, Rachel; Barreto, Jorge; Reveiz, Ludovic; Lavis, John N

2016-08-18

The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program? The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the "shortcuts" that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a "user-pays" model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated. When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be important to engage in other strategies to facilitate the uptake of the rapid reviews and to evaluate the chosen model in order to make refinements and add to the evidence base for evidence-informed decision-making.

Development and use of active clinical decision support for preemptive pharmacogenomics

PubMed Central

Bell, Gillian C; Crews, Kristine R; Wilkinson, Mark R; Haidar, Cyrine E; Hicks, J Kevin; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Cross, Shane J; Howard, Scott C; Freimuth, Robert R; Evans, William E; Broeckel, Ulrich; Relling, Mary V; Hoffman, James M

2014-01-01

Background Active clinical decision support (CDS) delivered through an electronic health record (EHR) facilitates gene-based drug prescribing and other applications of genomics to patient care. Objective We describe the development, implementation, and evaluation of active CDS for multiple pharmacogenetic test results reported preemptively. Materials and methods Clinical pharmacogenetic test results accompanied by clinical interpretations are placed into the patient's EHR, typically before a relevant drug is prescribed. Problem list entries created for high-risk phenotypes provide an unambiguous trigger for delivery of post-test alerts to clinicians when high-risk drugs are prescribed. In addition, pre-test alerts are issued if a very-high risk medication is prescribed (eg, a thiopurine), prior to the appropriate pharmacogenetic test result being entered into the EHR. Our CDS can be readily modified to incorporate new genes or high-risk drugs as they emerge. Results Through November 2012, 35 customized pharmacogenetic rules have been implemented, including rules for TPMT with azathioprine, thioguanine, and mercaptopurine, and for CYP2D6 with codeine, tramadol, amitriptyline, fluoxetine, and paroxetine. Between May 2011 and November 2012, the pre-test alerts were electronically issued 1106 times (76 for thiopurines and 1030 for drugs metabolized by CYP2D6), and the post-test alerts were issued 1552 times (1521 for TPMT and 31 for CYP2D6). Analysis of alert outcomes revealed that the interruptive CDS appropriately guided prescribing in 95% of patients for whom they were issued. Conclusions Our experience illustrates the feasibility of developing computational systems that provide clinicians with actionable alerts for gene-based drug prescribing at the point of care. PMID:23978487

AWIPS II Application Development, a SPoRT Perspective

NASA Technical Reports Server (NTRS)

Burks, Jason E.; Smith, Matthew; McGrath, Kevin M.

2014-01-01

The National Weather Service (NWS) is deploying its next-generation decision support system, called AWIPS II (Advanced Weather Interactive Processing System II). NASA's Short-term Prediction Research and Transition (SPoRT) Center has developed several software 'plug-ins' to extend the capabilities of AWIPS II. SPoRT aims to continue its mission of improving short-term forecasts by providing NASA and NOAA products on the decision support system used at NWS weather forecast offices (WFOs). These products are not included in the standard Satellite Broadcast Network feed provided to WFOs. SPoRT has had success in providing support to WFOs as they have transitioned to AWIPS II. Specific examples of transitioning SPoRT plug-ins to WFOs with newly deployed AWIPS II systems will be presented. Proving Ground activities (GOES-R and JPSS) will dominate SPoRT's future AWIPS II activities, including tool development as well as enhancements to existing products. In early 2012 SPoRT initiated the Experimental Product Development Team, a group of AWIPS II developers from several institutions supporting NWS forecasters with innovative products. The results of the team's spring and fall 2013 meeting will be presented. Since AWIPS II developers now include employees at WFOs, as well as many other institutions related to weather forecasting, the NWS has dealt with a multitude of software governance issues related to the difficulties of multiple remotely collaborating software developers. This presentation will provide additional examples of Research-to-Operations plugins, as well as an update on how governance issues are being handled in the AWIPS II developer community.

Decision-making in adult thalassemia patients undergoing unrelated bone marrow transplantation: quality of life, communication and ethical issues.

PubMed

Caocci, G; Pisu, S; Argiolu, F; Giardini, C; Locatelli, F; Vacca, A; Orofino, M G; Piras, E; De Stefano, P; Addari, M C; Ledda, A; La Nasa, G

2006-01-01

Bone marrow transplantation (BMT) represents a potentially curative treatment of thalassemia. For patients without an HLA-identical sibling donor, recourse to an unrelated donor is a practicable option but the candidates and their families are faced with a difficult decision. They can either choose to continue the supportive therapy, with no chance of definitive cure, or they accept the mortality risk of BMT in the hope of obtaining a definitive resolution of the disease. We investigated the communication strategies and the post transplantation quality of life (QoL) in 19 adult thalassemia patients surviving after an unrelated donor BMT. The patients were given two questionnaires: a questionnaire to evaluate pre-transplantation communication factors and the EORTC QLQ-C30 questionnaire to assess global QoL. All patients were satisfied with the communication modalities employed by the physicians. The global post transplantation QoL in our patient cohort was found to be good. The approach used in this study may offer a contribution to understanding the decision-making process leading to the choice of a treatment with a high mortality risk for a chronic, non-malignant disease. Finally, some ethical issues of this therapeutic approach are briefly addressed.

Optimizing Perioperative Decision Making: Improved Information for Clinical Workflow Planning

PubMed Central

Doebbeling, Bradley N.; Burton, Matthew M.; Wiebke, Eric A.; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

2012-01-01

Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40–70% of hospital revenues and 30–40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

Optimizing perioperative decision making: improved information for clinical workflow planning.

PubMed

Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

2012-01-01

Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Part VIII: Medicolegal considerations and recommendations.

PubMed

1986-06-06

These resuscitation guidelines were developed to "enhance the quality of care while protecting the patient's right to accept or reject therapy and to clarify the physician's role in making decisions to provide, withhold, or withdraw life support." Among the issues covered are the obligation to provide cardiopulmonary resuscitation (CPR), reasons to withhold or withdraw CPR, and the liability risks of CPR providers--laypersons, CPR teachers and organizations, and hospitals. Also discussed are the role of hospital ethics committees and medicolegal considerations in treating minors. The guidelines conclude with recommendations that states enact legislation allowing allied health personnel to render emergency care more effectively outside the hospital, providing "good samaritan" immunity to laypersons administering CPR, requiring basic life support training for police and firefighters, and acknowledging the patient's right to self determination in life-or-death decisions.

Development of a case tool to support decision based software development

NASA Technical Reports Server (NTRS)

Wild, Christian J.

1993-01-01

A summary of the accomplishments of the research over the past year are presented. Achievements include: made demonstrations with DHC, a prototype supporting decision based software development (DBSD) methodology, for Paramax personnel at ODU; met with Paramax personnel to discuss DBSD issues, the process of integrating DBSD and Refinery and the porting process model; completed and submitted a paper describing DBSD paradigm to IFIP '92; completed and presented a paper describing the approach for software reuse at the Software Reuse Workshop in April 1993; continued to extend DHC with a project agenda, facility necessary for a better project management; completed a primary draft of the re-engineering process model for porting; created a logging form to trace all the activities involved in the process of solving the reengineering problem, and developed a primary chart with the problems involved by the reengineering process.

Use of a computerized decision support system for primary and secondary prevention of work-related MSD disability.

PubMed

Womack, Sarah K; Armstrong, Thomas J

2005-09-01

The present study evaluates the effectiveness of a decision support system used to evaluate and control physical job stresses and prevent re-injury of workers who have experienced or are concerned about work-related musculoskeletal disorders. The software program is a database that stores detailed job information such as standardized work data, videos, and upper-extremity physical stress ratings for over 400 jobs in the plant. Additionally, the database users were able to record comments about the jobs and related control issues. The researchers investigated the utility and effectiveness of the software by analyzing its use over a 20-month period. Of the 197 comments entered by the users, 25% pertained to primary prevention, 75% pertained to secondary prevention, and 94 comments (47.7%) described ergonomic interventions. Use of the software tool improved primary and secondary prevention by improving the quality and efficiency of the ergonomic job analysis process.

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

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

PubMed

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

2013-07-01

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

Adults' decision-making about the electronic waste issue: The role of the nature of science conceptualizations and moral concerns in socio-scientific decision-making

NASA Astrophysics Data System (ADS)

Yu, Yuqing

Socio-scientific issues have become increasingly important in Science-Technology-Society (STS) education as a means to make science learning more relevant to students' lives. This study used the e-waste issue as a context to investigate two aspects of socio-scientific decision-making: (1) the relationship between the nature of science (NOS) conceptualizations and decision-making; and (2) moral concerns involved in the process of decision-making. This study contributes to the field of socio-scientific issue research and STS education in the following ways. First, it is the first study that performed meta-analysis to seek the relationship between the NOS understanding and decision-making. This study concludes that valuable NOS conceptualizations that are highly related to the socio-scientific issue under investigation, rather than general NOS understanding, exert statistically significant influences on decision-making. Second, this study empirically examined the Multiple Responses Model (MRM), which enables the transfer of qualitative NOS responses into quantitative data, and hence, inferential statistics. The current study justifies the significance of unidimensionality to the application of the MRM. It addresses the limitations associated with the MRM and provides implications for future use of the MRM in other contexts. Finally, the study explores the role of moral concerns in socio-scientific decision-making. Eight participants engaged in interviews that were designed to elicit their reactions and feelings regarding the issue of exporting e-waste to poor countries. Qualitative analyses demonstrated that moral considerations were significant influences on decision-making. In addition, participants' action responses revealed that they were motivated to take action to help the environment. The study has implications for socio-scientific issue studies in other contexts and for teacher education programs that use socio-scientific issues to advance teachers' reasoning and discourse skills.

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

From open source communications to knowledge

NASA Astrophysics Data System (ADS)

Preece, Alun; Roberts, Colin; Rogers, David; Webberley, Will; Innes, Martin; Braines, Dave

2016-05-01

Rapid processing and exploitation of open source information, including social media sources, in order to shorten decision-making cycles, has emerged as an important issue in intelligence analysis in recent years. Through a series of case studies and natural experiments, focussed primarily upon policing and counter-terrorism scenarios, we have developed an approach to information foraging and framing to inform decision making, drawing upon open source intelligence, in particular Twitter, due to its real-time focus and frequent use as a carrier for links to other media. Our work uses a combination of natural language (NL) and controlled natural language (CNL) processing to support information collection from human sensors, linking and schematising of collected information, and the framing of situational pictures. We illustrate the approach through a series of vignettes, highlighting (1) how relatively lightweight and reusable knowledge models (schemas) can rapidly be developed to add context to collected social media data, (2) how information from open sources can be combined with reports from trusted observers, for corroboration or to identify con icting information; and (3) how the approach supports users operating at or near the tactical edge, to rapidly task information collection and inform decision-making. The approach is supported by bespoke software tools for social media analytics and knowledge management.

Lenses for Framing Decisions: Undergraduates' Decision Making about Stem Cell Research

ERIC Educational Resources Information Center

Halverson, Kristy Lynn; Siegel, Marcelle A.; Freyermuth, Sharyn K.

2009-01-01

Decision making is influenced by multiple factors, especially when approaching controversial socio-scientific issues, such as stem cell research. In the present study, we used qualitative data from 132 college student papers in a biotechnology course to investigate how students made decisions about stem cell research issues. Students indicated…

Making ResourceFULL™ Decisions: A Process Model for Civic Engagement

ERIC Educational Resources Information Center

Radke, Barbara; Chazdon, Scott

2015-01-01

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

Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid

PubMed Central

Hersch, Jolyn; Jansen, Jesse; Barratt, Alexandra; Irwig, Les; Houssami, Nehmat; Jacklyn, Gemma; Thornton, Hazel; Dhillon, Haryana; McCaffery, Kirsten

2014-01-01

Objective To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening. Design Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34). Setting New South Wales, Australia. Participants Women aged 43–59 years with no personal history of breast cancer. Interventions The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content. Outcomes Comprehension of key decision aid content and acceptability of the materials. Results Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people's expectations, but women appreciated the opportunity to become better informed. Conclusions The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening. PMID:25256188

The Organizational Decision Making Climate of Issues Management Programs: A Case Study.

ERIC Educational Resources Information Center

Wills, Sandra

A study examined the decision making climate of organizations that are using issues management and what type of model of issues management is followed--theorists have been attempting to define issues management since it began appearing 20 year ago. Subjects, 112 males and 30 females who were professionals working in the area of issues management…

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

NONE

1998-04-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in DOE's Accelerating Cleanup: Paths to Closure strategy and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the quarter from December 31, 1997 through April 30, 1998 under the NGA project. The work accomplished by the NGA project team during the past four months can be categorized as follows: maintained open communication with DOE on a variety of activities and issues within the DOE environmental management complex; and provided ongoing support to state-DOE interactions in preparation for the March 30-31, 1998 NGA Federal Facilities Compliance Task Force Meeting with DOE. maintained communication with NGA Federal Facilities Compliance Task Force members regarding DOE efforts to formulate a configuration for mixed low-level waste and low-level treatment and disposal, DOE's Environmental Management Budget, and DOE's proposed Intersite Discussions.« less

THE NGA-DOE GRANT TO EXAMINE CRITICAL ISSUES RELATED TO RADIOACTIVE WASTE AND MATERIALS DISPOSITION INVOLVING DOE FACILITIES

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

NONE

1998-07-01

Through the National Governors' Association (NGA) project ''Critical Issues Related to Radioactive Waste and Materials Disposition Involving DOE Facilities'' NGA brings together Governors' policy advisors, state regulators, and DOE officials to examine critical issues related to the cleanup and operation of DOE nuclear weapons and research facilities. Topics explored through this project include: Decisions involving disposal of mixed, low-level, and transuranic (TRU) waste and disposition of nuclear materials. Decisions involving DOE budget requests and their effect on environmental cleanup and compliance at DOE facilities. Strategies to treat mixed, low-level, and transuranic (TRU) waste and their effect on individual sites inmore » the complex. Changes to the FFCA site treatment plans as a result of proposals in DOE's Accelerating Cleanup: Paths to Closure strategy and contractor integration analysis. Interstate waste and materials shipments. Reforms to existing RCRA and CERCLA regulations/guidance to address regulatory overlap and risks posed by DOE wastes. The overarching theme of this project is to help the Department improve coordination of its major program decisions with Governors' offices and state regulators and to ensure such decisions reflect input from these key state officials and stakeholders. This report summarizes activities conducted during the quarter from April 30, 1998 through June 30, 1998 under the NGA project. The work accomplished by the NGA project team during the past four months can be categorized as follows: maintained open communication with DOE on a variety of activities and issues within the DOE environmental management complex; and provided ongoing support to state-DOE interactions. maintained communication with NGA Federal Facilities Compliance Task Force members regarding DOE efforts to formulate a configuration for mixed low-level waste and low-level treatment and disposal, DOE's Environmental Management Budget, and DOE's proposed Intersite Discussions.« less

Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications.

PubMed

Kerns, Jennifer L; Mengesha, Biftu; McNamara, Blair C; Cassidy, Arianna; Pearlson, Geffan; Kuppermann, Miriam

2018-06-01

We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications. We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes. We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, p<.0001), as were posttraumatic stress and grief scores (r=0.7, p<.0001). In the adjusted analysis, higher decision satisfaction was associated with lower grief and posttraumatic stress scores (p=.02 and p=.01, respectively) and higher shared decision making was associated with lower posttraumatic stress scores (p=.01). Decision satisfaction and shared decision making have a positive effect on psychological outcomes after second-trimester abortion for pregnancy complications. Counseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications. These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. Copyright © 2018. Published by Elsevier Inc.

Decision insight into stakeholder conflict for ERN.

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

Siirola, John; Tidwell, Vincent Carroll; Benz, Zachary O.

Participatory modeling has become an important tool in facilitating resource decision making and dispute resolution. Approaches to modeling that are commonly used in this context often do not adequately account for important human factors. Current techniques provide insights into how certain human activities and variables affect resource outcomes; however, they do not directly simulate the complex variables that shape how, why, and under what conditions different human agents behave in ways that affect resources and human interactions related to them. Current approaches also do not adequately reveal how the effects of individual decisions scale up to have systemic level effectsmore » in complex resource systems. This lack of integration prevents the development of more robust models to support decision making and dispute resolution processes. Development of integrated tools is further hampered by the fact that collection of primary data for decision-making modeling is costly and time consuming. This project seeks to develop a new approach to resource modeling that incorporates both technical and behavioral modeling techniques into a single decision-making architecture. The modeling platform is enhanced by use of traditional and advanced processes and tools for expedited data capture. Specific objectives of the project are: (1) Develop a proof of concept for a new technical approach to resource modeling that combines the computational techniques of system dynamics and agent based modeling, (2) Develop an iterative, participatory modeling process supported with traditional and advance data capture techniques that may be utilized to facilitate decision making, dispute resolution, and collaborative learning processes, and (3) Examine potential applications of this technology and process. The development of this decision support architecture included both the engineering of the technology and the development of a participatory method to build and apply the technology. Stakeholder interaction with the model and associated data capture was facilitated through two very different modes of engagement, one a standard interface involving radio buttons, slider bars, graphs and plots, while the other utilized an immersive serious gaming interface. The decision support architecture developed through this project was piloted in the Middle Rio Grande Basin to examine how these tools might be utilized to promote enhanced understanding and decision-making in the context of complex water resource management issues. Potential applications of this architecture and its capacity to lead to enhanced understanding and decision-making was assessed through qualitative interviews with study participants who represented key stakeholders in the basin.« less

Designing Dynamic Adaptive Policy Pathways using Many-Objective Robust Decision Making

NASA Astrophysics Data System (ADS)

Kwakkel, Jan; Haasnoot, Marjolijn

2017-04-01

Dealing with climate risks in water management requires confronting a wide variety of deeply uncertain factors, while navigating a many dimensional space of trade-offs amongst objectives. There is an emerging body of literature on supporting this type of decision problem, under the label of decision making under deep uncertainty. Two approaches within this literature are Many-Objective Robust Decision Making, and Dynamic Adaptive Policy Pathways. In recent work, these approaches have been compared. One of the main conclusions of this comparison was that they are highly complementary. Many-Objective Robust Decision Making is a model based decision support approach, while Dynamic Adaptive Policy Pathways is primarily a conceptual framework for the design of flexible strategies that can be adapted over time in response to how the future is actually unfolding. In this research we explore this complementarity in more detail. Specifically, we demonstrate how Many-Objective Robust Decision Making can be used to design adaptation pathways. We demonstrate this combined approach using a water management problem, in the Netherlands. The water level of Lake IJselmeer, the main fresh water resource of the Netherlands, is currently managed through discharge by gravity. Due to climate change, this won't be possible in the future, unless water levels are changed. Changing the water level has undesirable flood risk and spatial planning consequences. The challenge is to find promising adaptation pathways that balance objectives related to fresh water supply, flood risk, and spatial issues, while accounting for uncertain climatic and land use change. We conclude that the combination of Many-Objective Robust Decision Making and Dynamic Adaptive Policy Pathways is particularly suited for dealing with deeply uncertain climate risks.

An integrated modeling approach to support management decisions of coupled groundwater-agricultural systems under multiple uncertainties

NASA Astrophysics Data System (ADS)

Hagos Subagadis, Yohannes; Schütze, Niels; Grundmann, Jens

2015-04-01

The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational frameworks. Such integrative research to link different knowledge domains faces several practical challenges. Such complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. A fuzzy-stochastic multiple criteria decision analysis tool was developed in this study to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrated physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approach is applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structure. Results from the developed method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach has enabled to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. Sensitivity analysis applied within the developed tool has shown that the decision makers' risk aversion and risk taking attitude may yield in different ranking of decision alternatives. The developed approach can be applied to address the complexities and uncertainties inherent in water resources systems to support management decisions, while serving as a platform for stakeholder participation.

Review of carbon dioxide research staffing and academic support

NASA Astrophysics Data System (ADS)

Clark, S. B.; Howard, L.; Stevenson, W.; Trice, J.

1985-04-01

More than 60 percent of the staff on Carbon Dioxide Research Division (CDRD) projects were university affiliated, and over one third of project scientists and engineers also had university teaching responsibilities. Almost 20 percent of project staff were students. CO2 research is unlikely to affect the general labor market for scientists and engineers because it uses such a small portion of the total pool. On the other hand, anticipated tight labor markets in some disciplines important to CO2 research may make it advantageous for CDRD to expand its support of university faculty, students, and staff to ensure that competent, knowledgeable researchers and managers are available for eventual policy decisions on CO2 issues. Options for academic support that lend themselves readily to the diffuse nature of CO2 research, while providing flexibility in the identification and accomplishment of specific programmatic objectives, include modifying procurement procedures for research contracts to enhance academic involvement, sponsoring summer institutes tailored to specific participants and focused on issues of interest to CDRD, and supporting traveling lecture programs designed to bring information of concern to CDRD to technical and nontechnical audiences.

Joint Center for Operational Analysis Journal. Volume 12, Issue 1, Spring 2010

DTIC Science & Technology

2010-01-01

enable research into captured records with “complete openness and rigid adherence to acadamic freedom and integrity.” The CRRC will thereby...various levels of effort in the former area, the latter provides a common ground and opportunities for developing close collaborations. This allows...consequence management (CM) capability, specifi cally the use of the CM Decision Support Tool (DST) developed by the DTRA. Ms. Jessica Iannotti

Japanese Naval Military Culture in the Pacific War

DTIC Science & Technology

2014-05-22

impact those interpretations had on doctrine and modernization. Although many historians have asserted that issues such as racism or industrial...of the causes of the Pacific War. It instead evaluates decision maker’s assessment of the military problem as it was presented to them and their...reflected differences in opinion, politics and the military culture that existed within the Navy. Yamamoto did not help his cause by supporting unpopular

Confirmatory Factor Analysis of Burnout Dimensions: Correlations with Job Stressors and Aspects of Social Support and Job Satisfaction

DTIC Science & Technology

1992-02-01

1986) revision of the Maslach and Jackson (1981) Maslach Burnout Inventory (MBI). Results of confirmatory factor analyses conducted on data... Maslach organizational issues: depersonalization was and Jackson (1981) Maslach Burnout Inventory related to decision-making policies, personal (MBI). The...manage- (1989). The dimensionality of a modified ment interventions to respond to different mani- form of the Maslach Burnout Inventory for festations

Evidence-Based Improvement: A Guide for States to Strengthen Their Frameworks and Supports Aligned to the Evidence Requirements of ESSA

ERIC Educational Resources Information Center

Hale, Sylvie; Dunn, Lenay; Filby, Nikola; Rice, John; Van Houten, Lori

2017-01-01

One of the broad intents of the Elementary and Secondary Education Act (ESEA) as amended by the Every Student Succeeds Act (ESSA) is to encourage evidence-based decision-making as a way of doing business. Nonregulatory guidance issued in September 2016 by the U.S. Department of Education (ED) clarifies and expands on both the nature of…

Survivability as a Tool for Evaluating Open Source Software

DTIC Science & Technology

2015-06-01

the thesis limited the program development, so it is only able to process project issues (bugs or feature requests), which is an important metric for...Ideally, these insights may provide an analytic framework to generate guidance for decision makers that may support the inclusion of OSS to more...refine their efforts to build quality software and to strengthen their software development communities. 1.4 Research Questions This thesis addresses

Rescheduling nursing shifts: scoping the challenge and examining the potential of mathematical model based tools.

PubMed

Clark, Alistair; Moule, Pam; Topping, Annie; Serpell, Martin

2015-05-01

To review research in the literature on nursing shift scheduling / rescheduling, and to report key issues identified in a consultation exercise with managers in four English National Health Service trusts to inform the development of mathematical tools for rescheduling decision-making. Shift rescheduling is unrecognised as an everyday time-consuming management task with different imperatives from scheduling. Poor rescheduling decisions can have quality, cost and morale implications. A systematic critical literature review identified rescheduling issues and existing mathematic modelling tools. A consultation exercise with nursing managers examined the complex challenges associated with rescheduling. Minimal research exists on rescheduling compared with scheduling. Poor rescheduling can result in greater disruption to planned nursing shifts and may impact negatively on the quality and cost of patient care, and nurse morale and retention. Very little research examines management challenges or mathematical modelling for rescheduling. Shift rescheduling is a complex and frequent management activity that is more challenging than scheduling. Mathematical modelling may have potential as a tool to support managers to minimise rescheduling disruption. The lack of specific methodological support for rescheduling that takes into account its complexity, increases the likelihood of harm for patients and stress for nursing staff and managers. © 2013 John Wiley & Sons Ltd.

Machine Learning and Decision Support in Critical Care

PubMed Central

Johnson, Alistair E. W.; Ghassemi, Mohammad M.; Nemati, Shamim; Niehaus, Katherine E.; Clifton, David A.; Clifford, Gari D.

2016-01-01

Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms. With increasing excitement surrounding “secondary use of medical records” and “Big Data” analytics, it is important to understand the limitations of current databases and what needs to change in order to enter an era of “precision medicine.” This review article covers many of the issues involved in the collection and preprocessing of critical care data. The three challenges in critical care are considered: compartmentalization, corruption, and complexity. A range of applications addressing these issues are covered, including the modernization of static acuity scoring; on-line patient tracking; personalized prediction and risk assessment; artifact detection; state estimation; and incorporation of multimodal data sources such as genomic and free text data. PMID:27765959

Utility assessment of a map-based online geo-collaboration tool.

PubMed

Sidlar, Christopher L; Rinner, Claus

2009-05-01

Spatial group decision-making processes often include both informal and analytical components. Discussions among stakeholders or planning experts are an example of an informal component. When participants discuss spatial planning projects they typically express concerns and comments by pointing to places on a map. The Argumentation Map model provides a conceptual basis for collaborative tools that enable explicit linkages of arguments to the places to which they refer. These tools allow for the input of explicitly geo-referenced arguments as well as the visual access to arguments through a map interface. In this paper, we will review previous utility studies in geo-collaboration and evaluate a case study of a Web-based Argumentation Map application. The case study was conducted in the summer of 2005 when student participants discussed planning issues on the University of Toronto St. George campus. During a one-week unmoderated discussion phase, 11 participants wrote 60 comments on issues such as safety, facilities, parking, and building aesthetics. By measuring the participants' use of geographic references, we draw conclusions on how well the software tool supported the potential of the underlying concept. This research aims to contribute to a scientific approach to geo-collaboration in which the engineering of novel spatial decision support methods is complemented by a critical assessment of their utility in controlled, realistic experiments.

Creating quality improvement culture in public health agencies.

PubMed

Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

[Computing in medical practice].

PubMed

Wechsler, Rudolf; Anção, Meide S; de Campos, Carlos José Reis; Sigulem, Daniel

2003-05-01

Currently, information technology is part of several aspects of our daily life. The objective of this paper is to analyze and discuss the use of information technology in both medical education and/or medical practice. Information was gathered through non-systematic bibliographic review, including articles, official regulations, book chapters and annals. Direct search and search of electronic databanks in Medline and Lilacs databases were also performed. This paper was structured in topics. First, there is a discussion on the electronic medical record. The following aspects are presented: history, functions, costs, benefits, ethical and legal issues, and positive and negative characteristics. Medical decision-support systems are also evaluated in view of the huge amount of information produced every year regarding healthcare. The impact of the Internet on the production and diffusion of knowledge is also analyzed. Telemedicine is assessed, since it presents new challenges to medical practice, and raises important ethical issues such as "virtual medical consultation." Finally, a practical experience of modernization of a pediatric outpatient center by the introduction of computers and telecommunication tools is described. Medical computing offers tools and instruments that support the administrative organization of medical visits, gather, store and process patient's data, generate diagnoses, provide therapeutical advice and access to information in order to improve medical knowledge and to make it available whenever and wherever adequate decision-making is required.

A Decision Support System Coupling Fuzzy Logic and Probabilistic Graphical Approaches for the Agri-Food Industry: Prediction of Grape Berry Maturity

PubMed Central

Brousset, Jean Marie; Abbal, Philippe; Guillemin, Hervé; Perret, Bruno; Goulet, Etienne; Guerin, Laurence; Barbeau, Gérard; Picque, Daniel

2015-01-01

Agri-food is one of the most important sectors of the industry and a major contributor to the global warming potential in Europe. Sustainability issues pose a huge challenge for this sector. In this context, a big issue is to be able to predict the multiscale dynamics of those systems using computing science. A robust predictive mathematical tool is implemented for this sector and applied to the wine industry being easily able to be generalized to other applications. Grape berry maturation relies on complex and coupled physicochemical and biochemical reactions which are climate dependent. Moreover one experiment represents one year and the climate variability could not be covered exclusively by the experiments. Consequently, harvest mostly relies on expert predictions. A big challenge for the wine industry is nevertheless to be able to anticipate the reactions for sustainability purposes. We propose to implement a decision support system so called FGRAPEDBN able to (1) capitalize the heterogeneous fragmented knowledge available including data and expertise and (2) predict the sugar (resp. the acidity) concentrations with a relevant RMSE of 7 g/l (resp. 0.44 g/l and 0.11 g/kg). FGRAPEDBN is based on a coupling between a probabilistic graphical approach and a fuzzy expert system. PMID:26230334

Breastfeeding: The Illusion of Choice.

PubMed

Dinour, Lauren M; Bai, Yeon K

2016-01-01

Breastfeeding is frequently described as a woman's decision, yet this choice is often illusionary owing to suboptimal social and structural supports. Despite passage of the Patient Protection and Affordable Care Act (2010) that requires all qualifying employers to provide mothers "reasonable" break time and a private, non-bathroom space to express breast milk, the majority of women in the United States still do not have access to both accommodations. At least three issues may be influencing this suboptimal implementation at workplaces: 1) federal law does not address lactation space functionality and accessibility, 2) federal law only protects a subset of employees, and 3) enforcement of the federal law requires women to file a complaint with the United States Department of Labor. To address each of these issues, we recommend the following modifications to current law: 1) additional requirements surrounding lactation space and functionality, 2) mandated coverage of exempt employees, and 3) requirement that employers develop company-specific lactation policies. If the goal is to give women a real choice of whether to continue breastfeeding after returning to work, we must provide the proper social and structural supports that will allow for a truly personal decision. No mother should have to choose between breastfeeding her child and earning a paycheck. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Smart Anesthesia Manager™ (SAM)--a real-time decision support system for anesthesia care during surgery.

PubMed

Nair, Bala G; Newman, Shu-Fang; Peterson, Gene N; Schwid, Howard A

2013-01-01

Anesthesia information management systems (AIMS) are being increasingly used in the operating room to document anesthesia care. We developed a system, Smart Anesthesia Manager™ (SAM) that works in conjunction with an AIMS to provide clinical and billing decision support. SAM interrogates AIMS database in near real time, detects issues related to clinical care, billing and compliance, and material waste. Issues and the steps for their resolution are brought to the attention of the anesthesia provider in real time through "pop-up" messages overlaid on top of AIMS screens or text pages. SAM improved compliance to antibiotic initial dose and redose to 99.3 ± 0.7% and 83.9 ± 3.4% from 88.5 ± 1.4% and 62.5 ± 1.6%, respectively. Beta-blocker protocol compliance increased to 94.6 ± 3.5% from 60.5 ± 8.6%. Inadvertent gaps (>15 min) in blood pressure monitoring were reduced to 34 ± 30 min/1000 cases from 192 ± 58 min/1000 cases. Additional billing charge capture of invasive lines procedures worth $144,732 per year and 1,200 compliant records were achieved with SAM. SAM was also able to reduce wastage of inhalation anesthetic agents worth $120,168 per year.

Flood Resilient Systems and their Application for Flood Resilient Planning

NASA Astrophysics Data System (ADS)

Manojlovic, N.; Gabalda, V.; Antanaskovic, D.; Gershovich, I.; Pasche, E.

2012-04-01

Following the paradigm shift in flood management from traditional to more integrated approaches, and considering the uncertainties of future development due to drivers such as climate change, one of the main emerging tasks of flood managers becomes the development of (flood) resilient cities. It can be achieved by application of non-structural - flood resilience measures, summarised in the 4As: assistance, alleviation, awareness and avoidance (FIAC, 2007). As a part of this strategy, the key aspect of development of resilient cities - resilient built environment can be reached by efficient application of Flood Resilience Technology (FReT) and its meaningful combination into flood resilient systems (FRS). FRS are given as [an interconnecting network of FReT which facilitates resilience (including both restorative and adaptive capacity) to flooding, addressing physical and social systems and considering different flood typologies] (SMARTeST, http://www.floodresilience.eu/). Applying the system approach (e.g. Zevenbergen, 2008), FRS can be developed at different scales from the building to the city level. Still, a matter of research is a method to define and systematise different FRS crossing those scales. Further, the decision on which resilient system is to be applied for the given conditions and given scale is a complex task, calling for utilisation of decision support tools. This process of decision-making should follow the steps of flood risk assessment (1) and development of a flood resilience plan (2) (Manojlovic et al, 2009). The key problem in (2) is how to match the input parameters that describe physical&social system and flood typology to the appropriate flood resilient system. Additionally, an open issue is how to integrate the advances in FReT and findings on its efficiency into decision support tools. This paper presents a way to define, systematise and make decisions on FRS at different scales of an urban system developed within the 7th FP Project SMARTeST. A web based three tier advisory system FLORETO-KALYPSO (http://floreto.wb.tu-harburg.de/, Manojlovic et al, 2009) devoted to support decision-making process at the building level has been further developed to support multi-scale decision making on resilient systems, improving the existing data mining algorithms of the Business Logic tier. Further tuning of the algorithms is to be performed based on the new developments and findings in applicability and efficiency of different FRe Technology for different flood typologies. The first results obtained at the case studies in Greater Hamburg, Germany indicate the potential of this approach to contribute to the multiscale resilient planning on the road to flood resilient cities. FIAC (2007): "Final report form the Awareness and Assistance Sub-committee", FIAC, Scottish Government Zevenbergen C. et al (2008) "Challenges in urban flood management: travelling across spatial and temporal scales", Journal of FRM Volume 1 Issue 2, p 81-88 Manojlovic N., et al (2009): "Capacity Building in FRM through a DSS Utilising Data Mining Approach", Proceed. 8th HIC, Concepcion, Chile, January, 2009

A methodology and decision support tool for informing state-level bioenergy policymaking: New Jersey biofuels as a case study

NASA Astrophysics Data System (ADS)

Brennan-Tonetta, Margaret

This dissertation seeks to provide key information and a decision support tool that states can use to support long-term goals of fossil fuel displacement and greenhouse gas reductions. The research yields three outcomes: (1) A methodology that allows for a comprehensive and consistent inventory and assessment of bioenergy feedstocks in terms of type, quantity, and energy potential. Development of a standardized methodology for consistent inventorying of biomass resources fosters research and business development of promising technologies that are compatible with the state's biomass resource base. (2) A unique interactive decision support tool that allows for systematic bioenergy analysis and evaluation of policy alternatives through the generation of biomass inventory and energy potential data for a wide variety of feedstocks and applicable technologies, using New Jersey as a case study. Development of a database that can assess the major components of a bioenergy system in one tool allows for easy evaluation of technology, feedstock and policy options. The methodology and decision support tool is applicable to other states and regions (with location specific modifications), thus contributing to the achievement of state and federal goals of renewable energy utilization. (3) Development of policy recommendations based on the results of the decision support tool that will help to guide New Jersey into a sustainable renewable energy future. The database developed in this research represents the first ever assessment of bioenergy potential for New Jersey. It can serve as a foundation for future research and modifications that could increase its power as a more robust policy analysis tool. As such, the current database is not able to perform analysis of tradeoffs across broad policy objectives such as economic development vs. CO2 emissions, or energy independence vs. source reduction of solid waste. Instead, it operates one level below that with comparisons of kWh or GGE generated by different feedstock/technology combinations at the state and county level. Modification of the model to incorporate factors that will enable the analysis of broader energy policy issues as those mentioned above, are recommended for future research efforts.

A Dynamic Information Framework (DIF): A Portal for the Changing Biogeochemistry of Aquatic Systems

NASA Astrophysics Data System (ADS)

Richey, J. E.; Fernandes, E. C. M.

2014-12-01

The ability of societies to adapt to climate and landuse change in aquatic systems is functionally and practically expressed by how regional stakeholders are able to address complex management issues. These targets represent a very complex set of intersecting issues of scale, cross-sector science and technology, education, politics, and economics. Implications transcend individual projects and ministries. An immediate challenge is to incorporate the realities of changing environmental conditions in these sectors into the policies and projects of the Ministries nominally responsible. Ideally this would be done on the basis of the absolute best understanding of the issues involved, and done in a way that optimizes a multi-stakeholder return. Central to a response is "actionable information-" the synthesis and "bringing to life" of the key information that integrates the end-to-end knowledge required to provide the high-level decision support to make the most informed decisions. But, in practice, the information necessary and even perspectives are virtually absent, in much of especially the developing world. To meet this challenge, we have been developing a Dynamic Information Framework (DIF), primarily through collaborations with the World Bank in Asia, Africa, and Brazil. The DIF is, essentially a decision support structure, built around "earth system" models. The environment is built on progressive information layers that are fed through hydrological and geospatial landscape models to produce outputs that address specific science questions related to water resources management of the region. Information layers from diverse sources are assembled, according to the principles of how the landscape is organized, and computer models are used to bring the information "to life." A fundamental aspect to a DIF is not only the convergence of multi-sector information, but how that information can be conveyed, in the most compelling, and visual, manner. Deployment of the environment in the Cloud facilitates access for stakeholders.

A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

PubMed

Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

2012-06-01

Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media releases, and correspondence. Interviews will be conducted in person with senior administrative leaders, government officials, screening experts, and high-level cancer system stakeholders. The proposed study comprises the third and final phase of an Emerging Team grant to address the challenges of health-policy decision making and colorectal cancer screening decisions in Canada. This study will contribute a unique prospective look at how policy makers address new, emerging scientific evidence in several different policy environments and at different stages of program planning and implementation. Findings will provide important insight into the various approaches that are or should be used to monitor emerging evidence, the relative importance of scientific versus contextual evidence for decision making, and the tools and processes that may be important to support challenging health-policy decisions.

Ethically-based clinical decision-making in physical therapy: process and issues.

PubMed

Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

2005-01-01

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

Framing health and foreign policy: lessons for global health diplomacy.

PubMed

Labonté, Ronald; Gagnon, Michelle L

2010-08-22

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts.

Framing health and foreign policy: lessons for global health diplomacy

PubMed Central

2010-01-01

Global health financing has increased dramatically in recent years, indicative of a rise in health as a foreign policy issue. Several governments have issued specific foreign policy statements on global health and a new term, global health diplomacy, has been coined to describe the processes by which state and non-state actors engage to position health issues more prominently in foreign policy decision-making. Their ability to do so is important to advancing international cooperation in health. In this paper we review the arguments for health in foreign policy that inform global health diplomacy. These are organized into six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning. Each of these frames has implications for how global health as a foreign policy issue is conceptualized. Differing arguments within and between these policy frames, while overlapping, can also be contradictory. This raises an important question about which arguments prevail in actual state decision-making. This question is addressed through an analysis of policy or policy-related documents and academic literature pertinent to each policy framing with some assessment of policy practice. The reference point for this analysis is the explicit goal of improving global health equity. This goal has increasing national traction within national public health discourse and decision-making and, through the Millennium Development Goals and other multilateral reports and declarations, is entering global health policy discussion. Initial findings support conventional international relations theory that most states, even when committed to health as a foreign policy goal, still make decisions primarily on the basis of the 'high politics' of national security and economic material interests. Development, human rights and ethical/moral arguments for global health assistance, the traditional 'low politics' of foreign policy, are present in discourse but do not appear to dominate practice. While political momentum for health as a foreign policy goal persists, the framing of this goal remains a contested issue. The analysis offered in this article may prove helpful to those engaged in global health diplomacy or in efforts to have global governance across a range of sectoral interests pay more attention to health equity impacts. PMID:20727211

Water Plan 2030: A Dynamic Education Model for Teaching Water Management Issues

NASA Astrophysics Data System (ADS)

Rupprecht, C.; Washburne, J.; Lansey, K.; Williams, A.

2006-12-01

Dynamic educational tools to assist teachers and students in recognizing the impacts of water management decisions in a realistic context are not readily available. Water policy issues are often complex and difficult for students trying to make meaningful connections between system components. To fill this need, we have developed a systems modeling-based educational decision support system (DSS) with supplementary materials. This model, called Water Plan 2030, represents a general semi-arid watershed; it allows users to examine water management alternatives by changing input values for various water uses and basin conditions and immediately receive graphical outputs to compare decisions. The main goal of our DSS model is to foster students' abilities to make knowledgeable decisions with regard to water resources issues. There are two reasons we have developed this model for traditional classroom settings. First, the DSS model provides teachers with a mechanism for educating students about inter-related hydrologic concepts, complex systems and facilitates discussion of water resources issues. Second, Water Plan 2030 encourages student discovery of cause/effect relationships in a dynamic, hands-on environment and develops the ability to realize the implications of water management alternatives. The DSS model has been utilized in an undergraduate, non-major science class for 5 course hours, each of the past 4 semesters. Accompanying the PC-based model are supplementary materials to improve the effectiveness of implementation by emphasizing important concepts and guiding learners through the model components. These materials include in-class tutorials, introductory questions, role-playing activities and homework extensions that have been revised after each user session, based on student and instructor feedback. Most recently, we have developed individual lessons that teach specific model functions and concepts. These modules provide teachers the flexibility to adapt the model to meet numerous teaching goals. Evaluation results indicate that students improved their understanding of fundamental concepts and system interactions and showed the most improvement in questions related to water use by sector and sustainability issues. Model modifications have also improved student feedback of the model effectiveness and user- friendliness. Positive results from this project have created the demand for a web-based version, which will be online in late 2006.

Regret and adaptive decision making in young children.

PubMed

O'Connor, Eimear; McCormack, Teresa; Beck, Sarah R; Feeney, Aidan

2015-07-01

In line with the claim that regret plays a role in decision making, O'Connor, McCormack, and Feeney (Child Development, 85 (2014) 1995-2010) found that children who reported feeling sadder on discovering they had made a non-optimal choice were more likely to make a different choice the next time around. We examined two issues of interpretation regarding this finding: whether the emotion measured was indeed regret and whether it was the experience of this emotion, rather than the ability to anticipate it, that affected decision making. To address the first issue, we varied the degree to which children aged 6 or 7 years were responsible for an outcome, assuming that responsibility is a necessary condition for regret. The second issue was addressed by examining whether children could accurately anticipate that they would feel worse on discovering they had made a non-optimal choice. Children were more likely to feel sad if they were responsible for the outcome; however, even if they were not responsible, children were more likely than chance to report feeling sadder. Moreover, across all conditions, feeling sadder was associated with making a better subsequent choice. In a separate task, we demonstrated that children of this age cannot accurately anticipate feeling sadder on discovering that they had not made the best choice. These findings suggest that although children may feel regret following a non-optimal choice, even if they were not responsible for an outcome, they may experience another negative emotion such as frustration. Experiencing either of these emotions seems to be sufficient to support better decision making. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

ENergy and Power Evaluation Program

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

NONE

1996-11-01

In the late 1970s, national and international attention began to focus on energy issues. Efforts were initiated to design and test analytical tools that could be used to assist energy planners in evaluating energy systems, particularly in developing countries. In 1984, the United States Department of Energy (DOE) commissioned Argonne National Laboratory`s Decision and Information Sciences Division (DIS) to incorporate a set of analytical tools into a personal computer-based package for distribution in developing countries. The package developed by DIS staff, the ENergy and Power Evaluation Program (ENPEP), covers the range of issues that energy planners must face: economic development,more » energy demand projections, supply-and-demand balancing, energy system expansion, and environmental impact analysis. Following the original DOE-supported development effort, the International Atomic Energy Agency (IAEA), with the assistance from the US Department of State (DOS) and the US Department of Energy (DOE), provided ENPEP training, distribution, and technical support to many countries. ENPEP is now in use in over 60 countries and is an international standard for energy planning tools. More than 500 energy experts have been trained in the use of the entire ENPEP package or some of its modules during the international training courses organized by the IAEA in collaboration with Argonne`s Decision and Information Sciences (DIS) Division and the Division of Educational Programs (DEP). This report contains the ENPEP program which can be download from the internet. Described in this report is the description of ENPEP Program, news, forums, online support and contacts.« less

Essential methodological considerations when using grounded theory.

PubMed

Achora, Susan; Matua, Gerald Amandu

2016-07-01

To suggest important methodological considerations when using grounded theory. A research method widely used in nursing research is grounded theory, at the centre of which is theory construction. However, researchers still struggle with some of its methodological issues. Although grounded theory is widely used to study and explain issues in nursing practice, many researchers are still failing to adhere to its rigorous standards. Researchers should articulate the focus of their investigations - the substantive area of interest as well as the focal population. This should be followed by a succinct explanation of the strategies used to collect and analyse data, supported by clear coding processes. Finally, the resolution of the core issues, including the core category and related categories, should be explained to advance readers' understanding. Researchers should endeavour to understand the tenets of grounded theory. This enables 'neophytes' in particular to make methodological decisions that will improve their studies' rigour and fit with grounded theory. This paper complements the current dialogue on improving the understanding of grounded theory methodology in nursing research. The paper also suggests important procedural decisions researchers need to make to preserve their studies' scientific merit and fit with grounded theory.

Utility of qualitative research findings in evidence-based public health practice.

PubMed

Jack, Susan M

2006-01-01

Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided.

Representing causal knowledge in environmental policy interventions: Advantages and opportunities for qualitative influence diagram applications.

PubMed

Carriger, John F; Dyson, Brian E; Benson, William H

2018-01-15

This article develops and explores a methodology for using qualitative influence diagrams in environmental policy and management to support decision making efforts that minimize risk and increase resiliency. Influence diagrams are representations of the conditional aspects of a problem domain. Their graphical properties are useful for structuring causal knowledge relevant to policy interventions and can be used to enhance inference and inclusivity of multiple viewpoints. Qualitative components of influence diagrams are beneficial tools for identifying and examining the interactions among the critical variables in complex policy development and implementation. Policy interventions on social-environmental systems can be intuitively diagrammed for representing knowledge of critical relationships among economic, environmental, and social attributes. Examples relevant to coastal resiliency issues in the U.S. Gulf Coast region are developed to illustrate model structures for developing qualitative influence diagrams useful for clarifying important policy intervention issues and enhancing transparency in decision making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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

ERIC Educational Resources Information Center

Emery, Katherine Beth

2013-01-01

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

Data-Based Decision-Making: Developing a Method for Capturing Teachers' Understanding of CBM Graphs

ERIC Educational Resources Information Center

Espin, Christine A.; Wayman, Miya Miura; Deno, Stanley L.; McMaster, Kristen L.; de Rooij, Mark

2017-01-01

In this special issue, we explore the decision-making aspect of "data-based decision-making". The articles in the issue address a wide range of research questions, designs, methods, and analyses, but all focus on data-based decision-making for students with learning difficulties. In this first article, we introduce the topic of…

The Commercial Challenges Of Pacs

NASA Astrophysics Data System (ADS)

Vanden Brink, John A.

1984-08-01

The increasing use of digital imaging techniques create a need for improved methods of digital processing, communication and archiving. However, the commercial opportunity is dependent on the resolution of a number of issues. These issues include proof that digital processes are more cost effective than present techniques, implementation of information system support in the imaging activity, implementation of industry standards, conversion of analog images to digital formats, definition of clinical needs, the implications of the purchase decision and technology requirements. In spite of these obstacles, a market is emerging, served by new and existing companies, that may become a $500 million market (U.S.) by 1990 for equipment and supplies.

Protecting scientists, science, and case protagonists: a discussion of the Taus v. Loftus commentaries.

PubMed

Dalenberg, Constance J

2014-12-01

This article is a discussion of the articles by Nicole Taus Kluemper, Erna Olafson, Frank Putnam, Laura Brown, Ross Cheit, and Gerald Koocher. The papers center on the issues raised by a decision by two psychologists to break the confidentiality of a case study published by David Corwin and Erna Olafson to gather information to support an alternative theoretical view of the case. The article reviews best understandings of the justifications proposed by the psychologists, who saw themselves as investigative reporters, discusses the papers that have been submitted, and proposes enhanced ethical guidelines and increased professional discussion of these issues. © The Author(s) 2014.

Predictive monitoring research: Summary of the PREMON system

NASA Technical Reports Server (NTRS)

Doyle, Richard J.; Sellers, Suzanne M.; Atkinson, David J.

1987-01-01

Traditional approaches to monitoring are proving inadequate in the face of two important issues: the dynamic adjustment of expectations about sensor values when the behavior of the device is too complex to enumerate beforehand, and the selective but effective interpretation of sensor readings when the number of sensors becomes overwhelming. This system addresses these issues by building an explicit model of a device and applying common-sense theories of physics to model causality in the device. The resulting causal simulation of the device supports planning decisions about how to efficiently yet reliably utilize a limited number of sensors to verify correct operation of the device.