Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

PubMed Central

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-01-01

ABSTRACT Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures. PMID:29405889

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

PubMed

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-12-01

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

E-DECIDER Decision Support Gateway For Earthquake Disaster Response

NASA Astrophysics Data System (ADS)

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

2013-12-01

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

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

DOT National Transportation Integrated Search

2014-12-01

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

Using Decision Support to Address Racial Disparities in Mental Health Service Utilization

ERIC Educational Resources Information Center

Rawal, Purva H.; Anderson, Tanya R.; Romansky, Jill R.; Lyons, John S.

2008-01-01

Unfortunately, racial disparities are well documented in the delivery of behavioral health services. This study examines the effects of implementing a decision support process, integrating clinical information into the administration of mental health services, on racial disparities in psychiatric hospital admissions for children in state custody.…

SANDS: A Service-Oriented Architecture for Clinical Decision Support in a National Health Information Network

PubMed Central

Wright, Adam; Sittig, Dean F.

2008-01-01

In this paper we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. PMID:18434256

39 CFR 501.6 - Suspension and revocation of authorization.

Code of Federal Regulations, 2014 CFR

2014-07-01

... decision of PT shall become a final decision of the Postal Service. The appeal may be filed with the Chief Information Officer of the Postal Service and must include all supporting evidence and state with specificity... Information Officer shall constitute a final decision of the Postal Service. (f) An order or final decision...

Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina

2017-06-21

This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.

Knowledge base and sensor bus messaging service architecture for critical tsunami warning and decision-support

NASA Astrophysics Data System (ADS)

Sabeur, Z. A.; Wächter, J.; Middleton, S. E.; Zlatev, Z.; Häner, R.; Hammitzsch, M.; Loewe, P.

2012-04-01

The intelligent management of large volumes of environmental monitoring data for early tsunami warning requires the deployment of robust and scalable service oriented infrastructure that is supported by an agile knowledge-base for critical decision-support In the TRIDEC project (TRIDEC 2010-2013), a sensor observation service bus of the TRIDEC system is being developed for the advancement of complex tsunami event processing and management. Further, a dedicated TRIDEC system knowledge-base is being implemented to enable on-demand access to semantically rich OGC SWE compliant hydrodynamic observations and operationally oriented meta-information to multiple subscribers. TRIDEC decision support requires a scalable and agile real-time processing architecture which enables fast response to evolving subscribers requirements as the tsunami crisis develops. This is also achieved with the support of intelligent processing services which specialise in multi-level fusion methods with relevance feedback and deep learning. The TRIDEC knowledge base development work coupled with that of the generic sensor bus platform shall be presented to demonstrate advanced decision-support with situation awareness in context of tsunami early warning and crisis management.

Web-based health services and clinical decision support.

PubMed

Jegelevicius, Darius; Marozas, Vaidotas; Lukosevicius, Arunas; Patasius, Martynas

2004-01-01

The purpose of this study was the development of a Web-based e-health service for comprehensive assistance and clinical decision support. The service structure consists of a Web server, a PHP-based Web interface linked to a clinical SQL database, Java applets for interactive manipulation and visualization of signals and a Matlab server linked with signal and data processing algorithms implemented by Matlab programs. The service ensures diagnostic signal- and image analysis-sbased clinical decision support. By using the discussed methodology, a pilot service for pathology specialists for automatic calculation of the proliferation index has been developed. Physicians use a simple Web interface for uploading the pictures under investigation to the server; subsequently a Java applet interface is used for outlining the region of interest and, after processing on the server, the requested proliferation index value is calculated. There is also an "expert corner", where experts can submit their index estimates and comments on particular images, which is especially important for system developers. These expert evaluations are used for optimization and verification of automatic analysis algorithms. Decision support trials have been conducted for ECG and ophthalmology ultrasonic investigations of intraocular tumor differentiation. Data mining algorithms have been applied and decision support trees constructed. These services are under implementation by a Web-based system too. The study has shown that the Web-based structure ensures more effective, flexible and accessible services compared with standalone programs and is very convenient for biomedical engineers and physicians, especially in the development phase.

Knowledge management in healthcare: towards 'knowledge-driven' decision-support services.

PubMed

Abidi, S S

2001-09-01

In this paper, we highlight the involvement of Knowledge Management in a healthcare enterprise. We argue that the 'knowledge quotient' of a healthcare enterprise can be enhanced by procuring diverse facets of knowledge from the seemingly placid healthcare data repositories, and subsequently operationalising the procured knowledge to derive a suite of Strategic Healthcare Decision-Support Services that can impact strategic decision-making, planning and management of the healthcare enterprise. In this paper, we firstly present a reference Knowledge Management environment-a Healthcare Enterprise Memory-with the functionality to acquire, share and operationalise the various modalities of healthcare knowledge. Next, we present the functional and architectural specification of a Strategic Healthcare Decision-Support Services Info-structure, which effectuates a synergy between knowledge procurement (vis-à-vis Data Mining) and knowledge operationalisation (vis-à-vis Knowledge Management) techniques to generate a suite of strategic knowledge-driven decision-support services. In conclusion, we argue that the proposed Healthcare Enterprise Memory is an attempt to rethink the possible sources of leverage to improve healthcare delivery, hereby providing a valuable strategic planning and management resource to healthcare policy makers.

Decision Support Framework (DSF) (Formerly Decision Support Platform)

EPA Science Inventory

The Science Advisory Board (SAB) provided several comments on the draft Ecosystem Services Research Program's (ESRP's) Multi-Year Plan (MYP). This presentation provides a response to comments related to the decision support framework (DSF) part of Long-Term Goal 1. The comments...

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

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

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

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

A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

PubMed

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

Using an ecosystem service decision support tool to support ridge to reef management: An example of sediment reduction in west Maui, Hawaii

NASA Astrophysics Data System (ADS)

Falinski, K. A.; Oleson, K.; Htun, H.; Kappel, C.; Lecky, J.; Rowe, C.; Selkoe, K.; White, C.

2016-12-01

Faced with anthropogenic stressors and declining coral reef states, managers concerned with restoration and resilience of coral reefs are increasingly recognizing the need to take a ridge-to-reef, ecosystem-based approach. An ecosystem services framing can help managers move towards these goals, helping to illustrate trade-offs and opportunities of management actions in terms of their impacts on society. We describe a research program building a spatial ecosystem services-based decision-support tool, and being applied to guide ridge-to-reef management in a NOAA priority site in West Maui. We use multiple modeling methods to link biophysical processes to ecosystem services and their spatial flows and social values in an integrating platform. Modeled services include water availability, sediment retention, nutrient retention and carbon sequestration on land. A coral reef ecosystem service model is under development to capture the linkages between terrestrial and coastal ecosystem services. Valuation studies are underway to quantify the implications for human well-being. The tool integrates techniques from decision science to facilitate decision making. We use the sediment retention model to illustrate the types of analyses the tool can support. The case study explores the tradeoffs between road rehabilitation costs and sediment export avoided. We couple the sediment and cost models with trade-off analysis to identify optimal distributed solutions that are most cost-effective in reducing erosion, and then use those models to estimate sediment exposure to coral reefs. We find that cooperation between land owners reveals opportunities for maximizing the benefits of fixing roads and minimizes costs. This research forms the building blocks of an ecosystem service decision support tool that we intend to continue to test and apply in other Pacific Island settings.

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

DOT National Transportation Integrated Search

2004-03-15

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

Disaster Response and Decision Support in Partnership with the California Earthquake Clearinghouse

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Rosinski, A.; Vaughan, D.; Morentz, J.

2014-12-01

Getting the right information to the right people at the right time is critical during a natural disaster. E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) is a NASA decision support system designed to produce remote sensing and geophysical modeling data products that are relevant to the emergency preparedness and response communities and serve as a gateway to enable the delivery of NASA decision support products to these communities. The E-DECIDER decision support system has several tools, services, and products that have been used to support end-user exercises in partnership with the California Earthquake Clearinghouse since 2012, including near real-time deformation modeling results and on-demand maps of critical infrastructure that may have been potentially exposed to damage by a disaster. E-DECIDER's underlying service architecture allows the system to facilitate delivery of NASA decision support products to the Clearinghouse through XchangeCore Web Service Data Orchestration that allows trusted information exchange among partner agencies. This in turn allows Clearinghouse partners to visualize data products produced by E-DECIDER and other NASA projects through incident command software such as SpotOnResponse or ArcGIS Online.

Participation and Service Access Rights for People with Intellectual Disability: A Role for Law?

ERIC Educational Resources Information Center

Carney, Terry

2013-01-01

Background: Supported decision-making and personal budgets for services are the new paradigms. Method: Supported decision-making proposals from the Australian State of Victoria are analysed against international trends to determine the viability of laws reflecting new international norms of the United Nations Convention on the Rights of Persons…

Driving with roadmaps and dashboards: using information resources to structure the decision models in service organizations.

PubMed

Chorpita, Bruce F; Bernstein, Adam; Daleiden, Eric L

2008-03-01

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.

47 CFR 54.725 - Universal service disbursements during pendency of a request for review and Administrator decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Review of Decisions... health care support mechanism, the Administrator shall not reimburse a service provider for the provision... Federal Communications Commission; provided, however, that the Administrator may disburse funds for any...

Opportunities and Strategies to Incorporate Ecosystem Services Knowledge and Decision Support Tools into Planning and Decision Making in Hawai`i

NASA Astrophysics Data System (ADS)

Bremer, Leah L.; Delevaux, Jade M. S.; Leary, James J. K.; J. Cox, Linda; Oleson, Kirsten L. L.

2015-04-01

Incorporating ecosystem services into management decisions is a promising means to link conservation and human well-being. Nonetheless, planning and management in Hawai`i, a state with highly valued natural capital, has yet to broadly utilize an ecosystem service approach. We conducted a stakeholder assessment, based on semi-structured interviews, with terrestrial ( n = 26) and marine ( n = 27) natural resource managers across the State of Hawai`i to understand the current use of ecosystem services (ES) knowledge and decision support tools and whether, how, and under what contexts, further development would potentially be useful. We found that ES knowledge and tools customized to Hawai`i could be useful for communication and outreach, justifying management decisions, and spatial planning. Greater incorporation of this approach is clearly desired and has a strong potential to contribute to more sustainable decision making and planning in Hawai`i and other oceanic island systems. However, the unique biophysical, socio-economic, and cultural context of Hawai`i, and other island systems, will require substantial adaptation of existing ES tools. Based on our findings, we identified four key opportunities for the use of ES knowledge and tools in Hawai`i: (1) linking native forest protection to watershed health; (2) supporting sustainable agriculture; (3) facilitating ridge-to-reef management; and (4) supporting statewide terrestrial and marine spatial planning. Given the interest expressed by natural resource managers, we envision broad adoption of ES knowledge and decision support tools if knowledge and tools are tailored to the Hawaiian context and coupled with adequate outreach and training.

Opportunities and strategies to incorporate ecosystem services knowledge and decision support tools into planning and decision making in Hawai'i.

PubMed

Bremer, Leah L; Delevaux, Jade M S; Leary, James J K; J Cox, Linda; Oleson, Kirsten L L

2015-04-01

Incorporating ecosystem services into management decisions is a promising means to link conservation and human well-being. Nonetheless, planning and management in Hawai'i, a state with highly valued natural capital, has yet to broadly utilize an ecosystem service approach. We conducted a stakeholder assessment, based on semi-structured interviews, with terrestrial (n = 26) and marine (n = 27) natural resource managers across the State of Hawai'i to understand the current use of ecosystem services (ES) knowledge and decision support tools and whether, how, and under what contexts, further development would potentially be useful. We found that ES knowledge and tools customized to Hawai'i could be useful for communication and outreach, justifying management decisions, and spatial planning. Greater incorporation of this approach is clearly desired and has a strong potential to contribute to more sustainable decision making and planning in Hawai'i and other oceanic island systems. However, the unique biophysical, socio-economic, and cultural context of Hawai'i, and other island systems, will require substantial adaptation of existing ES tools. Based on our findings, we identified four key opportunities for the use of ES knowledge and tools in Hawai'i: (1) linking native forest protection to watershed health; (2) supporting sustainable agriculture; (3) facilitating ridge-to-reef management; and (4) supporting statewide terrestrial and marine spatial planning. Given the interest expressed by natural resource managers, we envision broad adoption of ES knowledge and decision support tools if knowledge and tools are tailored to the Hawaiian context and coupled with adequate outreach and training.

EMDS users guide (version 2.0): knowledge-based decision support for ecological assessment.

Treesearch

Keith M. Reynolds

1999-01-01

The USDA Forest Service Pacific Northwest Research Station in Corvallis, Oregon, has developed the ecosystem management decision support (EMDS) system. The system integrates the logical formalism of knowledge-based reasoning into a geographic information system (GIS) environment to provide decision support for ecological landscape assessment and evaluation. The...

Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based Web service for clinical decision support.

PubMed

Kawamoto, Kensaku; Lobach, David F

2005-01-01

Despite their demonstrated ability to improve care quality, clinical decision support systems are not widely used. In part, this limited use is due to the difficulty of sharing medical knowledge in a machine-executable format. To address this problem, we developed a decision support Web service known as SEBASTIAN. In SEBASTIAN, individual knowledge modules define the data requirements for assessing a patient, the conclusions that can be drawn using that data, and instructions on how to generate those conclusions. Using standards-based XML messages transmitted over HTTP, client decision support applications provide patient data to SEBASTIAN and receive patient-specific assessments and recommendations. SEBASTIAN has been used to implement four distinct decision support systems; an architectural overview is provided for one of these systems. Preliminary assessments indicate that SEBASTIAN fulfills all original design objectives, including the re-use of executable medical knowledge across diverse applications and care settings, the straightforward authoring of knowledge modules, and use of the framework to implement decision support applications with significant clinical utility.

48 CFR 2.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... support or improve: organizational policy development; decision-making; management and administration... organizations, activities (including management and support services for R&D activities), or systems. These..., decision-making, management, or administration. Included are studies in support of R&D activities. Also...

48 CFR 2.101 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... support or improve: organizational policy development; decision-making; management and administration... organizations, activities (including management and support services for R&D activities), or systems. These..., decision-making, management, or administration. Included are studies in support of R&D activities. Also...

Non-monetary valuation using Multi-Criteria Decision Analysis: Sensitivity of additive aggregation methods to scaling and compensation assumptions

EPA Science Inventory

Analytical methods for Multi-Criteria Decision Analysis (MCDA) support the non-monetary valuation of ecosystem services for environmental decision making. Many published case studies transform ecosystem service outcomes into a common metric and aggregate the outcomes to set land ...

Knowledge-Based Information Management in Decision Support for Ecosystem Management

Treesearch

Keith Reynolds; Micahel Saunders; Richard Olson; Daniel Schmoldt; Michael Foster; Donald Latham; Bruce Miller; John Steffenson; Lawrence Bednar; Patrick Cunningham

1995-01-01

The Pacific Northwest Research Station (USDA Forest Service) is developing a knowledge-based information management system to provide decision support for watershed analysis in the Pacific Northwest region of the U.S. The decision support system includes: (1) a GIS interface that allows users to graphically navigate to specific provinces and watersheds and display a...

Development of Web Mapping Service Capabilities to Support NASA Disasters Applications/App Development

NASA Technical Reports Server (NTRS)

Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2014-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Development of Web Mapping Service Capabilities to Support NASA Disasters Applications / App Development

NASA Technical Reports Server (NTRS)

Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2014-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Service users' experiences of participation in decision making in mental health services.

PubMed

Dahlqvist Jönsson, P; Schön, U-K; Rosenberg, D; Sandlund, M; Svedberg, P

2015-11-01

Despite the potential positive impact of shared decision making on service users knowledge and experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. This study highlights the desire of users to participate more actively in decision making and demonstrates that persons with SMI struggle to be seen as competent and equal partners in decision-making situations. Those interviewed did not feel that their strengths, abilities and needs were being recognized, which resulted in a feeling of being omitted from involvement in decision-making situations. The service users describe some essential conditions that could work to promote participation in decision making. These included having personal support, having access to knowledge, being involved in a dialogue and clarity about responsibilities. Mental health nurses can play an essential role for developing and implementing shared decision making as a tool to promote recovery-oriented mental health services. Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions. © 2015 John Wiley & Sons Ltd.

mobilityRERC state of the science conference: Considerations for developing an evidence base for wheeled mobility and seating service delivery.

PubMed

Cohen, Laura; Greer, Nancy; Berliner, Elise; Sprigle, Stephen

2013-11-01

This article, developed as background content for discussion during the Mobility Rehabilitation Engineering Research Center State of the Science Conference, reviews research surrounding wheeled mobility and seating (WMS) service delivery, discusses the challenges of improving clinical decision-making, and discusses research approaches used to study and improve health services in other practice areas that might be leveraged to develop the evidence base for WMS. Narrative literature review. An overview of existing research found general agreement across models of WMS service delivery but little high quality evidence to support the recommended approaches and few studies of the relationship between service delivery steps and individual patient outcomes. The definition of successful clinical decision-making is different for different stakeholders. Clinical decision-making should incorporate the best available evidence along with patient values, preferences, circumstances, and clinical expertise. To advance the evidence base for WMS service delivery, alternatives to randomized controlled trials should be considered and reliable and valid outcome measures developed. Technological advances offer tremendous opportunities for individuals with complex rehabilitation technology needs. However, with ongoing scrutiny of WMS service delivery there is an increased need for evidence to support the clinical decision-making process and to support evidence-based coverage policies for WMS services and technologies. An evidence base for wheeled mobility and seating services is an important component of the clinical decision-making process. At present, there is little evidence regarding essential components of the wheeled mobility and seating evaluation or the relationship between the evaluation process and patient outcomes. Many factors can confound this relationship and present challenges to research in this area. All stakeholders (i.e. clinicians, rehabilitation technology suppliers, manufacturers, researchers, payers, policy makers, and wheelchair users) need to work together to develop and support an evidence base for wheeled mobility and seating service delivery.

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

EPA Science Inventory

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

Assessing Sustainability of Coral Reef Ecosystem Services using a Spatially-Explicit Decision Support Tool

EPA Science Inventory

Forecasting and communicating the potential outcomes of decision options requires support tools that aid in evaluating alternative scenarios in a user-friendly context and that highlight variables relevant to the decision options and valuable stakeholders. Envision is a GIS-base...

Reef Ecosystem Services and Decision Support Database

EPA Science Inventory

This scientific and management information database utilizes systems thinking to describe the linkages between decisions, human activities, and provisioning of reef ecosystem goods and services. This database provides: (1) Hierarchy of related topics - Click on topics to navigat...

Combat Service Support (CSS) Enabler Functional Assessment (CEFA)

DTIC Science & Technology

1998-07-01

CDR), Combined Arms Support Command (CASCOM) with a tool to aid decision making related to mitigating E/I peacetime (programmatic) and wartime risks...not be fielded by Fiscal Year (FY) 10. Based on their estimates, any decisions , especially reductions in manpower, which rely on the existence of the E...Support (CSS) enablers/initiatives (E/I), thereby providing the Commander (CDR), Combined Arms Support Command (CASCOM) with a tool to aid decision

What factors influence the decisions of mental health professionals to release service users from seclusion?

PubMed

Jackson, Haley; Baker, John; Berzins, Kathyrn

2018-06-22

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion. © 2018 Australian College of Mental Health Nurses Inc.

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.

Enabling Real-time Water Decision Support Services Using Model as a Service

NASA Astrophysics Data System (ADS)

Zhao, T.; Minsker, B. S.; Lee, J. S.; Salas, F. R.; Maidment, D. R.; David, C. H.

2014-12-01

Through application of computational methods and an integrated information system, data and river modeling services can help researchers and decision makers more rapidly understand river conditions under alternative scenarios. To enable this capability, workflows (i.e., analysis and model steps) are created and published as Web services delivered through an internet browser, including model inputs, a published workflow service, and visualized outputs. The RAPID model, which is a river routing model developed at University of Texas Austin for parallel computation of river discharge, has been implemented as a workflow and published as a Web application. This allows non-technical users to remotely execute the model and visualize results as a service through a simple Web interface. The model service and Web application has been prototyped in the San Antonio and Guadalupe River Basin in Texas, with input from university and agency partners. In the future, optimization model workflows will be developed to link with the RAPID model workflow to provide real-time water allocation decision support services.

A comparative assessment of tools for ecosystem services quantification and valuation

USGS Publications Warehouse

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

2013-01-01

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

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

PubMed

Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

2012-01-01

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

Customer Decision Making in Web Services with an Integrated P6 Model

NASA Astrophysics Data System (ADS)

Sun, Zhaohao; Sun, Junqing; Meredith, Grant

Customer decision making (CDM) is an indispensable factor for web services. This article examines CDM in web services with a novel P6 model, which consists of the 6 Ps: privacy, perception, propensity, preference, personalization and promised experience. This model integrates the existing 6 P elements of marketing mix as the system environment of CDM in web services. The new integrated P6 model deals with the inner world of the customer and incorporates what the customer think during the DM process. The proposed approach will facilitate the research and development of web services and decision support systems.

Creating Ecosystem Services Indices with EnviroAtlas Metrics

EPA Science Inventory

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

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

PubMed

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

2008-11-01

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

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.

Just in Time: How Evidence-on-Demand Services Support Decision Making in Ontario's Child and Youth Mental Health Sector

ERIC Educational Resources Information Center

Notarianni, Maryann; Sundar, Purnima; Carter, Charles

2016-01-01

Using the best available evidence to inform decision making is important for the design or delivery of effective health-related services and broader public policy. Several studies identify barriers and facilitators to evidence-informed decision making in Canadian health settings. This paper describes how the Ontario Centre of Excellence for Child…

Combining ecosystem services assessment with structured decision making to support ecological restoration planning.

PubMed

Martin, David M; Mazzotta, Marisa; Bousquin, Justin

2018-04-10

Accounting for ecosystem services in environmental decision making is an emerging research topic. Modern frameworks for ecosystem services assessment emphasize evaluating the social benefits of ecosystems, in terms of who benefits and by how much, to aid in comparing multiple courses of action. Structured methods that use decision analytic-approaches are emerging for the practice of ecological restoration. In this article, we combine ecosystem services assessment with structured decision making to estimate and evaluate measures of the potential benefits of ecological restoration with a case study in the Woonasquatucket River watershed, Rhode Island, USA. We partnered with a local watershed management organization to analyze dozens of candidate wetland restoration sites for their abilities to supply five ecosystem services-flood water retention, scenic landscapes, learning opportunities, recreational opportunities, and birds. We developed 22 benefit indicators related to the ecosystem services as well as indicators for social equity and reliability that benefits will sustain in the future. We applied conceptual modeling and spatial analysis to estimate indicator values for each candidate restoration site. Lastly, we developed a decision support tool to score and aggregate the values for the organization to screen the restoration sites. Results show that restoration sites in urban areas can provide greater social benefits than sites in less urban areas. Our research approach is general and can be used to investigate other restoration planning studies that perform ecosystem services assessment and fit into a decision-making process.

Development of WMS Capabilities to Support NASA Disasters Applications and App Development

NASA Astrophysics Data System (ADS)

Bell, J. R.; Burks, J. E.; Molthan, A.; McGrath, K. M.

2013-12-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Development of WMS Capabilities to Support NASA Disasters Applications and App Development

NASA Technical Reports Server (NTRS)

Bell, Jordan R.; Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2013-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia's addiction services agencies.

PubMed

Murphy, Matthew; MacCarthy, M Jayne; McAllister, Lynda; Gilbert, Robert

2014-12-05

Competency profiles for occupational clusters within Canada's substance abuse workforce (SAW) define the need for skill and knowledge in evidence-based practice (EBP) across all its members. Members of the Senior Management occupational cluster hold ultimate responsibility for decisions made within addiction services agencies and therefore must possess the highest level of proficiency in EBP. The objective of this study was to assess the knowledge of the principles of EBP, and use of the components of the evidence-based decision making (EBDM) process in members of this occupational cluster from selected addiction services agencies in Nova Scotia. A convenience sampling method was used to recruit participants from addiction services agencies. Semi-structured qualitative interviews were conducted with eighteen Senior Management. The interviews were audio-recorded, transcribed verbatim and checked by the participants. Interview transcripts were coded and analyzed for themes using content analysis and assisted by qualitative data analysis software (NVivo 9.0). Data analysis revealed four main themes: 1) Senior Management believe that addictions services agencies are evidence-based; 2) Consensus-based decision making is the norm; 3) Senior Management understand the principles of EBP and; 4) Senior Management do not themselves use all components of the EBDM process when making decisions, oftentimes delegating components of this process to decision support staff. Senior Management possess an understanding of the principles of EBP, however, when making decisions they often delegate components of the EBDM process to decision support staff. Decision support staff are not defined as an occupational cluster in Canada's SAW and have not been ascribed a competency profile. As such, there is no guarantee that this group possesses competency in EBDM. There is a need to advocate for the development of a defined occupational cluster and associated competency profile for this critical group.

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.

NASA Wrangler: Automated Cloud-Based Data Assembly in the RECOVER Wildfire Decision Support System

NASA Technical Reports Server (NTRS)

Schnase, John; Carroll, Mark; Gill, Roger; Wooten, Margaret; Weber, Keith; Blair, Kindra; May, Jeffrey; Toombs, William

2017-01-01

NASA Wrangler is a loosely-coupled, event driven, highly parallel data aggregation service designed to take advantageof the elastic resource capabilities of cloud computing. Wrangler automatically collects Earth observational data, climate model outputs, derived remote sensing data products, and historic biophysical data for pre-, active-, and post-wildfire decision making. It is a core service of the RECOVER decision support system, which is providing rapid-response GIS analytic capabilities to state and local government agencies. Wrangler reduces to minutes the time needed to assemble and deliver crucial wildfire-related data.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

PubMed

Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

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

PubMed

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

2014-06-01

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

An Intelligent Polar Cyberinfrastrucuture to Support Spatiotemporal Decision Making

NASA Astrophysics Data System (ADS)

Song, M.; Li, W.; Zhou, X.

2014-12-01

In the era of big data, polar sciences have already faced an urgent demand of utilizing intelligent approaches to support precise and effective spatiotemporal decision-making. Service-oriented cyberinfrastructure has advantages of seamlessly integrating distributed computing resources, and aggregating a variety of geospatial data derived from Earth observation network. This paper focuses on building a smart service-oriented cyberinfrastructure to support intelligent question answering related to polar datasets. The innovation of this polar cyberinfrastructure includes: (1) a problem-solving environment that parses geospatial question in natural language, builds geoprocessing rules, composites atomic processing services and executes the entire workflow; (2) a self-adaptive spatiotemporal filter that is capable of refining query constraints through semantic analysis; (3) a dynamic visualization strategy to support results animation and statistics in multiple spatial reference systems; and (4) a user-friendly online portal to support collaborative decision-making. By means of this polar cyberinfrastructure, we intend to facilitate integration of distributed and heterogeneous Arctic datasets and comprehensive analysis of multiple environmental elements (e.g. snow, ice, permafrost) to provide a better understanding of the environmental variation in circumpolar regions.

Developing an Ecosystem Services online Decision Support Tool to Assess the Impacts of Climate Change and Urban Growth in the Santa Cruz Watershed; Where We Live, Work, and Play

EPA Science Inventory

Processes through which ecosystems provide goods or benefit people can be referred to as "ecosystems services”, which may be quantified to clarify decision-making, with techniques including cost-benefit analysis. We are developing an online decision support tool, the Santa Cruz W...

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…

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

PubMed

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

2017-04-01

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

The CHOICE pilot project: Challenges of implementing a combined peer work and shared decision-making programme in an early intervention service.

PubMed

Simmons, Magenta B; Coates, Dominiek; Batchelor, Samantha; Dimopoulos-Bick, Tara; Howe, Deborah

2017-12-12

Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service. This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making. Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions. Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health. © 2017 John Wiley & Sons Australia, Ltd.

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 cyber-enabled spatial decision support system to inventory Mangroves in Mozambique: coupling scientific workflows and cloud computing

Treesearch

Wenwu Tang; Wenpeng Feng; Meijuan Jia; Jiyang Shi; Huifang Zuo; Christina E. Stringer; Carl C. Trettin

2017-01-01

Mangroves are an important terrestrial carbon reservoir with numerous ecosystem services. Yet, it is difficult to inventory mangroves because of their low accessibility. A sampling approach that produces accurate assessment while maximizing logistical integrity of inventory operation is often required. Spatial decision support systems (SDSSs) provide support for...

Family planning decisions for parents of children with a rare genetic condition: A scoping review.

PubMed

Gee, Melanie; Piercy, Hilary; Machaczek, Katarzyna

2017-12-01

Expansion of newborn screening programmes increases the complexity around reproductive choices, both in terms of the increased number of parents faced with making reproductive decisions from the earliest days of their affected child's life, and the number of conditions for which such decisions have to be made. We conducted a scoping review to explore: (i) reproductive decision-making among parents of children with recessive genetic conditions; and, (ii) the involvement of healthcare services in facilitating and supporting those decisions. Systematic search processes involved seven bibliographic databases, citation, and grey literature searches. From an initial total of 311 identified articles, seven met the inclusion criteria and were included in the review. The extracted data were organised around three themes: factors influencing reproductive decisions taken by parents, how those factors changed over time, and the involvement of healthcare services in supporting and facilitating reproductive decisions. Most studies focused on attitudes towards, and uptake of, pre-natal diagnosis (PND) and termination. None of the studies considered the wider range of reproductive choices facing all parents, including those of children with conditions for whom PND and termination is not available or where good health outcomes make these options less justifiable. The literature provided little insight into the role of healthcare staff in providing family planning support for these parents. There is a need to better understand the support parents need in their decision-making, and who is best placed to provide that support. Copyright © 2017 Elsevier B.V. All rights reserved.

Bringing ecosystem services into integrated water resources management.

PubMed

Liu, Shuang; Crossman, Neville D; Nolan, Martin; Ghirmay, Hiyoba

2013-11-15

In this paper we propose an ecosystem service framework to support integrated water resource management and apply it to the Murray-Darling Basin in Australia. Water resources in the Murray-Darling Basin have been over-allocated for irrigation use with the consequent degradation of freshwater ecosystems. In line with integrated water resource management principles, Australian Government reforms are reducing the amount of water diverted for irrigation to improve ecosystem health. However, limited understanding of the broader benefits and trade-offs associated with reducing irrigation diversions has hampered the planning process supporting this reform. Ecosystem services offer an integrative framework to identify the broader benefits associated with integrated water resource management in the Murray-Darling Basin, thereby providing support for the Government to reform decision-making. We conducted a multi-criteria decision analysis for ranking regional potentials to provide ecosystem services at river basin scale. We surveyed the wider public about their understanding of, and priorities for, managing ecosystem services and then integrated the results with spatially explicit indicators of ecosystem service provision. The preliminary results of this work identified the sub-catchments with the greatest potential synergies and trade-offs of ecosystem service provision under the integrated water resources management reform process. With future development, our framework could be used as a decision support tool by those grappling with the challenge of the sustainable allocation of water between irrigation and the environment. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

PubMed

da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

2005-01-01

This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

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

EPA Science Inventory

This product provides an integrated assessment framework linked to a decision support system (DSS) that incorporates the ecological integrity (EI) principles and goals described in detail in the US EPA’s Office of Water’s Healthy Watersheds Program (HWP), with Ecosyst...

Generic Sensor Data Fusion Services for Web-enabled Environmental Risk Management and Decision-Support Systems

NASA Astrophysics Data System (ADS)

Sabeur, Zoheir; Middleton, Stuart; Veres, Galina; Zlatev, Zlatko; Salvo, Nicola

2010-05-01

The advancement of smart sensor technology in the last few years has led to an increase in the deployment of affordable sensors for monitoring the environment around Europe. This is generating large amounts of sensor observation information and inevitably leading to problems about how to manage large volumes of data as well as making sense out the data for decision-making. In addition, the various European Directives (Water Framework Diectives, Bathing Water Directives, Habitat Directives, etc.. ) which regulate human activities in the environment and the INSPIRE Directive on spatial information management regulations have implicitely led the designated European Member States environment agencies and authorities to put in place new sensor monitoring infrastructure and share information about environmental regions under their statutory responsibilities. They will need to work cross border and collectively reach environmental quality standards. They will also need to regularly report to the EC on the quality of the environments of which they are responsible and make such information accessible to the members of the public. In recent years, early pioneering work on the design of service oriented architecture using sensor networks has been achieved. Information web-services infrastructure using existing data catalogues and web-GIS map services can now be enriched with the deployment of new sensor observation and data fusion and modelling services using OGC standards. The deployment of the new services which describe sensor observations and intelligent data-processing using data fusion techniques can now be implemented and provide added value information with spatial-temporal uncertainties to the next generation of decision support service systems. The new decision support service systems have become key to implement across Europe in order to comply with EU environmental regulations and INSPIRE. In this paper, data fusion services using OGC standards with sensor observation data streams are described in context of a geo-distributed service infrastructure specialising in multiple environmental risk management and decision-support. The sensor data fusion services are deployed and validated in two use cases. These are respectively concerned with: 1) Microbial risks forecast in bathing waters; and 2) Geohazards in urban zones during underground tunneling activities. This research was initiated in the SANY Integrated Project(www.sany-ip.org) and funded by the European Commission under the 6th Framework Programme.

Structured decision making as a framework for linking quantitative decision support to community values

EPA Science Inventory

Community-level decisions can have large impacts on production and delivery of ecosystem services, which ultimately affects community well-being. But engaging stakeholders in a process to explore these impacts is a significant challenge. The principles of Structured Decision Ma...

System for selecting relevant information for decision support.

PubMed

Kalina, Jan; Seidl, Libor; Zvára, Karel; Grünfeldová, Hana; Slovák, Dalibor; Zvárová, Jana

2013-01-01

We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

NASA Technical Reports Server (NTRS)

Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

2008-01-01

Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

An Ecosystem Service Evaluation Tool to Support Ridge-to-Reef Management and Conservation in Hawaii

NASA Astrophysics Data System (ADS)

Oleson, K.; Callender, T.; Delevaux, J. M. S.; Falinski, K. A.; Htun, H.; Jin, G.

2014-12-01

Faced with increasing anthropogenic stressors and diverse stakeholders, local managers are adopting a ridge-to-reef and multi-objective management approach to restore declining coral reef health state. An ecosystem services framework, which integrates ecological indicators and stakeholder values, can foster more applied and integrated research, data collection, and modeling, and thus better inform the decision-making process and realize decision outcomes grounded in stakeholders' values. Here, we describe a research program that (i) leverages remotely sensed and empirical data to build an ecosystem services-based decision-support tool geared towards ridge-to-reef management; and (ii) applies it as part of a structured, value-based decision-making process to inform management in west Maui, a NOAA coral reef conservation priority site. The tool links terrestrial and marine biophysical models in a spatially explicit manner to quantify and map changes in ecosystem services delivery resulting from management actions, projected climate change impacts, and adaptive responses. We couple model outputs with localized valuation studies to translate ecosystem service outcomes into benefits and their associated socio-cultural and/or economic values. Managers can use this tool to run scenarios during their deliberations to evaluate trade-offs, cost-effectiveness, and equity implications of proposed policies. Ultimately, this research program aims at improving the effectiveness, efficiency, and equity outcomes of ecosystem-based management. This presentation will describe our approach, summarize initial results from the terrestrial modeling and economic valuations for west Maui, and highlight how this decision support tool benefits managers in west Maui.

Decision Support Framework (DSF) For Planning Land And Resource Use To Sustainably Maintain Healthy Ecosystem Services And Communities

EPA Science Inventory

Land and resource use decisions are typically made to increase the economic viability of an area with little attention to the long term effects on human health and the environment from the resulting environmental condition after an action is taken. Currently, ecosystem services ...

Choice-Making among Medicaid HCBS and ICF/MR Recipients in Six States

ERIC Educational Resources Information Center

Lakin, K. Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-01-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in nonfamily settings in six states. Everyday choice in daily life and in…

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…

Building an Evidence Base for Speech-Language Services in the Schools: Challenges and Recommendations

ERIC Educational Resources Information Center

Whitmire, Kathleen A.; Rivers, Kenyatta O.; Mele-McCarthy, Joan A.; Staskowski, Maureen

2014-01-01

Speech-language pathologists are faced with demands for evidence to support practice. Federal legislation requires high-quality evidence for decisions regarding school-based services as part of evidence-based practice. The purpose of this article is to discuss the limited scientific evidence for making appropriate decisions about speech-language…

Web-based Traffic Noise Control Support System for Sustainable Transportation

NASA Astrophysics Data System (ADS)

Fan, Lisa; Dai, Liming; Li, Anson

Traffic noise is considered as one of the major pollutions that will affect our communities in the future. This paper presents a framework of web-based traffic noise control support system (WTNCSS) for a sustainable transportation. WTNCSS is to provide the decision makers, engineers and publics a platform to efficiently access the information, and effectively making decisions related to traffic control. The system is based on a Service Oriented Architecture (SOA) which takes the advantages of the convenience of World Wide Web system with the data format of XML. The whole system is divided into different modules such as the prediction module, ontology-based expert module and dynamic online survey module. Each module of the system provides a distinct information service to the decision support center through the HTTP protocol.

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.

Integrating climatic and fuels information into National Fire Risk Decision Support Tools

Treesearch

W. Cooke; V. Anantharaj; C. Wax; J. Choi; K. Grala; M. Jolly; G.P. Dixon; J. Dyer; D.L. Evans; G.B. Goodrich

2007-01-01

The Wildland Fire Assessment System (WFAS) is a component of the U.S. Department of Agriculture, Forest Service Decision Support Systems (DSS) that support fire potential modeling. Fire potential models for Mississippi and for Eastern fire environments have been developed as part of a National Aeronautic and Space Agency-funded study aimed at demonstrating the utility...

'Walking the tightrope': The role of peer support workers in facilitating consumers' participation in decision-making.

PubMed

Cleary, Michelle; Raeburn, Toby; Escott, Phil; West, Sancia; Lopez, Violeta

2018-05-09

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision-making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers' participation in decision-making and recovery. Semi-structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor-centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision-making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery-oriented care. © 2018 Australian College of Mental Health Nurses Inc.

7 CFR 652.36 - Appeal of decertification decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... technical service provider's written appeal, the Chief or his designee, will make a final determination, in... CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE SUPPORT ACTIVITIES TECHNICAL SERVICE PROVIDER ASSISTANCE... of the State Conservationist's decertification determination, the technical service provider may...

Organic Versus Contractor Logistics Support For Depot-Level Repair: Factors That Drive Sub-Optimal Decisions

DTIC Science & Technology

2016-02-16

Considerations in Using CLS or Organic Support Break-Even Analysis in the Decision Process When a business decision is made in an ideal environment, all costs...Line B). The break-even point (Point C) is the production quantity where the advantage moves to a different cost curve. For a business decision...the Services to provide regular reporting to them on contractor versus organic workload and money .1415 In sum, there are laws that mandate 50/50

Understanding the stakeholders' intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool.

PubMed

Cheung, Kei Long; Evers, Silvia M A A; Hiligsmann, Mickaël; Vokó, Zoltán; Pokhrel, Subhash; Jones, Teresa; Muñoz, Celia; Wolfenstetter, Silke B; Józwiak-Hagymásy, Judit; de Vries, Hein

2016-01-01

Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understanding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e., the Return on Investment tool. Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA's were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool. Ninety-three stakeholders participated. Significant differences in beliefs were found between non-intenders and intenders: risk perception, attitude, social support, and self-efficacy towards using the tool. Regression showed that demographics, pre-motivational, and motivational factors explained 69% of the variation in intention. This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

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.

Decision-making experiences of family members of older adults with moderate dementia towards community and residential care home services: a grounded theory study protocol.

PubMed

Le Low, Lisa Pau; Lam, Lai Wah; Fan, Kim Pong

2017-06-05

Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services. A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken. The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

The Infusion of Dust Model Model Outputs into Public Health Decision Making - an Examination of Differential Adoption of SOAP and Open Geospatial Consortium Service Products into Public Health Decision Support Systems

NASA Astrophysics Data System (ADS)

Benedict, K. K.

2008-12-01

Since 2004 the Earth Data Analysis Center, in collaboration with the researchers at the University of Arizona and George Mason University, with funding from NASA, has been developing a services oriented architecture (SOA) that acquires remote sensing, meteorological forecast, and observed ground level particulate data (EPA AirNow) from NASA, NOAA, and DataFed through a variety of standards-based service interfaces. These acquired data are used to initialize and set boundary conditions for the execution of the Dust Regional Atmospheric Model (DREAM) to generate daily 48-hour dust forecasts, which are then published via a combination of Open Geospatial Consortium (OGC) services (WMS and WCS), basic HTTP request-based services, and SOAP services. The goal of this work has been to develop services that can be integrated into existing public health decision support systems (DSS) to provide enhanced environmental data (i.e. ground surface particulate concentration estimates) for use in epidemiological analysis, public health warning systems, and syndromic surveillance systems. While the project has succeeded in deploying these products into the target systems, there has been differential adoption of the different service interface products, with the simple OGC and HTTP interfaces generating much greater interest by DSS developers and researchers than the more complex SOAP service interfaces. This paper reviews the SOA developed as part of this project and provides insights into how different service models may have a significant impact on the infusion of Earth science products into decision making processes and systems.

Service oriented architecture for clinical decision support: a systematic review and future directions.

PubMed

Loya, Salvador Rodriguez; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech

2014-12-01

The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems' performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS.

Service Oriented Architecture for Clinical Decision Support: A Systematic Review and Future Directions

PubMed Central

Loya, Salvador Rodriguez; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech

2017-01-01

The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems’ performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS PMID:25325996

E-DECIDER: Using Earth Science Data and Modeling Tools to Develop Decision Support for Earthquake Disaster Response

NASA Astrophysics Data System (ADS)

Glasscoe, Margaret T.; Wang, Jun; Pierce, Marlon E.; Yoder, Mark R.; Parker, Jay W.; Burl, Michael C.; Stough, Timothy M.; Granat, Robert A.; Donnellan, Andrea; Rundle, John B.; Ma, Yu; Bawden, Gerald W.; Yuen, Karen

2015-08-01

Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing new capabilities for decision making utilizing remote sensing data and modeling software to provide decision support for earthquake disaster management and response. E-DECIDER incorporates the earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools allows us to provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). This in turn is delivered through standards-compliant web services for desktop and hand-held devices.

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.

Integrating post-manufacturing issues into design and manufacturing decisions

NASA Technical Reports Server (NTRS)

Eubanks, Charles F.

1996-01-01

An investigation is conducted on research into some of the fundamental issues underlying the design for manufacturing, service and recycling that affect engineering decisions early in the conceptual design phase of mechanical systems. The investigation focuses on a system-based approach to material selection, manufacturing methods and assembly processes related to overall product requirements, performance and life-cycle costs. Particular emphasis is placed on concurrent engineering decision support for post-manufacturing issues such as serviceability, recyclability, and product retirement.

Supporting Managers, Hearing the Public: A Decision Support Approach for Evaluating Ecosystem Services and Social Benefits from Urban Wetland and Stream-Buffer Restoration

EPA Science Inventory

Public officials and environmental managers face difficult decisions about how to allocate limited funds to the most beneficial restoration projects and how to define what a “beneficial” project is. Beneficial to what? Or to whom? And where? Traditionally, managers ha...

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study.

PubMed

Wilson, Paul M; Farley, Kate; Thompson, Carl; Chambers, Duncan; Bickerdike, Liz; Watt, Ian S; Lambert, Mark; Turner, Rhiannon

2015-01-09

Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making: 1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers' intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence. Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

PREFER: a European service providing forest fire management support products

NASA Astrophysics Data System (ADS)

Eftychidis, George; Laneve, Giovanni; Ferrucci, Fabrizio; Sebastian Lopez, Ana; Lourenco, Louciano; Clandillon, Stephen; Tampellini, Lucia; Hirn, Barbara; Diagourtas, Dimitris; Leventakis, George

2015-06-01

PREFER is a Copernicus project of the EC-FP7 program which aims developing spatial information products that may support fire prevention and burned areas restoration decisions and establish a relevant web-based regional service for making these products available to fire management stakeholders. The service focuses to the Mediterranean region, where fire risk is high and damages from wildfires are quite important, and develop its products for pilot areas located in Spain, Portugal, Italy, France and Greece. PREFER aims to allow fire managers to have access to online resources, which shall facilitate fire prevention measures, fire hazard and risk assessment, estimation of fire impact and damages caused by wildfire as well as support monitoring of post-fire regeneration and vegetation recovery. It makes use of a variety of products delivered by space borne sensors and develop seasonal and daily products using multi-payload, multi-scale and multi-temporal analysis of EO data. The PREFER Service portfolio consists of two main suite of products. The first refers to mapping products for supporting decisions concerning the Preparedness/Prevention Phase (ISP Service). The service delivers Fuel, Hazard and Fire risk maps for this purpose. Furthermore the PREFER portfolio includes Post-fire vegetation recovery, burn scar maps, damage severity and 3D fire damage assessment products in order to support relative assessments required in context of the Recovery/Reconstruction Phase (ISR Service) of fire management.

Modelling and Decision Support of Clinical Pathways

NASA Astrophysics Data System (ADS)

Gabriel, Roland; Lux, Thomas

The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems.

Supported Decision-Making: The Expectations Held by People With Experience of Mental Illness.

PubMed

Knight, Fauzia; Kokanović, Renata; Ridge, Damien; Brophy, Lisa; Hill, Nicholas; Johnston-Ataata, Kate; Herrman, Helen

2018-05-01

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the "Inward Expert," the "Outward Entrustor," the "Self-Aware Observer," and the "Social Integrator." These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users' needs and preferences.

Coordinating complex decision support activities across distributed applications

NASA Technical Reports Server (NTRS)

Adler, Richard M.

1994-01-01

Knowledge-based technologies have been applied successfully to automate planning and scheduling in many problem domains. Automation of decision support can be increased further by integrating task-specific applications with supporting database systems, and by coordinating interactions between such tools to facilitate collaborative activities. Unfortunately, the technical obstacles that must be overcome to achieve this vision of transparent, cooperative problem-solving are daunting. Intelligent decision support tools are typically developed for standalone use, rely on incompatible, task-specific representational models and application programming interfaces (API's), and run on heterogeneous computing platforms. Getting such applications to interact freely calls for platform independent capabilities for distributed communication, as well as tools for mapping information across disparate representations. Symbiotics is developing a layered set of software tools (called NetWorks! for integrating and coordinating heterogeneous distributed applications. he top layer of tools consists of an extensible set of generic, programmable coordination services. Developers access these services via high-level API's to implement the desired interactions between distributed applications.

An adaptive approach to invasive plant management on U.S. Fish and Wildlife Service-owned native prairies in the Prairie Pothole Region: decision support under uncertainity

USGS Publications Warehouse

Gannon, Jill J.; Moore, Clinton T.; Shaffer, Terry L.; Flanders-Wanner, Bridgette

2011-01-01

Much of the native prairie managed by the U.S. Fish and Wildlife Service (Service) in the Prairie Pothole Region (PPR) is extensively invaded by the introduced cool-season grasses smooth brome (Bromus inermis) and Kentucky bluegrass (Poa pratensis). The central challenge to managers is selecting appropriate management actions in the face of biological and environmental uncertainties. We describe the technical components of a USGS management project, and explain how the components integrate and inform each other, how data feedback from individual cooperators serves to reduce uncertainty across the whole region, and how a successful adaptive management project is coordinated and maintained on a large scale. In partnership with the Service, the U.S. Geological Survey is developing an adaptive decision support framework to assist managers in selecting management actions under uncertainty and maximizing learning from management outcomes. The framework is built around practical constraints faced by refuge managers and includes identification of the management objective and strategies, analysis of uncertainty and construction of competing decision models, monitoring, and mechanisms for model feedback and decision selection. Nineteen Service field stations, spanning four states of the PPR, are participating in the project. They share a common management objective, available management strategies, and biological uncertainties. While the scope is broad, the project interfaces with individual land managers who provide refuge-specific information and receive updated decision guidance that incorporates understanding gained from the collective experience of all cooperators.

A decision framework for identifying models to estimate forest ecosystem services gains from restoration

USGS Publications Warehouse

Christin, Zachary; Bagstad, Kenneth J.; Verdone, Michael

2016-01-01

Restoring degraded forests and agricultural lands has become a global conservation priority. A growing number of tools can quantify ecosystem service tradeoffs associated with forest restoration. This evolving “tools landscape” presents a dilemma: more tools are available, but selecting appropriate tools has become more challenging. We present a Restoration Ecosystem Service Tool Selector (RESTS) framework that describes key characteristics of 13 ecosystem service assessment tools. Analysts enter information about their decision context, services to be analyzed, and desired outputs. Tools are filtered and presented based on five evaluative criteria: scalability, cost, time requirements, handling of uncertainty, and applicability to benefit-cost analysis. RESTS uses a spreadsheet interface but a web-based interface is planned. Given the rapid evolution of ecosystem services science, RESTS provides an adaptable framework to guide forest restoration decision makers toward tools that can help quantify ecosystem services in support of restoration.

Aggregate measures of ecosystem services: Can we take the pulse of nature?

USGS Publications Warehouse

Meyerson, L.A.; Baron, Jill S.; Melillo, J.M.; Naiman, R.J.; O'Malley, R.I.; Orians, G.; Palmer, Margaret A.; Pfaff, Alexander S.P.; Running, S.W.; Sala, O.E.

2005-01-01

National scale aggregate indicators of ecosystem services are useful for stimulating and supporting a broad public discussion about trends in the provision of these services. There are important considerations involved in producing an aggregate indicator, including whether the scientific and technological capacity exists, how to address varying perceptions of the societal importance of different services, and how to communicate information about these services to both decision makers and the general public. Although the challenges are formidable, they are not insurmountable. Quantification of ecosystem services and dissemination of information to decision makers and the public is critical for the responsible and sustainable management of natural resources.

Warrants, design, and safety of road ranger service patrols : draft final report.

DOT National Transportation Integrated Search

2016-11-01

This research project created a decision support system for managers who must decide if a roadway warrants the addition of the Safety Service Patrol (SSP). Meetings with Florida Department of Transportation (FDOT) service patrol program manager...

The use of the Dutch Self-Sufficiency Matrix (SSM-D) to inform allocation decisions to public mental health care for homeless people.

PubMed

Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Fassaert, Thijs J L; van Wifferen, Ron; Klazinga, Niek S

2014-10-01

The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.

Meet EPA Scientist Susan Yee, Ph.D.

EPA Pesticide Factsheets

Susan Yee, Ph.D., is an ecologist at EPA's Gulf Ecology Division. She is working on the Puerto Rico Sustainable Communities program, developing decision support tools to evaluate how alternative decisions impact coastal ecosystem goods and services

CAN BIVALVES BE USEFUL INDICATORS OF ECOSYSTEM CONDITION?

EPA Science Inventory

Numerous management decisions are made to sustain multiple, and often competing, products and services from coastal ecosystems. Scientific support for these decisions emanate from environmental indicators or selected measurements used in a monitoring program. Indicators are surro...

Preliminary results from a survey of U.S. Forest Service wildfire managers' attitudes toward aviation personnel exposure and risk

Treesearch

Matthew Wibbenmeyer; Michael Hand; David Calkin

2012-01-01

The U.S. Department of Agriculture, Forest Service (USFS) has, in recent years, increasingly emphasized the importance of safety to its employees, but wildfire management remains a risky endeavor. While wildfire management decisions affecting safety and exposure of firefighters to the wildland fire environment may be aided by decision support tools such the Wildfire...

Interprofessional education about patient decision support in specialty care.

PubMed

Politi, Mary C; Pieterse, Arwen H; Truant, Tracy; Borkhoff, Cornelia; Jha, Vikram; Kuhl, Laura; Nicolai, Jennifer; Goss, Claudia

2011-11-01

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.

Developing Cost Accounting and Decision Support Software for Comprehensive Community-Based Support Systems: An Analysis of Needs, Interest, and Readiness in the Field.

ERIC Educational Resources Information Center

Harrington, Robert; Jenkins, Peter; Marzke, Carolyn; Cohen, Carol

Prominent among the new models of social service delivery are organizations providing comprehensive, community-based supports and services (CCBSS) to children and their families. A needs analysis explored CCBSS sites' interest in and readiness to use a software tool designed to help them make more effective internal resource allocation decisions…

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.

Visualising Pareto-optimal trade-offs helps move beyond monetary-only criteria for water management decisions

NASA Astrophysics Data System (ADS)

Hurford, Anthony; Harou, Julien

2014-05-01

Water related eco-system services are important to the livelihoods of the poorest sectors of society in developing countries. Degradation or loss of these services can increase the vulnerability of people decreasing their capacity to support themselves. New approaches to help guide water resources management decisions are needed which account for the non-market value of ecosystem goods and services. In case studies from Brazil and Kenya we demonstrate the capability of many objective Pareto-optimal trade-off analysis to help decision makers balance economic and non-market benefits from the management of existing multi-reservoir systems. A multi-criteria search algorithm is coupled to a water resources management simulator of each basin to generate a set of Pareto-approximate trade-offs representing the best case management decisions. In both cases, volume dependent reservoir release rules are the management decisions being optimised. In the Kenyan case we further assess the impacts of proposed irrigation investments, and how the possibility of new investments impacts the system's trade-offs. During the multi-criteria search (optimisation), performance of different sets of management decisions (policies) is assessed against case-specific objective functions representing provision of water supply and irrigation, hydropower generation and maintenance of ecosystem services. Results are visualised as trade-off surfaces to help decision makers understand the impacts of different policies on a broad range of stakeholders and to assist in decision-making. These case studies show how the approach can reveal unexpected opportunities for win-win solutions, and quantify the trade-offs between investing to increase agricultural revenue and negative impacts on protected ecosystems which support rural livelihoods.

Attitudes towards poverty, organizations, ethics and morals: Israeli social workers' shared decision making.

PubMed

Levin, Lia; Schwartz-Tayri, Talia

2017-06-01

Partnerships between service users and social workers are complex in nature and can be driven by both personal and contextual circumstances. This study sought to explore the relationship between social workers' involvement in shared decision making with service users, their attitudes towards service users in poverty, moral standards and health and social care organizations' policies towards shared decision making. Based on the responses of 225 licensed social workers from health and social care agencies in the public, private and third sectors in Israel, path analysis was used to test a hypothesized model. Structural attributions for poverty contributed to attitudes towards people who live in poverty, which led to shared decision making. Also, organizational support in shared decision making, and professional moral identity, contributed to ethical behaviour which led to shared decision making. The results of this analysis revealed that shared decision making may be a scion of branched roots planted in the relationship between ethics, organizations and Stigma. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Experiences in Bridging the Gap Between Science and Decision Making at NASAs GSFC Earth Sciences Data and Information Services Center (GES DISC)

NASA Astrophysics Data System (ADS)

Kempler, S.; Teng, W.; Friedl, L.; Lynnes, C.

2008-12-01

In recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet's natural environment, NASA has implemented the 'Decision Support Through Earth Science Research Results' program to solicit "proposals that develop and demonstrate innovative and practicable applications of NASA Earth science observations and research"that focus on improving decision making activities", as stated in the NASA ROSES-2008, A.18 solicitation. This very successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations in the areas of agriculture, air quality, disaster management, ecosystems, public health, water resources, and aviation weather. The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. Coupling this experience with the GES DISC's total understanding and vast experience regarding Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, the GES DISC is in the unique position to more readily identify challenges that come with bringing science data to decision makers. These challenges consist of those that can be met within typical science data usage frameworks, as well as those challenges that arise when utilizing science data for previously unplanned applications, such as decision support systems. The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding how decisions are made, which leads to the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that 'really' evaluate success will be exemplified.

A service oriented approach for guidelines-based clinical decision support using BPMN.

PubMed

Rodriguez-Loya, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS).

33 CFR 20.901 - Summary decisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... decision as a matter of law. The party must file the motion no later than 15 days before the date fixed for the hearing and may include supporting affidavits with the motion. Any other party, 10 days or less after service of a motion for summary decision, may serve opposing affidavits or countermove for summary...

Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

PubMed

Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

2013-10-01

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. Copyright © 2013 Elsevier Inc. All rights reserved.

Capturing Ecosystem Services, Stakeholders' Preferences and Trade-Offs in Coastal Aquaculture Decisions: A Bayesian Belief Network Application

PubMed Central

Schmitt, Laetitia Helene Marie; Brugere, Cecile

2013-01-01

Aquaculture activities are embedded in complex social-ecological systems. However, aquaculture development decisions have tended to be driven by revenue generation, failing to account for interactions with the environment and the full value of the benefits derived from services provided by local ecosystems. Trade-offs resulting from changes in ecosystem services provision and associated impacts on livelihoods are also often overlooked. This paper proposes an innovative application of Bayesian belief networks - influence diagrams - as a decision support system for mediating trade-offs arising from the development of shrimp aquaculture in Thailand. Senior experts were consulted (n = 12) and primary farm data on the economics of shrimp farming (n = 20) were collected alongside secondary information on ecosystem services, in order to construct and populate the network. Trade-offs were quantitatively assessed through the generation of a probabilistic impact matrix. This matrix captures nonlinearity and uncertainty and describes the relative performance and impacts of shrimp farming management scenarios on local livelihoods. It also incorporates export revenues and provision and value of ecosystem services such as coastal protection and biodiversity. This research shows that Bayesian belief modeling can support complex decision-making on pathways for sustainable coastal aquaculture development and thus contributes to the debate on the role of aquaculture in social-ecological resilience and economic development. PMID:24155876

A GH-Based Ontology to Support Applications for Automating Decision Support

DTIC Science & Technology

2005-03-01

architecture for a decision support sys - tem. For this reason, it obtains data from, and updates, a database. IDA also wanted the prototype’s architecture...Chief In- formation Officer CoABS Control of Agent Based Sys - tems DBMS Database Management System DoD Department of Defense DTD Document Type...Generic Hub, the Moyeu Générique, and the Generische Nabe , specifying each as a separate service description with property names and values of the GH

Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions.

PubMed

Bowen, Michael E; Bhat, Deepa; Fish, Jason; Moran, Brett; Howell-Stampley, Temple; Kirk, Lynne; Persell, Stephen D; Halm, Ethan A

Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.

Use of Decision Models in the Development of Evidence-Based Clinical Preventive Services Recommendations: Methods of the U.S. Preventive Services Task Force.

PubMed

Owens, Douglas K; Whitlock, Evelyn P; Henderson, Jillian; Pignone, Michael P; Krist, Alex H; Bibbins-Domingo, Kirsten; Curry, Susan J; Davidson, Karina W; Ebell, Mark; Gillman, Matthew W; Grossman, David C; Kemper, Alex R; Kurth, Ann E; Maciosek, Michael; Siu, Albert L; LeFevre, Michael L

2016-10-04

The U.S. Preventive Services Task Force (USPSTF) develops evidence-based recommendations about preventive care based on comprehensive systematic reviews of the best available evidence. Decision models provide a complementary, quantitative approach to support the USPSTF as it deliberates about the evidence and develops recommendations for clinical and policy use. This article describes the rationale for using modeling, an approach to selecting topics for modeling, and how modeling may inform recommendations about clinical preventive services. Decision modeling is useful when clinical questions remain about how to target an empirically established clinical preventive service at the individual or program level or when complex determinations of magnitude of net benefit, overall or among important subpopulations, are required. Before deciding whether to use decision modeling, the USPSTF assesses whether the benefits and harms of the preventive service have been established empirically, assesses whether there are key issues about applicability or implementation that modeling could address, and then defines the decision problem and key questions to address through modeling. Decision analyses conducted for the USPSTF are expected to follow best practices for modeling. For chosen topics, the USPSTF assesses the strengths and limitations of the systematically reviewed evidence and the modeling analyses and integrates the results of each to make preventive service recommendations.

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.

78 FR 33451 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-04

... Supporting Justification, Frank Cebello, Executive Director, Global Business Management, asserts that the... and medium-size businesses. Request at 5. Governors' Decision No. 10-1 established prices and...' Decision No. 11-6 authorizes Postal Service management to prepare and present to the Commission product...

Knowledge Flow Mesh and Its Dynamics: A Decision Support Environment

DTIC Science & Technology

2008-06-01

paper was the ability of the United States military to achieve dominance through information superiority. The use of intelligent sensors and... Intelligence Agency, National Security Agency, Defense Intelligence Agency, and individual Service intelligence agencies). In fact, these edge entities would... intelligence , design, choice, and implementation. 6. Support variety of decision processes and styles. 7. DSS should be adaptable and flexible. 8. DSS

Power and Influence: Enhancing Information Services within the Organization. Information Services Management Series.

ERIC Educational Resources Information Center

St. Clair, Guy

As funds for supporting library and information services dwindle, librarians are beginning to recognize the value of evaluating and justifying their library in terms that the decision makers--those who control the budgets--understand. This book offers proven techniques for implementing a program that both promotes information services and dispels…

Decision support system based on DPSIR framework for a low flow Mediterranean river basin

NASA Astrophysics Data System (ADS)

Bangash, Rubab Fatima; Kumar, Vikas; Schuhmacher, Marta

2013-04-01

The application of decision making practices are effectively enhanced by adopting a procedural approach setting out a general methodological framework within which specific methods, models and tools can be integrated. Integrated Catchment Management is a process that recognizes the river catchment as a basic organizing unit for understanding and managing ecosystem process. Decision support system becomes more complex by considering unavoidable human activities within a catchment that are motivated by multiple and often competing criteria and/or constraints. DPSIR is a causal framework for describing the interactions between society and the environment. This framework has been adopted by the European Environment Agency and the components of this model are: Driving forces, Pressures, States, Impacts and Responses. The proposed decision support system is a two step framework based on DPSIR. Considering first three component of DPSIR, Driving forces, Pressures and States, hydrological and ecosystem services models are developed. The last two components, Impact and Responses, helped to develop Bayesian Network to integrate the models. This decision support system also takes account of social, economic and environmental aspects. A small river of Catalonia (Northeastern Spain), Francoli River with a low flow (~2 m3/s) is selected for integration of catchment assessment models and to improve knowledge transfer from research to the stakeholders with a view to improve decision making process. DHI's MIKE BASIN software is used to evaluate the low-flow Francolí River with respect to the water bodies' characteristics and also to assess the impact of human activities aiming to achieve good water status for all waters to comply with the WFD's River Basin Management Plan. Based on ArcGIS, MIKE BASIN is a versatile decision support tool that provides a simple and powerful framework for managers and stakeholders to address multisectoral allocation and environmental issues in river basins. While InVEST is a spatially explicit tool, used to model and map a suite of ecosystem services caused by land cover changes or climate change impacts. Moreover, results obtained from low-flow hydrological simulation and ecosystem services models serves as useful tools to develop decision support system based on DPSIR framework by integrating models. Bayesian Networks is used as a knowledge integration and visualization tool to summarize the outcomes of hydrological and ecosystem services models at the "Response" stage of DPSIR. Bayesian Networks provide a framework for modelling the logical relationship between catchment variables and decision objectives by quantifying the strength of these relationships using conditional probabilities. Participatory nature of this framework can provide better communication of water research, particularly in the context of a perceived lack of future awareness-raising with the public that helps to develop more sustainable water management strategies. Acknowledgements The present study was financially supported by Spanish Ministry of Economy and Competitiveness for its financial support through the project SCARCE (Consolider-Ingenio 2010 CSD2009-00065). R. F. Bangash also received PhD fellowship from AGAUR (Commissioner for Universities and Research of the Department of Innovation, Universities and Enterprise of the "Generalitat de Catalunya" and the European Social Fund).

Optimal assignment of workers to supporting services in a hospital

NASA Astrophysics Data System (ADS)

Sawik, Bartosz; Mikulik, Jerzy

2008-01-01

Supporting services play an important role in health care institutions such as hospitals. This paper presents an application of operations research model for optimal allocation of workers among supporting services in a public hospital. The services include logistics, inventory management, financial management, operations management, medical analysis, etc. The optimality criterion of the problem is to minimize operations costs of supporting services subject to some specific constraints. The constraints represent specific conditions for resource allocation in a hospital. The overall problem is formulated as an integer program in the literature known as the assignment problem, where the decision variables represent the assignment of people to various jobs. The results of some computational experiments modeled on a real data from a selected Polish hospital are reported.

Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery).

PubMed

Coffey, Michael; Hannigan, Ben; Meudell, Alan; Hunt, Julian; Fitzsimmons, Deb

2016-08-17

Recovery in mental health care is complex, highly individual and can be facilitated by a range of professional and non-professional support. In this study we will examine how recovery from mental health problems is promoted in non-medical settings. We hypothesise a relationship between involvement in decisions about care, social support and recovery and quality of life outcomes. We will use standardised validated instruments of involvement in decision-making, social contacts, recovery and quality of life with a random sample of people accessing non-statutory mental health social care services in Wales. We will add to this important information with detailed one to one case study interviews with people, their family members and their support workers. We will use a series of these interviews to examine how people build recovery over time to help us understand more about their involvement in decisions and the social links they build. We want to see how being involved in decisions about care and the social links people have are related to recovery and quality of life for people with experience of using mental health support services. We want to understand the different perspectives of the people involved in making recovery possible. We will use this information to guide further studies of particular types of social interventions and their use in helping recovery from mental health problems.

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

Development and usability testing of a web-based decision support for users and health professionals in psychiatric services.

PubMed

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

2017-09-01

Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A Simulation Approach to Decision Making in IT Service Strategy

PubMed Central

2014-01-01

We propose to use simulation modeling to support decision making in IT service strategy scope. Our main contribution is a simulation model that helps service providers analyze the consequences of changes in both the service capacity assigned to their customers and the tendency of service requests received on the fulfillment of a business rule associated with the strategic goal of customer satisfaction. This business rule is set in the SLAs that service provider and its customers agree to, which determine the maximum percentage of service requests that are permitted to be abandoned because they have exceeded the waiting time allowed. To illustrate the use and applications of the model, we include some of the experiments conducted and describe our conclusions. PMID:24790583

Modular Architecture for Integrated Model-Based Decision Support.

PubMed

Gaebel, Jan; Schreiber, Erik; Oeser, Alexander; Oeltze-Jafra, Steffen

2018-01-01

Model-based decision support systems promise to be a valuable addition to oncological treatments and the implementation of personalized therapies. For the integration and sharing of decision models, the involved systems must be able to communicate with each other. In this paper, we propose a modularized architecture of dedicated systems for the integration of probabilistic decision models into existing hospital environments. These systems interconnect via web services and provide model sharing and processing capabilities for clinical information systems. Along the lines of IHE integration profiles from other disciplines and the meaningful reuse of routinely recorded patient data, our approach aims for the seamless integration of decision models into hospital infrastructure and the physicians' daily work.

Decision science: a scientific approach to enhance public health budgeting.

PubMed

Honoré, Peggy A; Fos, Peter J; Smith, Torney; Riley, Michael; Kramarz, Kim

2010-01-01

The allocation of resources for public health programming is a complicated and daunting responsibility. Financial decision-making processes within public health agencies are especially difficult when not supported with techniques for prioritizing and ranking alternatives. This article presents a case study of a decision analysis software model that was applied to the process of identifying funding priorities for public health services in the Spokane Regional Health District. Results on the use of this decision support system provide insights into how decision science models, which have been used for decades in business and industry, can be successfully applied to public health budgeting as a means of strengthening agency financial management processes.

Intelligent ship traffic monitoring for oil spill prevention: risk based decision support building on AIS.

PubMed

Eide, Magnus S; Endresen, Oyvind; Brett, Per Olaf; Ervik, Jon Leon; Røang, Kjell

2007-02-01

The paper describes a model, which estimates the risk levels of individual crude oil tankers. The intended use of the model, which is ready for trial implementation at The Norwegian Coastal Administrations new Vardø VTS (Vessel Traffic Service) centre, is to facilitate the comparison of ships and to support a risk based decision on which ships to focus attention on. For a VTS operator, tasked with monitoring hundreds of ships, this is a valuable decision support tool. The model answers the question, "Which ships are likely to produce an oil spill accident, and how much is it likely to spill?".

Developing scientific information to support decisions for sustainable reef ecosystem services

EPA Science Inventory

The U.S. Environmental Protection Agency (EPA) has recently realigned its research enterprise around the concept of sustainability, including improving understanding of benefits derived from ecosystems. We provide an example of how EPA is applying structured decision-making (SDM)...

Forward view: advancing health library and knowledge services in England.

PubMed

Lacey Bryant, Sue; Bingham, Helen; Carlyle, Ruth; Day, Alison; Ferguson, Linda; Stewart, David

2018-03-01

This article is the fourth in a series on New Directions. The National Health Service is under pressure, challenged to meet the needs of an ageing population, whilst striving to improve standards and ensure decision making is underpinned by evidence. Health Education England is steering a new course for NHS library and knowledge services in England to ensure access to knowledge and evidence for all decision makers. Knowledge for Healthcare calls for service transformation, role redesign, greater coordination and collaboration. To meet user expectations, health libraries must achieve sustainable, affordable access to digital content. Traditional tasks will progressively become mechanised. Alongside supporting learners, NHS librarians and knowledge specialists will take a greater role as knowledge brokers, delivering business critical services. They will support the NHS workforce to signpost patients and the public to high-quality information. There is a need for greater efficiency and effectiveness through greater co-operation and service mergers. Evaluation of service quality will focus more on outcomes, less on counting. These changes require an agile workforce, fit for the future. There is a bright future in which librarians' expertise is used to mobilise evidence, manage and share knowledge, support patients, carers and families, optimise technology and social media and provide a keystone for improved patient care and safety. © 2018 Health Libraries Group.

NOAA Climate Information and Tools for Decision Support Services

NASA Astrophysics Data System (ADS)

Timofeyeva, M. M.; Higgins, W.; Strager, C.; Horsfall, F. M.

2013-12-01

NOAA is an active participant of the Global Framework for Climate Services (GFCS) contributing data, information, analytical capabilities, forecasts, and decision support services to the Climate Services Partnership (CSP). These contributions emerge from NOAA's own climate services, which have evolved to respond to the urgent and growing need for reliable, trusted, transparent, and timely climate information across all sectors of the U.S. economy. Climate services not only enhance development opportunities in many regions, but also reduce vulnerability to climate change around the world. The NOAA contribution lies within the NOAA Climate Goal mission, which is focusing its efforts on four key climate priority areas: water, extremes, coastal inundation, and marine ecosystems. In order to make progress in these areas, NOAA is exploiting its fundamental capabilities, including foundational research to advance understanding of the Earth system, observations to preserve and build the climate data record and monitor changes in climate conditions, climate models to predict and project future climate across space and time scales, and the development and delivery of decision support services focused on risk management. NOAA's National Weather Services (NWS) is moving toward provision of Decision Support Services (DSS) as a part of the Roadmap on the way to achieving a Weather Ready National (WRN) strategy. Both short-term and long-term weather, water, and climate information are critical for DSS and emergency services and have been integrated into NWS in the form of pilot projects run by National and Regional Operations Centers (NOC and ROCs respectively) as well as several local offices. Local offices with pilot projects have been focusing their efforts on provision of timely and actionable guidance for specific tasks such as DSS in support of Coastal Environments and Integrated Environmental Studies. Climate information in DSS extends the concept of climate services to provision of information that will help guide long-term preparedness for severe weather events and extreme conditions as well as climate variability and change GFCS recently summarized examples of existing initiatives to advance provision of climate services in the 2012 publication Climate ExChange. In this publication, NWS introduced the new Local Climate Analysis Tool (LCAT), a tool that is used to conduct local climate studies that are needed to create efficient and reliable guidance for DSS. LCAT allows for analyzing trends in local climate variables and identifying local impacts of climate variability (e.g., ENSO) on weather and water conditions. In addition to LCAT, NWS, working in partnership with the North East Regional Climate center, released xmACIS version 2, a climate data mining tool, for NWS field operations. During this talk we will demonstrate LCAT and xmACIS as well as outline several examples of their application to DSS and its potential use for achieving GFCS goals. The examples include LCAT-based temperature analysis for energy decisions, guidance on weather and water events leading to increased algal blooms and red tide months in advance, local climate sensitivities to droughts, probabilities of hot/cold conditions and their potential impacts on agriculture and fish kills or fish stress.

Perceived risks around choice and decision making at end-of-life: a literature review.

PubMed

Wilson, F; Gott, M; Ingleton, C

2013-01-01

the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

Development of a spatial decision support system for flood risk management in Brazil that combines volunteered geographic information with wireless sensor networks

NASA Astrophysics Data System (ADS)

Horita, Flávio E. A.; Albuquerque, João Porto de; Degrossi, Lívia C.; Mendiondo, Eduardo M.; Ueyama, Jó

2015-07-01

Effective flood risk management requires updated information to ensure that the correct decisions can be made. This can be provided by Wireless Sensor Networks (WSN) which are a low-cost means of collecting updated information about rivers. Another valuable resource is Volunteered Geographic Information (VGI) which is a comparatively new means of improving the coverage of monitored areas because it is able to supply supplementary information to the WSN and thus support decision-making in flood risk management. However, there still remains the problem of how to combine WSN data with VGI. In this paper, an attempt is made to investigate AGORA-DS, which is a Spatial Decision Support System (SDSS) that is able to make flood risk management more effective by combining these data sources, i.e. WSN with VGI. This approach is built over a conceptual model that complies with the interoperable standards laid down by the Open Geospatial Consortium (OGC) - e.g. Sensor Observation Service (SOS) and Web Feature Service (WFS) - and seeks to combine and present unified information in a web-based decision support tool. This work was deployed in a real scenario of flood risk management in the town of São Carlos in Brazil. The evidence obtained from this deployment confirmed that interoperable standards can support the integration of data from distinct data sources. In addition, they also show that VGI is able to provide information about areas of the river basin which lack data since there is no appropriate station in the area. Hence it provides a valuable support for the WSN data. It can thus be concluded that AGORA-DS is able to combine information provided by WSN and VGI, and provide useful information for supporting flood risk management.

Evaluation of a Potential for Enhancing the Decision Support System of the Interagency Modeling and Atmospheric Assessment Center with NASA Earth Science Research Results

NASA Technical Reports Server (NTRS)

Blonski, Slawomir; Berglund, Judith; Spruce, Joseph P.; McKellip, Rodney; Jasinski, Michael; Borak, Jordan; Lundquist, Julie

2007-01-01

NASA's objective for the Applied Sciences Program of the Science Mission Directorate is to expand and accelerate the realization of economic and societal benefits from Earth science, information, and technology. This objective is accomplished by using a systems approach to facilitate the incorporation of Earth observations and predictions into the decision-support tools used by partner organizations to provide essential services to society. The services include management of forest fires, coastal zones, agriculture, weather prediction, hazard mitigation, aviation safety, and homeland security. In this way, NASA's long-term research programs yield near-term, practical benefits to society. The Applied Sciences Program relies heavily on forging partnerships with other Federal agencies to accomplish its objectives. NASA chooses to partner with agencies that have existing connections with end-users, information infrastructure already in place, and decision support systems that can be enhanced by the Earth science information that NASA is uniquely poised to provide (NASA, 2004).

"Librarian's Anxiety"? How Community College Librarians Feel about Their Reference Desk Service

ERIC Educational Resources Information Center

Powers, Anne

2010-01-01

A survey of community college librarians in California reveals that the nature of reference service required of them, limitations on budget, staffing, technical support, resources, decision-making ability, and professional development opportunities, affect their professional attitudes. Librarians see reference service as primarily a teaching role.…

Mapping Socio-Environmentally Vulnerable Populations Access and Exposure to Ecosystem Services at the U.S.- Mexico Borderlands

EPA Science Inventory

The USGS is developing a binational decision support tool to understand the exchange of ecosystem services in the Santa Cruz Watershed located on the border between Arizona and Sonora, Mexico. Ecosystem services are life-sustaining benefits human societies receive from the enviro...

Grand Challenges in Clinical Decision Support v10

PubMed Central

Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A.; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

2008-01-01

There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: Improve the human-computer interface; Disseminate best practices in CDS design, development, and implementation; Summarize patient-level information; Prioritize and filter recommendations to the user; Create an architecture for sharing executable CDS modules and services; Combine recommendations for patients with co-morbidities; Prioritize CDS content development and implementation; Create internet-accessible clinical decision support repositories; Use freetext information to drive clinical decision support; Mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:18029232

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

Cancer.gov

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

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.

Instruction and Service Time Decisions: Itinerant Services to Deaf and Hard-of-Hearing Students

ERIC Educational Resources Information Center

Antia, Shirin D.; Rivera, M. Christina

2016-01-01

The purpose of this study was to (a) describe the specific kinds of services provided by itinerant teachers to deaf and hard-of-hearing (DHH) students in general education settings, (b) examine the relationship between student academic performance and instructional support provided by the itinerant teacher, and (c) examine how service provision…

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

PubMed

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

2017-06-09

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

Decision Support Model for Introduction of Gamification Solution Using AHP

PubMed Central

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform. PMID:24892075

Decision support model for introduction of gamification solution using AHP.

PubMed

Kim, Sangkyun

2014-01-01

Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

PubMed Central

Albersen, Bregje Joanna Antonia; De Brouwere, Vincent; van Roosmalen, Jos; Zweekhorst, Marjolein

2017-01-01

Background In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Objective The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. Results We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. Conclusions The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. PMID:28336504

Providing effective and preferred care closer to home: a realist review of intermediate care.

PubMed

Pearson, Mark; Hunt, Harriet; Cooper, Chris; Shepperd, Sasha; Pawson, Ray; Anderson, Rob

2015-11-01

Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice. © 2015 John Wiley & Sons Ltd.

Summary: Ecosystem Services and Human Welfare

EPA Science Inventory

The ecosystem services paradigm is a framework conceived to engage support among people, especially policy- and decision-makers, for the recognition that human welfare, prosperity, security, and well-being are intrinsically linked to the health of the environment. Simply stated, ...

Developing a model-based decision support system for call-a-ride paratransit service problems.

DOT National Transportation Integrated Search

2011-02-01

Paratransit is the transportation service that supplements larger public transportation : systems by providing individualized rides without fixed routes or timetables. In 1990, : the Americans with Disabilities Act (ADA) was passed which allows passe...

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

PubMed

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

2006-09-01

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

Assessing the vulnerability of human and biological communities to changing ecosystem services using a GIS-based multi-criteria decision support tool

USGS Publications Warehouse

Villarreal, Miguel; Norman, Laura M.; Labiosa, William B.

2012-01-01

In this paper we describe an application of a GIS-based multi-criteria decision support web tool that models and evaluates relative changes in ecosystem services to policy and land management decisions. The Santa Cruz Watershed Ecosystem Portfolio (SCWEPM) was designed to provide credible forecasts of responses to ecosystem drivers and stressors and to illustrate the role of land use decisions on spatial and temporal distributions of ecosystem services within a binational (U.S. and Mexico) watershed. We present two SCWEPM sub-models that when analyzed together address bidirectional relationships between social and ecological vulnerability and ecosystem services. The first model employs the Modified Socio-Environmental Vulnerability Index (M-SEVI), which assesses community vulnerability using information from U.S. and Mexico censuses on education, access to resources, migratory status, housing situation, and number of dependents. The second, relating land cover change to biodiversity (provisioning services), models changes in the distribution of terrestrial vertebrate habitat based on multitemporal vegetation and land cover maps, wildlife habitat relationships, and changes in land use/land cover patterns. When assessed concurrently, the models exposed some unexpected relationships between vulnerable communities and ecosystem services provisioning. For instance, the most species-rich habitat type in the watershed, Desert Riparian Forest, increased over time in areas occupied by the most vulnerable populations and declined in areas with less vulnerable populations. This type of information can be used to identify ecological conservation and restoration targets that enhance the livelihoods of people in vulnerable communities and promote biodiversity and ecosystem health.

Use of a remote clinical decision support service for a multicenter trial to implement prediction rules for children with minor blunt head trauma.

PubMed

Goldberg, Howard S; Paterno, Marilyn D; Grundmeier, Robert W; Rocha, Beatriz H; Hoffman, Jeffrey M; Tham, Eric; Swietlik, Marguerite; Schaeffer, Molly H; Pabbathi, Deepika; Deakyne, Sara J; Kuppermann, Nathan; Dayan, Peter S

2016-03-01

To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma. We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments. Patterns of CDS review included either a delayed, near-real-time review, where the physician viewed CDS recommendations generated by the nursing assessment, or a real-time review, where the physician viewed recommendations generated by their own documentation. A backstopping, vendor-based CDS triggered with zero delay when no recommendation was available in the EHR from the web-service. We assessed the execution characteristics of the integrated system and the source of the generated recommendations viewed by physicians. The ECRS mean execution time was 0.74 ±0.72 s. Overall execution time was substantially different at the two sites, with mean total transaction times of 19.67 and 3.99 s. Of 1930 analyzed transactions from the two sites, 60% (310/521) of all physician documentation-initiated recommendations and 99% (1390/1409) of all nurse documentation-initiated recommendations originated from the remote web service. The remote CDS system was the source of recommendations in more than half of the real-time cases and virtually all the near-real-time cases. Comparisons are limited by allowable variation in user workflow and resolution of the EHR clock. With maturation and adoption of standards for CDS services, remote CDS shows promise to decrease time-to-trial for multicenter evaluations of candidate decision support interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

'It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services.

PubMed

Robinson, Suzanne; Glasby, Jon; Allen, Kerry

2013-11-01

Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices. © 2013 John Wiley & Sons Ltd.

Shared decision making in Australia in 2017.

PubMed

Trevena, Lyndal; Shepherd, Heather L; Bonner, Carissa; Jansen, Jesse; Cust, Anne E; Leask, Julie; Shadbolt, Narelle; Del Mar, Chris; McCaffery, Kirsten; Hoffmann, Tammy

2017-06-01

Shared decision making (SDM) is now firmly established within national clinical standards for accrediting hospitals, day procedure services, public dental services and medical education in Australia, with plans to align general practice, aged care and disability service. Implementation of these standards and training of health professionals is a key challenge for the Australian health sector at this time. Consumer involvement in health research, policy and clinical service governance has also increased, with a major focus on encouraging patients to ask questions during their clinical care. Tools to support shared decision making are increasingly used but there is a need for more systemic approaches to their development, cultural adaptation and implementation. Sustainable solutions to ensure tools are kept up-to-date with the best available evidence will be important for the future. Copyright © 2017. Published by Elsevier GmbH.

RF-CLASS: A Remote-sensing-based Interoperable Web service system for Flood Crop Loss Assessment

NASA Astrophysics Data System (ADS)

Di, L.; Yu, G.; Kang, L.

2014-12-01

Flood is one of the worst natural disasters in the world. Flooding often causes significant crop loss over large agricultural areas in the United States. Two USDA agencies, the National Agricultural Statistics Service (NASS) and Risk Management Agency (RMA), make decisions on flood statistics, crop insurance policy, and recovery management by collecting, analyzing, reporting, and utilizing flooded crop acreage and crop loss information. NASS has the mandate to report crop loss after all flood events. RMA manages crop insurance policy and uses crop loss information to guide the creation of the crop insurance policy and the aftermath compensation. Many studies have been conducted in the recent years on monitoring floods and assessing the crop loss due to floods with remote sensing and geographic information technologies. The Remote-sensing-based Flood Crop Loss Assessment Service System (RF-CLASS), being developed with NASA and USDA support, aims to significantly improve the post-flood agricultural decision-making supports in USDA by integrating and advancing the recently developed technologies. RF-CLASS will operationally provide information to support USDA decision making activities on collecting and archiving flood acreage and duration, recording annual crop loss due to flood, assessing the crop insurance rating areas, investigating crop policy compliance, and spot checking of crop loss claims. This presentation will discuss the remote sensing and GIS based methods for deriving the needed information to support the decision making, the RF-CLASS cybersystem architecture, the standards and interoperability arrangements in the system, and the current and planned capabilities of the system.

Rapid decision support tool based on novel ecosystem service variables for retrofitting of permeable pavement systems in the presence of trees.

PubMed

Scholz, Miklas; Uzomah, Vincent C

2013-08-01

The retrofitting of sustainable drainage systems (SuDS) such as permeable pavements is currently undertaken ad hoc using expert experience supported by minimal guidance based predominantly on hard engineering variables. There is a lack of practical decision support tools useful for a rapid assessment of the potential of ecosystem services when retrofitting permeable pavements in urban areas that either feature existing trees or should be planted with trees in the near future. Thus the aim of this paper is to develop an innovative rapid decision support tool based on novel ecosystem service variables for retrofitting of permeable pavement systems close to trees. This unique tool proposes the retrofitting of permeable pavements that obtained the highest ecosystem service score for a specific urban site enhanced by the presence of trees. This approach is based on a novel ecosystem service philosophy adapted to permeable pavements rather than on traditional engineering judgement associated with variables based on quick community and environment assessments. For an example case study area such as Greater Manchester, which was dominated by Sycamore and Common Lime, a comparison with the traditional approach of determining community and environment variables indicates that permeable pavements are generally a preferred SuDS option. Permeable pavements combined with urban trees received relatively high scores, because of their great potential impact in terms of water and air quality improvement, and flood control, respectively. The outcomes of this paper are likely to lead to more combined permeable pavement and tree systems in the urban landscape, which are beneficial for humans and the environment. Copyright © 2013 Elsevier B.V. All rights reserved.

Physician Attitudes toward Adopting Genome-Guided Prescribing through Clinical Decision Support

PubMed Central

Overby, Casey Lynnette; Erwin, Angelika Ludtke; Abul-Husn, Noura S.; Ellis, Stephen B.; Scott, Stuart A.; Obeng, Aniwaa Owusu; Kannry, Joseph L.; Hripcsak, George; Bottinger, Erwin P.; Gottesman, Omri

2014-01-01

This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII). The survey also includes items to measure physicians’ characteristics (awareness, experience, and perceived usefulness), attitudes about personal genome testing (PGT) services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS). The majority were residency program trainees (~88%). Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions. PMID:25562141

Ongoing child welfare services: Understanding the relationship of worker and organizational characteristics to service provision.

PubMed

Lwin, Kristen; Fluke, John; Trocmé, Nico; Fallon, Barbara; Mishna, Faye

2018-06-01

Ongoing child welfare services are put in place after completion of the initial maltreatment investigation when there is a perceived need to mitigate the risk of future harm. The knowledge of how clinical, worker, and organizational characteristics interact with this decision to provide ongoing child welfare services is not well integrated in the research literature. Using secondary data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008, this study's primary objective is to understand the relationship of clinical, worker, and organizational characteristics to the decision to transfer a case to ongoing child welfare services and their relative contribution to the transfer decision in Canada. Findings indicate that several clinical level variables are associated with families receiving ongoing services. Additionally, organizational factors, such as type of services offered by the organization and the number of employee support programs available to workers, significantly predicted the decision to transfer a case to ongoing services. While no worker factors, such as education, amount of training, experience, or caseload, were associated with ongoing service receipt, the intraclass correlation coefficient of the final three-level parsimonious model indicated substantial clustering at the worker level. Results indicate that Canadian child welfare workers make decisions differently based on factors not available in the current study and that what would be deemed as important worker characteristics do not necessarily predict this outcome. Findings and implications for future research are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

PubMed

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

2014-01-01

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

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

PubMed

Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

2014-01-01

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

A decision support tool for adaptive management of native prairie ecosystems

USGS Publications Warehouse

Hunt, Victoria M.; Jacobi, Sarah; Gannon, Jill J.; Zorn, Jennifer E.; Moore, Clinton; Lonsdorf, Eric V.

2016-01-01

The Native Prairie Adaptive Management initiative is a decision support framework that provides cooperators with management-action recommendations to help them conserve native species and suppress invasive species on prairie lands. We developed a Web-based decision support tool (DST) for the U.S. Fish and Wildlife Service and the U.S. Geological Survey initiative. The DST facilitates cross-organizational data sharing, performs analyses to improve conservation delivery, and requires no technical expertise to operate. Each year since 2012, the DST has used monitoring data to update ecological knowledge that it translates into situation-specific management-action recommendations (e.g., controlled burn or prescribed graze). The DST provides annual recommendations for more than 10,000 acres on 20 refuge complexes in four U.S. states. We describe how the DST promotes the long-term implementation of the program for which it was designed and may facilitate decision support and improve ecological outcomes of other conservation efforts.

Warfighter Associate: Decision Aiding and Metrics for Mission Command

DTIC Science & Technology

2012-01-23

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

Decision-Guided Recommenders with Composite Alternatives

ERIC Educational Resources Information Center

Alodhaibi, Khalid

2011-01-01

Recommender systems aim to support users in their decision-making process while interacting with large information spaces and recommend items of interest to users based on preferences they have expressed, either explicitly or implicitly. Recommender systems are increasingly used with product and service selection over the Internet. Although…

Sbexpert users guide (version 1.0): A knowledge-based decision-support system for spruce beetle management. Forest Service general technical report

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

Reynolds, K.M.; Holsten, E.H.; Werner, R.A.

1995-03-01

SBexpert version 1.0 is a knowledge-based decision-support system for management of spruce beetle developed for use in Microsoft Windows. The users guide provides detailed instructions on the use of all SBexpert features. SBexpert has four main subprograms; introduction, analysis, textbook, and literature. The introduction is the first of the five subtopics in the SBexpert help system. The analysis topic is an advisory system for spruce beetle management that provides recommendation for reducing spruce beetle hazard and risk to spruce stands and is the main analytical topic in SBexpert. The textbook and literature topics provide complementary decision support for analysis.

What We Can Learn from Amazon for Clinical Decision Support Systems.

PubMed

Abid, Sidra; Keshavjee, Karim; Karim, Arsalan; Guergachi, Aziz

2017-01-01

Health care continue to lag behind other industries, such as retail and financial services, in the use of decision-support-like tools. Amazon is particularly prolific in the use of advanced predictive and prescriptive analytics to assist its customers to purchase more, while increasing satisfaction, retention, repeat-purchases and loyalty. How can we do the same in health care? In this paper, we explore various elements of the Amazon website and Amazon's data science and big data practices to gather inspiration for re-designing clinical decision support in the health care sector. For each Amazon element we identified, we present one or more clinical applications to help us better understand where Amazon's.

Aids to navigation service force mix 2000 project. Volume 1 : development and application of an aids to navigation service force mix decision support system

DOT National Transportation Integrated Search

1992-07-01

The Aids to Navigation (ATON) Service Force Mix (SFM) 2000 Project is documented in a Project Overview and three separately bound volumes. This is the Project Overview. The Project Overview describes the purpose, approach, analysis, and results of th...

Assessing predictive services' 7-day fire potential outlook

Treesearch

Karin Riley; Crystal Stonesifer; Dave Calkin; Haiganoush Preisler

2015-01-01

The Predictive Services program was created under the National Wildfire Coordinating Group in 2001 to address the need for long- and short-term decision support information for fire managers and operations personnel. The primary mission of Predictive Services is to integrate fire weather, fire danger, and resource availability to enable strategic fire suppression...

CIRUN: Climate Information Responding to User Needs

NASA Astrophysics Data System (ADS)

Busalacchi, A. J.

2009-12-01

The Earth System will experience real climate change over the next 50 years, exceeding the scope of natural climate variability. A paramount question facing society is how to adapt to this certainty of climate variability and change. In response, OSTP and NOAA are considering how comprehensive climate services would best inform decisions about adaptation. Similarly, NASA is considering the optimal configuration of the next generation of Earth, environmental, and climate observations to be deployed over the coming 10-20 years. Moreover, much of the added-value information for specific climate-related decisions will be provided by private, academic and non-governmental organizations. In this context, over the past several years the University of Maryland has established the CIRUN (Climate Information: Responding to User Needs) initiative to identify the nature of national needs for climate information and services from a decision support perspective. To date, CIRUN has brought together decisionmakers in a number of sectors to help understand their perspectives on climate with the goal of improving the usefulness of climate information, observations and prediction products to specific user communities. CIRUN began with a major workshop in October 2007 that convened 430 participants in agriculture, parks and recreation, terrestrial ecosystems, insurance/investment, energy, national security, state/local/municipal, water, human health, commerce and manufacturing, transportation, and coastal/marine sectors. Plenary speakers such as Norman Augustine, R. James Woolsey, James Mahoney, and former Senator Joseph Tydings, breakout panel sessions, and participants provided input based on the following: - How would you characterize the exposure or vulnerability to climate variability or change impacting your organization? - Does climate variability and/or change currently factor into your organization's objectives or operations? - Are any of your existing plans being affected by climate or projections of climate change? - Is your organization developing a plan for adapting to climate change? - What are your needs for climate observations, predictions, and services? Please cite one or more specific examples when possible. - Do you currently have access to the climate information your organization needs? - What next steps are needed to assure effective use of climate services in your decision making? As a result, a dialogue with various user communities and a subsequent series of more sector specific workshops has been established regarding how significantly enhanced climate observations, data management, modeling, and predictions can provide valuable decision support for business and policy decisions. In particular, CIRUN has helped - To identify how users, stakeholders, and decision makers are influenced by climate on time scales from seasons to decades - To identify the needs and requirements of users, stakeholders, and decision makers for climate information, observations, predictions, and services from global to local scales - To identify what adaptation measures are being considered in the private and public sectors, and how this might result in new classes of information for decision support - To recommend principal elements of the path forward toward more effective use of climate services in decision making.

The Cure for Ailing Self-Service Business Intelligence

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

Burke, Marsha; Simpson, Wayne; Staples, Shad

There are many reasons that self-service models fail. Furthermore, these reasons are directly applicable in the management of self-service business inteligence modeling. Our article expands upon the reasons for failure and suggests how self-service models can be made successful through implementation of a centralized approach to development, testing, implementation and support for the delivery of decision making information.

The Cure for Ailing Self-Service Business Intelligence

DOE PAGES

Burke, Marsha; Simpson, Wayne; Staples, Shad

2016-09-14

There are many reasons that self-service models fail. Furthermore, these reasons are directly applicable in the management of self-service business inteligence modeling. Our article expands upon the reasons for failure and suggests how self-service models can be made successful through implementation of a centralized approach to development, testing, implementation and support for the delivery of decision making information.

Decision support system in an international-voice-services business company

NASA Astrophysics Data System (ADS)

Hadianti, R.; Uttunggadewa, S.; Syamsuddin, M.; Soewono, E.

2017-01-01

We consider a problem facing by an international telecommunication services company in maximizing its profit. From voice services by controlling cost and business partnership. The competitiveness in this industry is very high, so that any efficiency from controlling cost and business partnership can help the company to survive in the very high competitiveness situation. The company trades voice traffic with a large number of business partners. There are four trading schemes that can be chosen by this company, namely, flat rate, class tiering, volume commitment, and revenue capped. Each scheme has a specific characteristic on the rate and volume deal, where the last three schemes are regarded as strategic schemes to be offered to business partner to ensure incoming traffic volume for both parties. This company and each business partner need to choose an optimal agreement in a certain period of time that can maximize the company’s profit. In this agreement, both parties agree to use a certain trading scheme, rate and rate/volume/revenue deal. A decision support system is then needed in order to give a comprehensive information to the sales officers to deal with the business partners. This paper discusses the mathematical model of the optimal decision for incoming traffic volume control, which is a part of the analysis needed to build the decision support system. The mathematical model is built by first performing data analysis to see how elastic the incoming traffic volume is. As the level of elasticity is obtained, we then derive a mathematical modelling that can simulate the impact of any decision on trading to the revenue of the company. The optimal decision can be obtained from these simulations results. To evaluate the performance of the proposed method we implement our decision model to the historical data. A software tool incorporating our methodology is currently in construction.

Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England

PubMed Central

2012-01-01

Background Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings. PMID:22769593

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...

7 CFR 283.32 - ALJ's initial decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false ALJ's initial decision. 283.32 Section 283.32 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... the State agency submits the notice of appeal and evidence in support of the appeal. The ALJ may...

75 FR 51864 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... decisions. Data elements with respect to the SHORT subscription service that would be provided through the... information about technical data elements to support transmission and data-integrity processes between the... for making well-informed investment decisions. Broad access to the information collected by the SHORT...

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...

Financial Decision Making during Economic Contraction: The Special Case of Community Colleges.

ERIC Educational Resources Information Center

Seater, Barbara

Although faced with declining revenues and increasing enrollments, community colleges have also traditionally provided expensive support services for nontraditional students and maintained costly technological capacities to respond to the training needs of business. Financial decision-makers face unsettling questions as they attempt to achieve…

Ethics support for GPs: what should it look like?

PubMed

Clark-Grill, Monika

2016-03-01

INTRODUCTION Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan 'Clinical ethics is everyone's business' indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them. METHODS A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful. FINDINGS Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups. CONCLUSION The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services. KEYWORDS General practice; primary care; ethics; support; education.

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...

A Simplified Decision Support Approach for Evaluating Wetlands Ecosystem Services

EPA Science Inventory

State-level managers and restoration advocates have expressed a desire for approaches that address wetlands services and benefits for two purposes: to demonstrate the benefits of money budgeted for restoration, and to compare proposals when awarding restoration funds for specific...

Towards sustainable infrastructure management: knowledge-based service-oriented computing framework for visual analytics

NASA Astrophysics Data System (ADS)

Vatcha, Rashna; Lee, Seok-Won; Murty, Ajeet; Tolone, William; Wang, Xiaoyu; Dou, Wenwen; Chang, Remco; Ribarsky, William; Liu, Wanqiu; Chen, Shen-en; Hauser, Edd

2009-05-01

Infrastructure management (and its associated processes) is complex to understand, perform and thus, hard to make efficient and effective informed decisions. The management involves a multi-faceted operation that requires the most robust data fusion, visualization and decision making. In order to protect and build sustainable critical assets, we present our on-going multi-disciplinary large-scale project that establishes the Integrated Remote Sensing and Visualization (IRSV) system with a focus on supporting bridge structure inspection and management. This project involves specific expertise from civil engineers, computer scientists, geographers, and real-world practitioners from industry, local and federal government agencies. IRSV is being designed to accommodate the essential needs from the following aspects: 1) Better understanding and enforcement of complex inspection process that can bridge the gap between evidence gathering and decision making through the implementation of ontological knowledge engineering system; 2) Aggregation, representation and fusion of complex multi-layered heterogeneous data (i.e. infrared imaging, aerial photos and ground-mounted LIDAR etc.) with domain application knowledge to support machine understandable recommendation system; 3) Robust visualization techniques with large-scale analytical and interactive visualizations that support users' decision making; and 4) Integration of these needs through the flexible Service-oriented Architecture (SOA) framework to compose and provide services on-demand. IRSV is expected to serve as a management and data visualization tool for construction deliverable assurance and infrastructure monitoring both periodically (annually, monthly, even daily if needed) as well as after extreme events.

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

From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services.

PubMed

Daleiden, Eric L; Chorpita, Bruce F

2005-04-01

The Hawaii Department of Health Child and Adolescent Mental Health Division has explored various strategies to promote widespread use of empirical evidence to improve the quality of services and outcomes for youth. This article describes a core set of clinical decisions and how several general and local evidence bases may inform those decisions. Multiple quality improvement strategies are illustrated in the context of a model that outlines four phases of evidence: data, information, knowledge, and wisdom.

A framework for production of systematic review based briefings to support evidence-informed decision-making.

PubMed

Chambers, Duncan; Wilson, Paul

2012-07-09

We have developed a framework for translating existing sources of synthesized and quality-assessed evidence, primarily systematic reviews, into actionable messages in the form of short accessible briefings. The service aims to address real-life problems in response to requests from decision-makers.Development of the framework was based on a scoping review of existing resources and our initial experience with two briefing topics, including models of service provision for young people with eating disorders. We also drew on previous experience in dissemination research and practice. Where appropriate, we made use of the SUPporting POlicy relevant Reviews and Trials (SUPPORT) tools for evidence-informed policymaking. To produce a product that it is fit for this purpose it has been necessary to go beyond a traditional summary of the available evidence relating to effectiveness. Briefings have, therefore, included consideration of cost effectiveness, local applicability, implications relating to local service delivery, budgets, implementation and equity. Our first evidence briefings produced under this framework cover diagnostic endoscopy by specialist nurses and integrated care pathways in mental healthcare settings. The framework will enable researchers to present and contextualize evidence from systematic reviews and other sources of synthesized and quality-assessed evidence. The approach is designed to address the wide range of questions of interest to decision-makers, especially those commissioning services or managing service delivery and organization in primary or secondary care. Evaluation of the use and usefulness of the evidence briefings we produce is an integral part of the framework and will help to fill a gap in the literature.

Collaborative Arrival Planning: Data Sharing and User Preference Tools

NASA Technical Reports Server (NTRS)

Zelenka, Richard E.; Edwards, Thomas A. (Technical Monitor)

1998-01-01

Air traffic growth and air carrier economic pressures have motivated efforts to increase the flexibility of the air traffic management process and change the relationship between the air traffic control service provider and the system user. One of the most visible of these efforts is the U.S. government/industry "free flight" initiative, in which the service provider concentrates on safety and cross-airline fairness, and the user on their business objectives and operating preferences, including selecting their own path and speed in real-time. In the terminal arrival phase of flight, severe restrictions and rigid control are currently placed on system users, typically without regard for individual user operational preferences. Airborne delays applied to arriving aircraft into capacity constrained airports are imposed on a first-come, first-serve basis, and thus do not allow the system user to plan for or prioritize late arrivals, or to economically optimize their arrival sequence. A central tenant of the free-flight operating paradigm is collaboration between service providers and users in reaching air traffic management decisions. Such collaboration would be particularly beneficial to an airline's "hub" operation, where off-schedule arrival aircraft are a consistent problem, as they cause serious air-port ramp difficulties, rippling airline scheduling effects, and result in large economic inefficiencies. Greater collaboration can also lead to increased airport capacity and decrease the severity of over-capacity rush periods. In the NASA Collaborative Arrival Planning (CAP) project, both independent exchange of real-time data between the service provider and system user and collaborative decision support tools are addressed. Data exchange of real-time arrival scheduling, airspace management, and air carrier fleet data between the FAA service provider and an air carrier is being conducted and evaluated. Collaborative arrival decision support tools to allow intra-airline arrival preferences are being developed and simulated. The CAP project is part of and leveraged from the NASA/FAA Center TRACON Automation System (CTAS), a fielded set of decision support tools that provide computer generated advisories for both enroute and terminal area controllers to manage and control arrival traffic more efficiently. In this paper, the NASA Collaborative Arrival Planning project is outlined and recent results detailed, including the real-time use of CTAS arrival scheduling data by a major air carrier and simulations of tactical and strategic user preference decision support tools.

Benchmarking Discount Rate in Natural Resource Damage Assessment with Risk Aversion.

PubMed

Wu, Desheng; Chen, Shuzhen

2017-08-01

Benchmarking a credible discount rate is of crucial importance in natural resource damage assessment (NRDA) and restoration evaluation. This article integrates a holistic framework of NRDA with prevailing low discount rate theory, and proposes a discount rate benchmarking decision support system based on service-specific risk aversion. The proposed approach has the flexibility of choosing appropriate discount rates for gauging long-term services, as opposed to decisions based simply on duration. It improves injury identification in NRDA since potential damages and side-effects to ecosystem services are revealed within the service-specific framework. A real embankment case study demonstrates valid implementation of the method. © 2017 Society for Risk Analysis.

Natural capital and ecosystem services informing decisions: From promise to practice

PubMed Central

Guerry, Anne D.; Polasky, Stephen; Lubchenco, Jane; Chaplin-Kramer, Rebecca; Daily, Gretchen C.; Griffin, Robert; Ruckelshaus, Mary; Bateman, Ian J.; Duraiappah, Anantha; Elmqvist, Thomas; Feldman, Marcus W.; Folke, Carl; Hoekstra, Jon; Kareiva, Peter M.; Keeler, Bonnie L.; Li, Shuzhuo; McKenzie, Emily; Ouyang, Zhiyun; Reyers, Belinda; Ricketts, Taylor H.; Rockström, Johan; Tallis, Heather; Vira, Bhaskar

2015-01-01

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals. PMID:26082539

Natural capital and ecosystem services informing decisions: From promise to practice.

PubMed

Guerry, Anne D; Polasky, Stephen; Lubchenco, Jane; Chaplin-Kramer, Rebecca; Daily, Gretchen C; Griffin, Robert; Ruckelshaus, Mary; Bateman, Ian J; Duraiappah, Anantha; Elmqvist, Thomas; Feldman, Marcus W; Folke, Carl; Hoekstra, Jon; Kareiva, Peter M; Keeler, Bonnie L; Li, Shuzhuo; McKenzie, Emily; Ouyang, Zhiyun; Reyers, Belinda; Ricketts, Taylor H; Rockström, Johan; Tallis, Heather; Vira, Bhaskar

2015-06-16

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals.

To Stay or to Leave: Factors Influencing Victims' Decisions to Stay or Leave a Domestic Violence Emergency Shelter.

PubMed

Fisher, Elisa M; Stylianou, Amanda M

2016-04-28

Domestic violence (DV) emergency shelters play a vital role in supporting victims who seek to leave abusive partners and gain independence. Research indicates that numerous positive outcomes for victims and their children are associated with utilization of DV shelter programs. Yet, research also suggests that DV shelter programs may be unable to comprehensively meet the needs of all victims, and many choose to leave shelters soon after their arrival. To better understand the ways in which DV shelter programs support victims but also fail to meet their needs, this article explores the factors that influence victims' decisions to stay or leave a DV emergency shelter program through qualitative interviews with 33 DV shelter residents. Study participants indicate that three types of factors influence their decision to stay or leave the shelter program: (a) contextual factors, (b) partner or family relationship factors, and (c) shelter-specific factors. Shelter-specific factors cited as important contributors to satisfaction or dissatisfaction with shelter living include policies, staff and services, displacement from one's home community, and facilities. Findings provide information from the perspective of victims on the factors that influence one's decision to stay or leave a DV program and can be used to support service providers and advocates in building programs that are both supportive of victims' needs and conductive to longer shelter stays. © The Author(s) 2016.

Telephone Support During Overseas Deployment for Military Spouses

DTIC Science & Technology

2017-12-01

other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a...negotiating roles and relationships; changes during deployment; strategies to support the spouse and the service member; and cues to alert spouses when to...14 o Table 4. Decision Making When Service Member (SM) Home and Deployed ............. 15 • Spouse Deployed Contents – Elearning modules

A Simplified Decision Support Approach for Evaluating Wetlands Ecosystem Services

EPA Science Inventory

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

Alternative Federal Day Care Strategies for the 1970's. (Excerpts from the Final Report).

ERIC Educational Resources Information Center

Todd, Sheldon P.

This report discusses federal government support of day care services. Two alternatives are presented: (1) services designed, regulated and funded by a central agency, and (2) services provided through a free market industry in which decisions about regulations and care would be made by consumers, with only minimal central regulation. The market…

The Invasive Species Forecasting System

NASA Technical Reports Server (NTRS)

Schnase, John; Most, Neal; Gill, Roger; Ma, Peter

2011-01-01

The Invasive Species Forecasting System (ISFS) provides computational support for the generic work processes found in many regional-scale ecosystem modeling applications. Decision support tools built using ISFS allow a user to load point occurrence field sample data for a plant species of interest and quickly generate habitat suitability maps for geographic regions of management concern, such as a national park, monument, forest, or refuge. This type of decision product helps resource managers plan invasive species protection, monitoring, and control strategies for the lands they manage. Until now, scientists and resource managers have lacked the data-assembly and computing capabilities to produce these maps quickly and cost efficiently. ISFS focuses on regional-scale habitat suitability modeling for invasive terrestrial plants. ISFS s component architecture emphasizes simplicity and adaptability. Its core services can be easily adapted to produce model-based decision support tools tailored to particular parks, monuments, forests, refuges, and related management units. ISFS can be used to build standalone run-time tools that require no connection to the Internet, as well as fully Internet-based decision support applications. ISFS provides the core data structures, operating system interfaces, network interfaces, and inter-component constraints comprising the canonical workflow for habitat suitability modeling. The predictors, analysis methods, and geographic extents involved in any particular model run are elements of the user space and arbitrarily configurable by the user. ISFS provides small, lightweight, readily hardened core components of general utility. These components can be adapted to unanticipated uses, are tailorable, and require at most a loosely coupled, nonproprietary connection to the Web. Users can invoke capabilities from a command line; programmers can integrate ISFS's core components into more complex systems and services. Taken together, these features enable a degree of decentralization and distributed ownership that have helped other types of scientific information services succeed in recent years.

Evaluating management tradeoffs between economic fiber production and other ecosystem services in a Chinese-fir dominated forest plantation in Fujian Province.

PubMed

Kang, Haijun; Seely, Brad; Wang, Guangyu; Innes, John; Zheng, Dexiang; Chen, Pingliu; Wang, Tongli; Li, Qinglin

2016-07-01

Chinese fir (Cunninghamia lanceolata) is not only a valuable timber species, but also plays an important role in the provision of ecosystem services. Forest management decisions to increase the production of fiber for economic gain may have negative impacts on the long-term flow of ecosystem services from forest resources. Such tradeoffs should be taken into account to fulfill the requirements of sustainable forest management. Here we employed an established, ecosystem-based, stand-level model (FORECAST) in combination with a simplified harvest-scheduling model to evaluate the potential tradeoffs among indicators of provisional, regulating and supporting ecosystem services in a Chinese-fir-dominated landscape located in Fujian Province as a case study. Indicators included: merchantable volume harvested, biomass harvested, ecosystem carbon storage, CO2 fixation, O2 released, biomass nitrogen content, pollutant absorption, and soil fertility. A series of alternative management scenarios, representing different combinations of rotation length and harvest intensity, were simulated to facilitate the analysis. Results from the analysis were summarized in the form of a decision matrix designed to provide a method for forest managers to evaluate management alternatives and tradeoffs in the context of key indicators of ecosystem services. The scenario analysis suggests that there are considerable tradeoffs in terms of ecosystem services associated with stand and landscape-level management decisions. Longer rotations and increased retention tended to favor regulating and supporting services while the opposite was true for provisional services. Copyright © 2016 Elsevier B.V. All rights reserved.

From NHS Choices to the integrated customer service platform.

PubMed

Gann, Bob; Grant, Maria J

2013-03-01

In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Outsourcing decision factors in publicly owned electric utilities

NASA Astrophysics Data System (ADS)

Gonzales, James Edward

Purpose. The outsourcing of services in publicly owned electric utilities has generated some controversy. The purpose of this study was to explore this controversy by investigating the relationships between eight key independent variables and a dependent variable, "manager perceptions of overall value of outsourced services." The intent was to provide data so that utilities could make better decisions regarding outsourcing efforts. Theoretical framework. Decision theory was used as the framework for analyzing variables and alternatives used to support the outsourcing decision-making process. By reviewing these eight variables and the projected outputs and outcomes, a more predictive and potentially successful outsourcing effort can be realized. Methodology. A survey was distributed to a sample of 323 publicly owned electric utilities randomly selected from a population of 2,020 in the United States. Analysis of the data was made using statistical techniques including the Chi-Square, Lambda, Spearman's coefficient of rank correlation, as well as the Hypothesis Test, Rank Correlation, to test for relationships among the variables. Findings. Relationships among the eight key variables and perceptions of the overall value of outsourced services were generally weak. The notable exception was with the driving force (reason) for outsourcing decisions where the relationship was strongly positive. Conclusions and recommendations. The data in support of the research questions suggest that seven of the eight key variables may be weakly predictive of perceptions of the overall value of outsourced services. However, the primary driving force for outsourcing was strongly predictive. The data also suggest that many of the sampled utilities did not formally address these variables and alternatives, and therefore may not be achieving maximal results. Further studies utilizing customer perceptions rather than those of outsourcing service managers are recommended. In addition, it is recommended that a smaller sample population be analyzed after identifying one or more champions to ensure cooperation and legitimacy of data. Finally, this study supports the position that a manager's ability to identify and understand the relationships between these eight key variables and desired outcomes and outputs may contribute to more successful outsourcing operations.

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

PubMed

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

2016-01-01

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

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study.

PubMed

van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda

2017-02-07

Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about the PA/NP profession and legislations was often lacking. Role standardisations, long-term political planning and support from professional associations are needed to support policy makers in implementing skill mix in primary care.

Examining the Relationship Between Intimate Partner Violence and Concern for Animal Care and Safekeeping.

PubMed

Wuerch, Melissa A; Giesbrecht, Crystal J; Price, Jill A B; Knutson, Tracy; Wach, Frances

2017-03-01

The current study examined the knowledge and experience of animal welfare and human service providers in urban and rural communities of Saskatchewan, Canada. Nine exploratory qualitative interviews were conducted to gather a more in-depth understanding of whether the concern for animal care and safekeeping impacts the decision to leave situations of intimate partner violence. The interviews were semistructured and guided by four questions, which were designed, reviewed, and revised based on feedback from a community-based research team. Thematic analysis highlighted important findings, allowing for the generation of suggestions for improvement of current supports and services offered. The current study findings suggest that concern for animal care and safekeeping creates significant barriers regarding the decision to leave situations of intimate partner violence and abuse, warranting further research to inform support services and resources within a Canadian context.

Proceedings of the workshop "Development of biological decision support systems for resource managers": Denver, Colorado, October 27-29, 1998

USGS Publications Warehouse

Getter, James; D'Erchia, Terry D.; Root, Ralph; Getter, James; D'Erchia, Terry D.; Root, Ralph

1999-01-01

The format for this 3-day workshop (27-29 October 1998) included plenary presentations by USGS Biological Resources Division (BRD) and U.S. Fish and Wildlife Service per onnel who u e and develop decision support systems (DSS); breakout ses ions addressing DSS technical information aspect , outreach/ customer requirements, and future perspectives; and a DSS Steering Committee meeting to evaluate work hop goals and to provide guidance for fu ture efforts. Steering committee action item developed from workshop inputs were to ( I) develop a "DSS framework" document for u e in biological research. (2) develop a "proof of concept" DSS based upon the framework document, and (3) integrate decision support ystem into BRD program elements.

Development of spatial density maps based on geoprocessing web services: application to tuberculosis incidence in Barcelona, Spain.

PubMed

Dominkovics, Pau; Granell, Carlos; Pérez-Navarro, Antoni; Casals, Martí; Orcau, Angels; Caylà, Joan A

2011-11-29

Health professionals and authorities strive to cope with heterogeneous data, services, and statistical models to support decision making on public health. Sophisticated analysis and distributed processing capabilities over geocoded epidemiological data are seen as driving factors to speed up control and decision making in these health risk situations. In this context, recent Web technologies and standards-based web services deployed on geospatial information infrastructures have rapidly become an efficient way to access, share, process, and visualize geocoded health-related information. Data used on this study is based on Tuberculosis (TB) cases registered in Barcelona city during 2009. Residential addresses are geocoded and loaded into a spatial database that acts as a backend database. The web-based application architecture and geoprocessing web services are designed according to the Representational State Transfer (REST) principles. These web processing services produce spatial density maps against the backend database. The results are focused on the use of the proposed web-based application to the analysis of TB cases in Barcelona. The application produces spatial density maps to ease the monitoring and decision making process by health professionals. We also include a discussion of how spatial density maps may be useful for health practitioners in such contexts. In this paper, we developed web-based client application and a set of geoprocessing web services to support specific health-spatial requirements. Spatial density maps of TB incidence were generated to help health professionals in analysis and decision-making tasks. The combined use of geographic information tools, map viewers, and geoprocessing services leads to interesting possibilities in handling health data in a spatial manner. In particular, the use of spatial density maps has been effective to identify the most affected areas and its spatial impact. This study is an attempt to demonstrate how web processing services together with web-based mapping capabilities suit the needs of health practitioners in epidemiological analysis scenarios.

Development of spatial density maps based on geoprocessing web services: application to tuberculosis incidence in Barcelona, Spain

PubMed Central

2011-01-01

Background Health professionals and authorities strive to cope with heterogeneous data, services, and statistical models to support decision making on public health. Sophisticated analysis and distributed processing capabilities over geocoded epidemiological data are seen as driving factors to speed up control and decision making in these health risk situations. In this context, recent Web technologies and standards-based web services deployed on geospatial information infrastructures have rapidly become an efficient way to access, share, process, and visualize geocoded health-related information. Methods Data used on this study is based on Tuberculosis (TB) cases registered in Barcelona city during 2009. Residential addresses are geocoded and loaded into a spatial database that acts as a backend database. The web-based application architecture and geoprocessing web services are designed according to the Representational State Transfer (REST) principles. These web processing services produce spatial density maps against the backend database. Results The results are focused on the use of the proposed web-based application to the analysis of TB cases in Barcelona. The application produces spatial density maps to ease the monitoring and decision making process by health professionals. We also include a discussion of how spatial density maps may be useful for health practitioners in such contexts. Conclusions In this paper, we developed web-based client application and a set of geoprocessing web services to support specific health-spatial requirements. Spatial density maps of TB incidence were generated to help health professionals in analysis and decision-making tasks. The combined use of geographic information tools, map viewers, and geoprocessing services leads to interesting possibilities in handling health data in a spatial manner. In particular, the use of spatial density maps has been effective to identify the most affected areas and its spatial impact. This study is an attempt to demonstrate how web processing services together with web-based mapping capabilities suit the needs of health practitioners in epidemiological analysis scenarios. PMID:22126392

UnitedHealth Group

Cancer.gov

UnitedHealth Group provides accessible and affordable services, improved quality of care, coordinated health care efforts, and a supportive environment for shared decision making between patients and their physicians.

Choice-making among Medicaid HCBS and ICF/MR recipients in six states.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger; Taub, Sarah; Chiri, Giuseppina

2008-09-01

Choice in everyday decisions and in support-related decisions was addressed among 2,398 adults with intellectual and developmental disabilities receiving Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services and living in non family settings in six states. Everyday choice in daily life and in support-related choice was considerably higher on average for HCBS than for ICF/MR recipients, but after controlling for level of intellectual disability, medical care needs, mobility, behavioral and psychiatric conditions, and self-reporting, we found that choice was more strongly associated with living in a congregate setting than whether that setting was HCBS- or ICF/MR-financed. Marked differences in choice were also evident between states.

Decision Support Framework (DSF) For Planning Land And Resource Use To Sustainably Maintain Healthy Ecosystem Services and Communities - March 30, 2009

EPA Science Inventory

Land and resource use decisions are typically made by individuals, towns, counties, tribes, states and sometimes multiple states (regions) to increase economic viability of an area with little attention to the long term effects on human health and the environment. Individuals an...

Decision Support Framework (DSF) For Planning Land And Resource Use To Sustainably Maintain Healthy Ecosystem Services And Communities - March 31, 2009

EPA Science Inventory

Land and resource use decisions are typically made by individuals, towns, counties, tribes, states and sometimes multiple states (regions) to increase economic viability of an area with little attention to the long term effects on human health and the environment. Individuals an...

Developing Effective Academic Accommodations in Higher Education: A Collaborative Decision-Making Process

ERIC Educational Resources Information Center

Hsiao, Feilin; Zeiser, Shelly; Nuss, Daniel; Hatschek, Keith

2018-01-01

This case study describes a collaborative decision-making process for developing effective academic accommodations for a music major with a disability, whose prior accommodations suggested by the Disability Support Services (DSS) failed to address her needs. Cross-departmental collaboration between the DSS and the School of Music, as well as…

48 CFR 37.114 - Special acquisition requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Verification and Validation of NASA-Supported Enhancements to Decision Support Tools of PECAD

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; McKellip, Rodney; Moore, Roxzana F.; Fendley, Debbie

2005-01-01

This section of the evaluation report summarizes the verification and validation (V&V) of recently implemented, NASA-supported enhancements to the decision support tools of the Production Estimates and Crop Assessment Division (PECAD). The implemented enhancements include operationally tailored Moderate Resolution Imaging Spectroradiometer (MODIS) products and products of the Global Reservoir and Lake Monitor (GRLM). The MODIS products are currently made available through two separate decision support tools: the MODIS Image Gallery and the U.S. Department of Agriculture (USDA) Foreign Agricultural Service (FAS) MODIS Normalized Difference Vegetation Index (NDVI) Database. Both the Global Reservoir and Lake Monitor and MODIS Image Gallery provide near-real-time products through PECAD's CropExplorer. This discussion addresses two areas: 1. Assessments of the standard NASA products on which these enhancements are based. 2. Characterizations of the performance of the new operational products.

Integrating complex business processes for knowledge-driven clinical decision support systems.

PubMed

Kamaleswaran, Rishikesan; McGregor, Carolyn

2012-01-01

This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS.

Bush School Capstone course support : the regional impact of climate change on transportation infrastructure and decision making.

DOT National Transportation Integrated Search

2009-09-01

The Master of Public Service and Administration program at Texas A&Ms Bush School of Government : and Public Service requires that all second year graduate students participate in a two semester Capstone : course. These courses represent the pract...

Protecting Our Life Support Systems: An Inventory of US Federal Research on Ecosystem Services

EPA Science Inventory

In the United States, a broad range of federal resource management and environmental agencies are conducting research related to ecosystem services, and government agencies at all levels are increasingly interested in measuring the outcomes of proposed decision and policy options...

78 FR 48686 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...: Conduct Beneficiary Experience with Care Surveys; Use: On September 16, 2009, the Department of Health and... both medical and emotional health, health care support, and medication decisions). Form Number: CMS... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document...

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.

Refocusing and Evolving Subseasonal-to-Seasonal Services in NOAA's National Weather Service

NASA Astrophysics Data System (ADS)

Timofeyeva-Livezey, M. M.; Horsfall, F. M. C.; Silva, V.; Mangan, M. R.; Meyers, J. C.; Zdrojewski, J.

2017-12-01

NOAA's National Weather Service (NWS) recently completed a reorganization to better support its goal to build a Weather-Ready Nation. As part of the reorganization, NWS streamlined its 11 national service programs, including climate services, to provide a more structured approach to supporting service delivery needs. As the American public increasingly requests information at sub-seasonal and seasonal time scales for decision making, the NWS Climate Services Program is striving to meet those needs by accelerating transition of research to operations, improving delivery of products and services, and enhancing partnerships to facilitate provision of seamless weather, water, and climate products and services at regional and local scales. Additionally, NWS forecasters are requesting more tools to be able to put severe weather and water events into a climate context to provide more effective impact-based decision support services (IDSS). This paper will describe the activities to more effectively integrate climate services into the NWS suite of environmental information, the roles of the NWS offices supporting or delivering sub-seasonal and seasonal information to the US public, and engaging NWS core and deep-core partners in provision of information on climatological risks and preparedness as a part of IDSS. We will discuss the process by which we collect user requests and/or needs and the NWS process that allows us to move these requests and needs through a formal requirements validation process and thus place the requirement on a path to identify a potential solution for implementation. The validation of a NWS climate-related requirement is also key to identify research, development, and transition mission delivery needs that are supported through the Office of Oceanic and Atmospheric Research (OAR) Climate Program Office (CPO). In addition, we will present the outcomes of key actions of the first ever NWS National Climate Services Meeting (NCSM) that was held in May 2016 with the participation of more than 250 NWS climate services staff and key partners from across the country. The key actions include understanding core and deep-core partners, advancing training for NWS staff focused on IDSS, and better organization of service delivery at regional and local levels.

Services and supports for young children with Down syndrome: parent and provider perspectives.

PubMed

Marshall, J; Tanner, J P; Kozyr, Y A; Kirby, R S

2015-05-01

As individuals with Down syndrome are living longer and more socially connected lives, early access to supports and services for their parents will ensure an optimal start and improved outcomes. The family's journey begins at the child's diagnosis, and cumulative experiences throughout infancy and childhood set the tone for a lifetime of decisions made by the family regarding services, supports and activities. This study utilized focus groups and interviews with seven nurses, five therapists, 25 service co-ordinators, and 10 English- and three Spanish-speaking parents to better understand family experiences and perceptions on accessing Down syndrome-related perinatal, infant and childhood services and supports. Parents and providers reflected on key early life issues for children with Down syndrome and their families in five areas: prenatal diagnosis; perinatal care; medical and developmental services; care co-ordination and services; and social and community support. Systems of care are not consistently prepared to provide appropriate family-centred services to individuals with Down syndrome and their families. Individuals with disabilities require formal and informal supports from birth to achieve and maintain a high quality of life. © 2014 John Wiley & Sons Ltd.

The Role of the Technical Specialist in Disaster Response and Recovery

NASA Astrophysics Data System (ADS)

Curtis, J. C.

2017-12-01

Technical Specialists provide scientific expertise for making operational decisions during natural hazards emergencies. Technical Specialists are important members of any Incident Management Team (IMT) as is described in in the National Incident Management System (NIMS) that has been designed to respond to emergencies. Safety for the responders and the threatened population is the foremost consideration in command decisions and objectives, and the Technical Specialist is on scene and in the command post to support and promote safety while aiding decisions for incident objectives. The Technical Specialist's expertise can also support plans, logistics, and even finance as well as operations. This presentation will provide actual examples of the value of on-scene Technical Specialists, using National Weather Service "Decision Support Meteorologists" and "Incident Meteorologists". These examples will demonstrate the critical role of scientists that are trained in advising and presenting life-critical analysis and forecasts during emergencies. A case will be made for local, state, and/or a national registry of trained and deployment-ready scientists that can support emergency response.

Strategic analytics: towards fully embedding evidence in healthcare decision-making.

PubMed

Garay, Jason; Cartagena, Rosario; Esensoy, Ali Vahit; Handa, Kiren; Kane, Eli; Kaw, Neal; Sadat, Somayeh

2015-01-01

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency's programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making. Copyright © 2014 Longwoods Publishing.

A qualitative study of professional and client perspectives on information flows and decision aid use.

PubMed

Stirling, Christine; Lloyd, Barbara; Scott, Jenn; Abbey, Jenny; Croft, Toby; Robinson, Andrew

2012-03-29

This paper explores the meanings given by a diverse range of stakeholders to a decision aid aimed at helping carers of people in early to moderate stages of dementia (PWD) to select community based respite services. Decision aids aim to empower clients to share decision making with health professionals. However, the match between health professionals' perspectives on decision support needs and their clients' perspective is an important and often unstudied aspect of decision aid use. A secondary analysis was undertaken of qualitative data collected as part of a larger study. The data included twelve interviews with carers of people with dementia, three interviews with expert advisors, and three focus groups with health professionals. A theoretical analysis was conducted, drawing on theories of 'positioning' and professional identity. Health professionals are seen to hold varying attitudes and beliefs about carers' decision support needs, and these appeared to be grounded in the professional identity of each group. These attitudes and beliefs shaped their attitudes towards decision aids, the information they believed should be offered to dementia carers, and the timing of its offering. Some groups understood carers as needing to be protected from realistic information and consequently saw a need to filter information to carer clients. Health professionals' beliefs may cause them to restrict information flows, which can limit carers' ability to make decisions, and limit health services' ability to improve partnering and shared decision making. In an era where information is freely available to those with the resources to access it, we question whether health professionals should filter information.

An optimization modeling approach to awarding large fire support wildfire helicopter contracts from the US Forest Service

Treesearch

Stephanie A. Snyder; Keith D. Stockmann; Gaylord E. Morris

2012-01-01

The US Forest Service used contracted helicopter services as part of its wildfire suppression strategy. An optimization decision-modeling system was developed to assist in the contract selection process. Three contract award selection criteria were considered: cost per pound of delivered water, total contract cost, and quality ratings of the aircraft and vendors....

Research and development portfolio of the sustainability science team national sustainable operations USDA Forest Service

Treesearch

Trista Patterson; David Nicholls; Jonathan Long

2015-01-01

The Sustainability Science Team (SST) of the U.S. Department of Agriculture (USDA) Forest Service Sustainable Operations Initiative is a 18-member virtual research and development team, located across five regions and four research stations of the USDA Forest Service. The team provides research, publication, systems analysis, and decision support to the Sustainable...

Aids to navigation service force mix 2000 project. Volume 2 : development and application of an aids to navigation service force mix decision support system : aid assignments and vessel summary reports

DOT National Transportation Integrated Search

1992-06-01

The Aids to Navigation (ATON) Service Force Mix (SFM) 2000 Project is documented in a Project Overview and three separately bound volumes. This is Volume II. The Project Overview describes the purpose, approach, analysis, and results of the ATON SFM ...

50 CFR 17.84 - Special rules-vertebrates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... too steep to support populations of woundfin. (7) The reintroduced populations will be checked... population grows from the point of being established toward the maximum number that its habitat can support... decision to terminate the translocated population. A joint State-Service consultation will determine when...

47 CFR 54.705 - Committees of the Administrator's Board of Directors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... decisions concerning: (i) How the Administrator projects demand for the schools and libraries support... libraries support mechanism; (iii) Administration of the application process, including activities to ensure... be applied to services purchased by eligible schools and libraries; (x) Performance of audits of...

A Distributed Architecture for Tsunami Early Warning and Collaborative Decision-support in Crises

NASA Astrophysics Data System (ADS)

Moßgraber, J.; Middleton, S.; Hammitzsch, M.; Poslad, S.

2012-04-01

The presentation will describe work on the system architecture that is being developed in the EU FP7 project TRIDEC on "Collaborative, Complex and Critical Decision-Support in Evolving Crises". The challenges for a Tsunami Early Warning System (TEWS) are manifold and the success of a system depends crucially on the system's architecture. A modern warning system following a system-of-systems approach has to integrate various components and sub-systems such as different information sources, services and simulation systems. Furthermore, it has to take into account the distributed and collaborative nature of warning systems. In order to create an architecture that supports the whole spectrum of a modern, distributed and collaborative warning system one must deal with multiple challenges. Obviously, one cannot expect to tackle these challenges adequately with a monolithic system or with a single technology. Therefore, a system architecture providing the blueprints to implement the system-of-systems approach has to combine multiple technologies and architectural styles. At the bottom layer it has to reliably integrate a large set of conventional sensors, such as seismic sensors and sensor networks, buoys and tide gauges, and also innovative and unconventional sensors, such as streams of messages from social media services. At the top layer it has to support collaboration on high-level decision processes and facilitates information sharing between organizations. In between, the system has to process all data and integrate information on a semantic level in a timely manner. This complex communication follows an event-driven mechanism allowing events to be published, detected and consumed by various applications within the architecture. Therefore, at the upper layer the event-driven architecture (EDA) aspects are combined with principles of service-oriented architectures (SOA) using standards for communication and data exchange. The most prominent challenges on this layer include providing a framework for information integration on a syntactic and semantic level, leveraging distributed processing resources for a scalable data processing platform, and automating data processing and decision support workflows.

Building a model-based decision support system for solving vehicle routing and driver scheduling problems under hours of service regulations.

DOT National Transportation Integrated Search

2011-08-27

"In principle, hours-of-service (HOS) regulations are intended to help truck drivers ensure get adequate rest and perform safe operations. The new HOS regulations, however, may lead to substantial cost increases for regional common carriers which hav...

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…

Mapping ecosystem services in a Great Lakes estuary supports local decision-making

EPA Science Inventory

Estuaries of the Laurentian Great Lakes provide a concentrated supply of ecosystem goods and services from which humans benefit. As long-term centers of human activity, most estuaries of the Great Lakes and have a legacy of chemical contamination, degraded habitats, and non-point...

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.

An Artificial Neural Network-Based Decision-Support System for Integrated Network Security

DTIC Science & Technology

2014-09-01

group that they need to know in order to make team-based decisions in real-time environments, (c) Employ secure cloud computing services to host mobile...THESIS Presented to the Faculty Department of Electrical and Computer Engineering Graduate School of Engineering and Management Air Force...out-of-the-loop syndrome and create complexity creep. As a result, full automation efforts can lead to inappropriate decision-making despite a

Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

PubMed

McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk

2015-01-01

Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality.

PubMed

Baldwin, Richard; Chenoweth, Lynnette; Dela Rama, Marie; Wang, Alex Y

Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size. The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality. A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance. The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance. The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed. The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.

Non-Functional Property Driven Service Governance: Performance Implications

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

Liu, Yan; Zhu, Liming; Bass, Len

2007-09-17

Service governance is a set of businesses processes, policies and technical solutions that support enterprises in their implementation and management of their SOA. The decisions of service governance, especially concerning service boundaries at the enterprise level, influence the deployment topology of business services across or within business organizations. Deployment topologies are realized by integration technologies such as Enterprise Service Bus (ESB). Service governance and technical solutions interact in a subtle way including through communication patterns and protocols between services and ESBs, as well as the deployment and configuration of ESB. These factors have a strong influence on the Non- Functionalmore » Properties (NFP) of a SOA solution. A systematic approach is essential to understand alternative technical solutions for a specific service governance decision. This paper proposes a modeling approach to evaluate the performance-related NFP impacts when mapping service governance to technical solutions using an ESB. This approach is illustrated by the quantitative performance analysis of a real« less

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

PubMed

Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

2016-09-01

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

[Current situation and development trend of Chinese medicine information research].

PubMed

Dong, Yan; Cui, Meng

2013-04-01

Literature resource service was the main service that Chinese medicine (CM) information offered. But in recent years users have started to request the health information knowledge service. The CM information researches and application service mainly included: (1) the need of strength studies on theory, application of technology, information retrieval, and information standard development; (2) Information studies need to support clinical decision making, new drug research; (3) Quick response based on the network monitoring and support to emergency countermeasures. CM information researches have the following treads: (1) developing the theory system structure of CM information; (2) studying the methodology system of CM information; (3) knowledge discovery and knowledge innovation.

Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

ERIC Educational Resources Information Center

Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

2006-01-01

In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

Decision Support Framework (DSF) For Planning Land And Resource Use To Sustainably Maintain Healthy Ecosystem Services And Communities - Slides For March 31, 2009

EPA Science Inventory

Land and resource use decisions are typically made by individuals, towns, counties, tribes, states and sometimes multiple states (regions) to increase economic viability of an area with little attention to the long term effects on human health and the environment. Individuals an...

An integrated information system for the acquisition, management and sharing of environmental data aimed to decision making

NASA Astrophysics Data System (ADS)

La Loggia, Goffredo; Arnone, Elisa; Ciraolo, Giuseppe; Maltese, Antonino; Noto, Leonardo; Pernice, Umberto

2012-09-01

This paper reports the first results of the Project SESAMO - SistEma informativo integrato per l'acquisizione, geStione e condivisione di dati AMbientali per il supportO alle decisioni (Integrated Information System for the acquisition, management and sharing of environmental data aimed to decision making). The main aim of the project is to design and develop an integrated environmental information platform able to provide monitoring services for decision support, integrating data from different environmental monitoring systems (including WSN). This ICT platform, based on a service-oriented architecture (SOA), will be developed to coordinate a wide variety of data acquisition systems, based on heterogeneous technologies and communication protocols, providing different sort of environmental monitoring services. The implementation and validation of the SESAMO platform and its services will involve three specific environmental domains: 1) Urban water losses; 2) Early warning system for rainfall-induced landslides; 3) Precision irrigation planning. Services in the first domain are enabled by a low cost sensors network collecting and transmitting data, in order to allow the pipeline network managers to analyze pressure, velocity and discharge data for reducing water losses in an urban contest. This paper outlines the SESAMO functional and technological structure and then gives a concise description of the service design and development process for the second and third domain. Services in the second domain are enabled by a prototypal early warning system able to identify in near-real time high-risk zones of rainfall-induced landslides. Services in the third domain are aimed to optimize irrigation planning of vineyards depending on plant water stress.

Collaboration and co-production of climate knowledge: lessons from a network on the front-line

NASA Astrophysics Data System (ADS)

Kettle, N.

2016-12-01

The science-practice gap is broadly considered a major barrier to the production and application of decision-relevant science. This study uses a social network analysis, based on 126 interviews, to analyze the roles and network ties among climate scientists, service providers, and decision makers in Alaska. Our research highlights the importance of key actors and significant differences in bonding and bridging ties across roles - structural characteristics that provide a basis for informing recommendations to build adaptive capacity and support the co-production of knowledge. Our findings also illustrate that some individuals in the network engage in multiple roles, suggesting that conceptualizing the science-practice interface as consisting of "producers" and "consumers" oversimplifies how individuals engage in climate science, services, and decision making. This research supports the notion that the development and use of climate information is a networked phenomenon. It also emphasizes the importance of centralized individuals who are capable of engaging in multiple roles for the transition of knowledge action.

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.

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

PubMed

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

2009-07-01

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

Shared decision-making in mental health care-A user perspective on decisional needs in community-based services.

PubMed

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

2016-01-01

Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Evaluation of the Effect of Decision Support on the Efficiency of Primary Care Providers in the Outpatient Practice

PubMed Central

Hankey, Ronald A.; Decker, Lindsay K.; Cha, Stephen S.; Greenes, Robert A.; Liu, Hongfang; Chaudhry, Rajeev

2015-01-01

Background: Clinical decision support (CDS) for primary care has been shown to improve delivery of preventive services. However, there is little evidence for efficiency of physicians due to CDS assistance. In this article, we report a pilot study for measuring the impact of CDS on the time spent by physicians for deciding on preventive services and chronic disease management. Methods: We randomly selected 30 patients from a primary care practice, and assigned them to 10 physicians. The physicians were requested to perform chart review to decide on preventive services and chronic disease management for the assigned patients. The patients assignment was done in a randomized crossover design, such that each patient received 2 sets of recommendations—one from a physician with CDS assistance and the other from a different physician without CDS assistance. We compared the physician recommendations made using CDS assistance, with the recommendations made without CDS assistance. Results: The physicians required an average of 1 minute 44 seconds, when they were they had access to the decision support system and 5 minutes when they were unassisted. Hence the CDS assistance resulted in an estimated saving of 3 minutes 16 seconds (65%) of the physicians’ time, which was statistically significant (P < .0001). There was no statistically significant difference in the number of recommendations. Conclusion: Our findings suggest that CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management. The result needs to be confirmed by performing similar studies at other institutions. PMID:25155103

Facing uncertainty in ecosystem services-based resource management.

PubMed

Grêt-Regamey, Adrienne; Brunner, Sibyl H; Altwegg, Jürg; Bebi, Peter

2013-09-01

The concept of ecosystem services is increasingly used as a support for natural resource management decisions. While the science for assessing ecosystem services is improving, appropriate methods to address uncertainties in a quantitative manner are missing. Ignoring parameter uncertainties, modeling uncertainties and uncertainties related to human-environment interactions can modify decisions and lead to overlooking important management possibilities. In this contribution, we present a new approach for mapping the uncertainties in the assessment of multiple ecosystem services. The spatially explicit risk approach links Bayesian networks to a Geographic Information System for forecasting the value of a bundle of ecosystem services and quantifies the uncertainties related to the outcomes in a spatially explicit manner. We demonstrate that mapping uncertainties in ecosystem services assessments provides key information for decision-makers seeking critical areas in the delivery of ecosystem services in a case study in the Swiss Alps. The results suggest that not only the total value of the bundle of ecosystem services is highly dependent on uncertainties, but the spatial pattern of the ecosystem services values changes substantially when considering uncertainties. This is particularly important for the long-term management of mountain forest ecosystems, which have long rotation stands and are highly sensitive to pressing climate and socio-economic changes. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

PubMed

Kashyap, Vipul; Morales, Alfredo; Hongsermeier, Tonya

2006-01-01

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

Substitute decision-making for adults with intellectual disabilities living in residential care: learning through experience.

PubMed

Dunn, Michael C; Clare, Isabel C H; Holland, Anthony J

2008-03-01

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, 'strategic substitute decision-making', paralleled the MCA's legal and ethical framework, whilst the second process, 'relational substitute decision-making', was markedly different from these statutory procedures. In this setting, 'relational substitute decision-making' underpinned everyday personal and social interventions connected with residents' daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed.

A streamlined sustainability assessment tool for improved decision making in the urban water industry.

PubMed

Schulz, Matthias; Short, Michael D; Peters, Gregory M

2012-01-01

Water supply is a key consideration in sustainable urban planning. Ideally, detailed quantitative sustainability assessments are undertaken during the planning stage to inform the decision-making process. In reality, however, the significant time and cost associated with undertaking such detailed environmental and economic assessments is often cited as a barrier to wider implementation of these key decision support tools, particularly for decisions made at the local or regional government level. In an attempt to overcome this barrier of complexity, 4 water service providers in Melbourne, Australia, funded the development of a publicly available streamlined Environmental Sustainability Assessment Tool, which is aimed at a wide range of decision makers to assist them in broadening the type and number of water servicing options that can be considered for greenfield or backlog developments. The Environmental Sustainability Assessment Tool consists of a simple user interface and draws on life cycle inventory data to allow for rapid estimation of the environmental and economic performance of different water servicing scenarios. Scenario options can then be further prioritized by means of an interactive multicriteria analysis. The intent of this article is to identify the key issues to be considered in a streamlined sustainability assessment tool for the urban water industry, and to demonstrate the feasibility of generating accurate life cycle assessments and life cycle costings, using such a tool. We use a real-life case study example consisting of 3 separate scenarios for a planned urban development to show that this kind of tool can emulate life cycle assessments and life cycle costings outcomes obtained through more detailed studies. This simplified approach is aimed at supporting "sustainability thinking" early in the decision-making process, thereby encouraging more sustainable water and sewerage infrastructure solutions. Copyright © 2011 SETAC.

Exploring views on current and future cochlear implant service delivery: the perspectives of users, parents and professionals at cochlear implant centres and in the community.

PubMed

Athalye, Sheetal; Archbold, Sue; Mulla, Imran; Lutman, Mark; Nikolopoulous, Thomas

2015-09-01

The objective of this survey was to explore the perceptions of implant users/carers and professionals across the UK about current and future cochlear implant service delivery and the challenges. Data were collected via an online questionnaire consisting of totally 22 questions. The questionnaire contained both open- and close-ended questions. Totally, seven hundred and forty-eight responses were received. In spite of the wide range of respondents, there was a broad consensus of opinion across groups. The majority of participants were satisfied with the service they currently receive, but wanted some changes. They reported their current experience of implant services to be mainly driven by decisions made by the implant team. For the future, they preferred the service to be mainly driven by decisions made jointly by the team and the user and/or parent/carer. The majority of participants wanted the cochlear implant services to be integrated into local audiology and other services such as education. Restrictions on number of candidates funded and political decisions and issues were seen as major challenges. Qualitative analysis of the open-ended responses supported the questionnaire responses. This research highlighted the benefits and limitations of the current cochlear implant service delivery as well as the potential implications for the long term. While respondents were generally happy with the current cochlear implant service provision, they expressed some concerns about the long-term sustainability and management, wanting integration into the local services, and more involvement of parents and users in decisions.

Visual Decision Support Tool for Supporting Asset Management Performance, Risk, and Cost Analysis (WERF Report INFR5R12)

EPA Science Inventory

Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and m...

Ecosystem services and emergent vulnerability in managed ecosystems: A geospatial decision-support tool

Treesearch

Colin M. Beier; Trista M. Patterson; F. Stuart Chapin III

2008-01-01

Managed ecosystems experience vulnerabilities when ecological resilience declines and key flows of ecosystem services become depleted or lost. Drivers of vulnerability often include local management actions in conjunction with other external, larger scale factors. To translate these concepts to management applications, we developed a conceptual model of feedbacks...

A National Approach to Quantify and Map Biodiversity ...

EPA Pesticide Factsheets

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conservation planning, human well-being, and environmental decision analysis. Mapping and quantifying ecosystem services have become strategic national interests for integrating ecology with economics to help understand the effects of human policies and actions and their subsequent impacts on both ecosystem function and human welfare. The degradation of natural ecosystems and climate variation impact the environment and society by affecting ecological integrity and ecosystems’ capacity to provide critical services (i.e., the contributions of ecosystems to human well-being). These challenges will require complex management decisions that can often involve significant trade-offs between societal desires and environmental needs. Evaluating trade-offs in terms of ecosystem services and human well-being provides an intuitive and comprehensive way to assess the broad implications of our decisions and to help shape policies that enhance environmental and social sustainability. In answer to this challenge, the U.S. government has created a partnership among the U.S. Environmental Protection Agency, other Federal agencies, academic institutions, and, Non-Governmental Organizations to develop the EnviroAtlas, an online Decision Support Tool that allows users (e.g., planners, policy-makers, resource managers, NGOs, private indu

Design and Development of a Sharable Clinical Decision Support System Based on a Semantic Web Service Framework.

PubMed

Zhang, Yi-Fan; Gou, Ling; Tian, Yu; Li, Tian-Chang; Zhang, Mao; Li, Jing-Song

2016-05-01

Clinical decision support (CDS) systems provide clinicians and other health care stakeholders with patient-specific assessments or recommendations to aid in the clinical decision-making process. Despite their demonstrated potential for improving health care quality, the widespread availability of CDS systems has been limited mainly by the difficulty and cost of sharing CDS knowledge among heterogeneous healthcare information systems. The purpose of this study was to design and develop a sharable clinical decision support (S-CDS) system that meets this challenge. The fundamental knowledge base consists of independent and reusable knowledge modules (KMs) to meet core CDS needs, wherein each KM is semantically well defined based on the standard information model, terminologies, and representation formalisms. A semantic web service framework was developed to identify, access, and leverage these KMs across diverse CDS applications and care settings. The S-CDS system has been validated in two distinct client CDS applications. Model-level evaluation results confirmed coherent knowledge representation. Application-level evaluation results reached an overall accuracy of 98.66 % and a completeness of 96.98 %. The evaluation results demonstrated the technical feasibility and application prospect of our approach. Compared with other CDS engineering efforts, our approach facilitates system development and implementation and improves system maintainability, scalability and efficiency, which contribute to the widespread adoption of effective CDS within the healthcare domain.

Data Mining for Web-Based Support Systems: A Case Study in e-Custom Systems

NASA Astrophysics Data System (ADS)

Razmerita, Liana; Kirchner, Kathrin

This chapter provides an example of a Web-based support system (WSS) used to streamline trade procedures, prevent potential security threats, and reduce tax-related fraud in cross-border trade. The architecture is based on a service-oriented architecture that includes smart seals and Web services. We discuss the implications and suggest further enhancements to demonstrate how such systems can move toward a Web-based decision support system with the support of data mining methods. We provide a concrete example of how data mining can help to analyze the vast amount of data collected while monitoring the container movements along its supply chain.

Enhancing Health-Care Services with Mixed Reality Systems

NASA Astrophysics Data System (ADS)

Stantchev, Vladimir

This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

Improving Reliability of Service Operation Using FMEA Review and New Opportunity for Investigations

NASA Astrophysics Data System (ADS)

Sutrisno, Agung; Gunawan, Indra

2016-01-01

Despite its growing contribution to the global economy, investigation on the application status of service FMEA study to support realization of reliable service operation is very limited in literature. Motivated by such situation, the paper presented an initial survey on the status and research gaps in developing and applying FMEA in service sectors. Systematic preliminary survey using specific criteria are undertaken. Our study indicated that development and application of service FMEA are partially addressing the characteristics of service operations and it is still applied into the good deed and profit oriented operations. Opportunities for further investigation pertaining to advancement of its decision supporting tool for service risk appraisal, its modification to cope with sustainability related requirements and application of service FMEA in not for profit oriented operations are presented as new avenues for further investigation

Hydra: A web-based system for cardiovascular analysis, diagnosis and treatment.

PubMed

Novo, J; Hermida, A; Ortega, M; Barreira, N; Penedo, M G; López, J E; Calvo, C

2017-02-01

Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc. This article presents a web-based system, called Hydra, which integrates a full and detailed set of services and functionalities for clinical decision support in order to help and improve the work of clinicians in cardiovascular patient diagnosis, risk assessment, treatment and monitoring over time. Hydra integrates a number of different services: a service for inputting all the information gathered by specialists (physical examination, habits, BP, blood analysis, electrocardiogram, etc.); a tool to automatically determine the CV risk stratification, including well-known standard risk stratification tables; and, finally, various tools to incorporate, analyze and graphically present the records of the ambulatory BP monitoring that provides BP analysis over a given period of time (24 or 48 hours). In addition, the platform presents a set of reports derived from all the information gathered from the patient in order to support physicians in their clinical decisions. Hydra was tested and validated in a real domain. In particular, internal medicine specialists at the Hypertension Unit of the Santiago de Compostela University Hospital (CHUS) validated the platform and used it in different clinical studies to demonstrate its utility. It was observed that the platform increased productivity and accuracy in the assessment of patient data yielding a cost reduction in clinical practice. This paper proposes a complete platform that includes different services for cardiovascular clinical decision support. It was also run as a web-based application to facilitate its use by clinicians, who can access the platform from any remote computer with Internet access. Hydra also includes different automated methods to facilitate the physicians' work and avoid potential errors in the analysis of patient data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

National fuel-treatment budgeting in US federal agencies: capturing opportunities for transparent decision-making

Treesearch

Keith M. Reynolds; Paul F. Hessburg; Robert E. Keane; James P. Menakis

2009-01-01

The Ecosystem Management Decision Support (EMDS) system has been used by the US Department of Agriculture, Forest Service and Bureaus of the Department of the Interior since 2006 to evaluate wildfire potential across all administrative units in the continental US, and to establish priorities for allocating fuel-treatment budgets. This article discusses an EMDS fuels-...

Goal Setting, Decision-Making Skills and Academic Performance of Undergraduate Distance Learners: Implications for Retention and Support Services

ERIC Educational Resources Information Center

Tanglang, Nebath; Ibrahim, Aminu Kazeem

2015-01-01

The study adopted an ex-post facto research design. Randomization sampling technique was used to select 346 undergraduate distance learners and the learners were grouped into four, High and Low Goal setter learners and High and Low Decision-making skills learners. The instruments for data collection were Undergraduate Academic Goal Setting Scale…

Support Systems which Affect the Hispanic and Anglo Adolescent Mother's Decision To Continue Her Education.

ERIC Educational Resources Information Center

Wilson, Ruth D.

For an ethnographic study of the personal and educational needs of Hispanic and Anglo adolescent mothers and the services affecting their decision to remain in school, researchers interviewed eight teenage mothers--four in a special high school teen parents' program and four who had dropped out of the program. Two young women in each group were…

Implementing shared decision making in routine mental health care

PubMed Central

Slade, Mike

2017-01-01

Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non‐maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high‐quality decision support tools; integrating SDM with other recovery‐supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified. PMID:28498575

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

Cancer.gov

Emotional Support Services The diagnosis of a brain tumor elicits many different and sometimes difficult emotions, not only for the patient, but also for their family members. Patients may encounter changes in cognitive functioning and language, a diminished ability to focus or make decisions, or short-term memory loss, all of which can greatly affect their personal and professional lives. We are dedicated to helping patients and their families deal with the physical and emotional facets of this disease.

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.

Use of Service-Learning to Teach Health Literacy with Online Graduate Nursing Students.

PubMed

George, Tracy P; DeCristofaro, Claire

To meet Healthy People 2020 goals, health literacy must be included in health care program curricula. In a fully online graduate nursing course, an innovative service-learning activity asked students to collaborate in the creation of low-literacy patient education pamphlets for practice partners at a community rehabilitation facility. Involvement with community stakeholders such as support groups and interprofessional team members enhanced interdisciplinary educational outcomes. Through this innovative project-based activity, students were able to meet the clinical education and decision support needs of rehabilitation patients while translating academic coursework to support actual community needs.

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.

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Implementing Climate Services in Peru: CLIMANDES Project

NASA Astrophysics Data System (ADS)

Lavado-Casimiro, Waldo; Mauchle, Fabian; Diaz, Amelia; Seiz, Gabriela; Rubli, Alex; Rossa, Andrea; Rosas, Gabriela; Ita, Niceforo; Calle, Victoria; Villegas, Esequiel; Ambrosetti, Paolo; Brönnimann, Stefan; Hunziker, Stefan; Jacques, Martin; Croci-Maspoli, Mischa; Konzelmann, Thomas; Gubler, Stefanie; Rohrer, Mario

2014-05-01

The climate variability and change will have increasing influence on the economic and social development of all countries and regions, such as the Andes in Latin America. The CLIMANDES project (Climate services to support decision-making in the Andean Region) will address these issues in Peru. CLIMANDES supports the WMO Regional Training Centre (RTC) in Lima, which is responsible for the training of specialized human resources in meteorology and climatology in the South American Andes (Module 1). Furthermore, CLIMANDES will provide high-quality climate services to inform policy makers in the Andean region (Module 2). It is coordinated by the World Meteorological Organization (WMO) and constitutes a pilot project under the umbrella of the WMO-led Global Framework for Climate Services (GFCS). The project is funded by the Swiss Agency for Development and Cooperation (SDC) and runs from August 2012 - July 2015. Module 1 focuses on restructuring the curricula of Meteorology at the La Molina Agraria University (UNALM) and applied training of meteorologists of the Peruvian National Service of Meteorology and Hydrology (SENAMHI). In Module 2, the skills will be shared and developed in the production and delivery of high-quality climate products and services tailored to the needs of the decision makers in the pilot regions Cusco and Junín. Such services will benefit numerous sectors including agriculture, education, health, tourism, energy, transport and others. The goals of the modules 1 and 2 will be achieved through the collaboration of the UNALM, SENAMHI and the Federal Office of Meteorology and Climatology MeteoSwiss, with the support of the University of Bern (UNIBE), Meteodat and WMO.

Realizing the potential of ecosystem services: a framework for relating ecological changes to economic benefits.

PubMed

Wainger, Lisa; Mazzotta, Marisa

2011-10-01

Increasingly government agencies are seeking to quantify the outcomes of proposed policy options in terms of ecosystem service benefits, yet conflicting definitions and ad hoc approaches to measuring ecosystem services have created confusion regarding how to rigorously link ecological change to changes in human well-being. Here, we describe a step-by-step framework for producing ecological models and metrics that can effectively serve an economic-benefits assessment of a proposed change in policy or management. A focus of the framework is developing comparable units of ecosystem goods and services to support decision-making, even if outcomes cannot be monetized. Because the challenges to translating ecological changes to outcomes appropriate for economic analyses are many, we discuss examples that demonstrate practical methods and approaches to overcoming data limitations. The numerous difficult decisions that government agencies must make to fairly use and allocate natural resources provides ample opportunity for interdisciplinary teams of natural and social scientists to improve methods for quantifying changes in ecosystem services and their effects on human well-being. This framework is offered with the intent of promoting the success of such teams as they support managers in evaluating the equivalency of ecosystem service offsets and trades, establishing restoration and preservation priorities, and more generally, in developing environmental policy that effectively balances multiple perspectives.

A Spatially-Explicit Technique for Evaluation of Alternative ...

EPA Pesticide Factsheets

Ecosystems contribute to maintaining human well-being directly through provision of goods and indirectly through provision of services that support clean water, clean air, flood protection and atmospheric stability. Transparently accounting for biophysical attributes from which humans derive benefit is essential to support dialog among the public, resource managers, decision makers, and scientists. We analyzed the potential ecosystem goods and services production from alternative future land use scenarios in the US Tampa Bay region. Ecosystem goods and service metrics included carbon sequestration, nitrogen removal, air pollutant removal, and stormwater retention. Each scenario was compared to a 2006 baseline land use. Estimated production of denitrification services changed by 28% and carbon sequestration by 20% between 2006 and the “business as usual” scenario. An alternative scenario focused on “natural resource protection” resulted in an estimated 9% loss in air pollution removal. Stormwater retention was estimated to change 18% from 2006 to 2060 projections. Cost effective areas for conservation, almost 1588 ha, beyond current conservation lands, were identified by comparing ecosystem goods and services production to assessed land values. Our ecosystem goods and services approach provides a simple and quantitative way to examine a more complete set of potential outcomes from land use decisions. This study demonstrates an approach for spatially expli

A decision support tool for identifying abuse of controlled substances by ForwardHealth Medicaid members.

PubMed

Mailloux, Allan T; Cummings, Stephen W; Mugdh, Mrinal

2010-01-01

Our objective was to use Wisconsin's Medicaid Evaluation and Decision Support (MEDS) data warehouse to develop and validate a decision support tool (DST) that (1) identifies Wisconsin Medicaid fee-for-service recipients who are abusing controlled substances, (2) effectively replicates clinical pharmacist recommendations for interventions intended to curb abuse of physician and pharmacy services, and (3) automates data extraction, profile generation and tracking of recommendations and interventions. From pharmacist manual reviews of medication profiles, seven measures of overutilization of controlled substances were developed, including (1-2) 6-month and 2-month "shopping" scores, (3-4) 6-month and 2-month forgery scores, (5) duplicate/same day prescriptions, (6) count of controlled substance claims, and the (7) shopping 6-month score for the individual therapeutic class with the highest score. The pattern analysis logic for the measures was encoded into SQL and applied to the medication profiles of 190 recipients who had already undergone manual review. The scores for each measure and numbers of providers were analyzed by exhaustive chi-squared automatic interaction detection (CHAID) to determine significant thresholds and combinations of predictors of pharmacist recommendations, resulting in a decision tree to classify recipients by pharmacist recommendations. The overall correct classification rate of the decision tree was 95.3%, with a 2.4% false positive rate and 4.0% false negative rate for lock-in versus prescriber-alert letter recommendations. Measures used by the decision tree include the 2-month and 6-month shopping scores, and the number of pharmacies and prescribers. The number of pharmacies was the best predictor of abuse of controlled substances. When a Medicaid recipient receives prescriptions for controlled substances at 8 or more pharmacies, the likelihood of a lock-in recommendation is 90%. The availability of the Wisconsin MEDS data warehouse has enabled development and application of a decision tree for detecting recipient fraud and abuse of controlled substance medications. Using standard pharmacy claims data, the decision tree effectively replicates pharmacist manual review recommendations. The DST has automated extraction and evaluation of pharmacy claims data for creating recommendations for guiding pharmacists in the selection of profiles for manual review. The DST is now the primary method used by the Wisconsin Medicaid program to detect fraud and abuse of physician and pharmacy services committed by recipients.

A decision support system for telemedicine through the mobile telecommunications platform.

PubMed

Eren, Ali; Subasi, Abdulhamit; Coskun, Osman

2008-02-01

In this paper we have discussed the application of artificial intelligence in telemedicine using mobile device. The main goal of our research is to develop methods and systems to collect, analyze, distribute and use medical diagnostics information from multiple knowledge sources and areas of expertise. Physicians may collect and analyze information obtained from experts worldwide with the help of a medical decision support system. In this information retrieval system, modern communication tools such as computers and mobile phones can be used efficiently. In this work we propose a medical decision support system using the general packet radio service (GPRS). GPRS, a data extension of the mobile telephony standard Global system for mobile communications (GSM) is emerging as the first true packet-switched architecture to allow mobile subscribers to benefit from high-speed transmission rates and run JAVA based applications from their mobile terminals. An academic prototype of a medical decision support system using mobile device was implemented. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

Patient-oriented Computerized Clinical Guidelines for Mobile Decision Support in Gestational Diabetes.

PubMed

García-Sáez, Gema; Rigla, Mercedes; Martínez-Sarriegui, Iñaki; Shalom, Erez; Peleg, Mor; Broens, Tom; Pons, Belén; Caballero-Ruíz, Estefanía; Gómez, Enrique J; Hernando, M Elena

2014-03-01

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients' self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient's access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients' personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients' acceptance of the whole system. © 2014 Diabetes Technology Society.

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

PubMed

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

2013-01-01

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

A Neuro-Fuzzy Approach in the Classification of Students' Academic Performance

PubMed Central

2013-01-01

Classifying the student academic performance with high accuracy facilitates admission decisions and enhances educational services at educational institutions. The purpose of this paper is to present a neuro-fuzzy approach for classifying students into different groups. The neuro-fuzzy classifier used previous exam results and other related factors as input variables and labeled students based on their expected academic performance. The results showed that the proposed approach achieved a high accuracy. The results were also compared with those obtained from other well-known classification approaches, including support vector machine, Naive Bayes, neural network, and decision tree approaches. The comparative analysis indicated that the neuro-fuzzy approach performed better than the others. It is expected that this work may be used to support student admission procedures and to strengthen the services of educational institutions. PMID:24302928

A neuro-fuzzy approach in the classification of students' academic performance.

PubMed

Do, Quang Hung; Chen, Jeng-Fung

2013-01-01

Classifying the student academic performance with high accuracy facilitates admission decisions and enhances educational services at educational institutions. The purpose of this paper is to present a neuro-fuzzy approach for classifying students into different groups. The neuro-fuzzy classifier used previous exam results and other related factors as input variables and labeled students based on their expected academic performance. The results showed that the proposed approach achieved a high accuracy. The results were also compared with those obtained from other well-known classification approaches, including support vector machine, Naive Bayes, neural network, and decision tree approaches. The comparative analysis indicated that the neuro-fuzzy approach performed better than the others. It is expected that this work may be used to support student admission procedures and to strengthen the services of educational institutions.

A Decision Support System for Concrete Bridge Maintenance

NASA Astrophysics Data System (ADS)

Rashidi, Maria; Lemass, Brett; Gibson, Peter

2010-05-01

The maintenance of bridges as a key element in transportation infrastructure has become a major concern for asset managers and society due to increasing traffic volumes, deterioration of existing bridges and well-publicised bridge failures. A pivotal responsibility for asset managers in charge of bridge remediation is to identify the risks and assess the consequences of remediation programs to ensure that the decisions are transparent and lead to the lowest predicted losses in recognized constraint areas. The ranking of bridge remediation treatments can be quantitatively assessed using a weighted constraint approach to structure the otherwise ill-structured phases of problem definition, conceptualization and embodiment [1]. This Decision Support System helps asset managers in making the best decision with regards to financial limitations and other dominant constraints imposed upon the problem at hand. The risk management framework in this paper deals with the development of a quantitative intelligent decision support system for bridge maintenance which has the ability to provide a source for consistent decisions through selecting appropriate remediation treatments based upon cost, service life, product durability/sustainability, client preferences, legal and environmental constraints. Model verification and validation through industry case studies is ongoing.

'They never talked to me about... ': Perspectives on aged care resident transfer to emergency departments.

PubMed

Arendts, Glenn; Popescu, Aurora; Howting, Denise; Quine, Susan; Howard, Kirsten

2015-06-01

To explore perspectives of three groups concerning transfers from aged care facilities to emergency departments. We sought to reveal factors influencing transfer decisions; how active each group was in making decisions; and to what extent groups ceded decision-making to others. Semi-structured interviews of 11 residents, 14 relatives and 17 staff with content analysis of interview transcripts. The three groups substantially differed in their involvement with initiating, and attitudes towards, transfer. Residents were least likely to be involved in the decision, yet most likely to support transfer. Staff felt conflicted between their desire to provide optimal treatment for one ill resident, and their obligations to other residents under care. Staff perspectives were largely consistent with published data, but we describe new results for other informant groups. Group expectations and preferences differ substantially. Service delivery to meet all preferences presents a challenge for health service design. © 2013 ACOTA.

After the Fall: The Use of Surplus Capacity in an Academic Library Automation System.

ERIC Educational Resources Information Center

Wright, A. J.

The possible uses of excess central processing unit capacity in an integrated academic library automation system discussed in this draft proposal include (1) in-house services such as word processing, electronic mail, management decision support using PERT/CPM techniques, and control of physical plant operation; (2) public services such as the…

NOAA's National Water Model - Integration of National Water Model with Geospatial Data creating Water Intelligence

NASA Astrophysics Data System (ADS)

Clark, E. P.; Cosgrove, B.; Salas, F.

2016-12-01

As a significant step forward to transform NOAA's water prediction services, NOAA plans to implement a new National Water Model (NWM) Version 1.0 in August 2016. A continental scale water resources model, the NWM is an evolution of the WRF-Hydro architecture developed by the National Center for Atmospheric Research (NCAR). The NWM will provide analyses and forecasts of flow for the 2.7 million stream reaches nationwide in the National Hydrography Dataset Plus v2 (NHDPlusV2) jointly developed by the USGS and EPA. The NWM also produces high-resolution water budget variables of snow, soil moisture, and evapotranspiration on a 1-km grid. NOAA's stakeholders require additional decision support application to be built on these data. The Geo-intelligence division of the Office of Water Prediction is building new products and services that integrate output from the NWM with geospatial datasets such as infrastructure and demographics to better estimate the impacts dynamic water resource states on community resiliency. This presentation will detail the methods and underlying information to produce prototypes water resources intelligence that is timely, actionable and credible. Moreover, it will to explore the NWM capability to support sector-specific decision support services.

Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making.

PubMed

Coombs, Maureen A; Parker, Roses; de Vries, Kay

2017-07-01

Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.

Examining MTSS Implementation across Systems for SLD Identification: A Case Study

ERIC Educational Resources Information Center

Barrett, Courtenay A.; Newman, Daniel S.

2018-01-01

Although research supports the effectiveness of the multitiered system of supports (MTSS) on academic and behavioral outcomes, districts aim to engage in data-based decision making and examine the effectiveness of their own MTSS implementation. This case study describes how one regional education service agency (RESA) in the Midwest implemented…

Enabling Self-Determination for Older Workers with Intellectual Disabilities in Supported Employment in Australia

ERIC Educational Resources Information Center

McDermott, Shannon; Edwards, Robyn

2012-01-01

Background: Promoting self-determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood. Methods: This research explored the views of…

47 CFR 54.8 - Prohibition on participation: suspension and debarment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prompt notice of the decision to debar. Debarment shall be effective upon the earlier of receipt of...-income support mechanism. Such matters include the receipt of funds or discounted services through one or... providers regarding one or more of these support mechanisms. (2) Civil liability. The disposition of a civil...

76 FR 30509 - Court Orders and Legal Processes Affecting Thrift Savings Plan Accounts

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-26

... Health and Human Services, Administration for Children and Families, Federal Office of Child Support... amending its regulations to shorten the time period in which child support orders and MVRA orders are... have the payment made as early as 30 days after the date of the TSP decision letter. The Agency...

Verification and Validation of NASA-Supported Enhancements to PECAD's Decision Support Tools

NASA Technical Reports Server (NTRS)

McKellipo, Rodney; Ross, Kenton W.

2006-01-01

The NASA Applied Sciences Directorate (ASD), part of the Earth-Sun System Division of NASA's Science Mission Directorate, has partnered with the U.S. Department of Agriculture (USDA) to enhance decision support in the area of agricultural efficiency-an application of national importance. The ASD integrated the results of NASA Earth science research into USDA decision support tools employed by the USDA Foreign Agricultural Service (FAS) Production Estimates and Crop Assessment Division (PECAD), which supports national decision making by gathering, analyzing, and disseminating global crop intelligence. Verification and validation of the following enhancements are summarized: 1) Near-real-time Moderate Resolution Imaging Spectroradiometer (MODIS) products through PECAD's MODIS Image Gallery; 2) MODIS Normalized Difference Vegetation Index (NDVI) time series data through the USDA-FAS MODIS NDVI Database; and 3) Jason-1 and TOPEX/Poseidon lake level estimates through PECAD's Global Reservoir and Lake Monitor. Where possible, each enhanced product was characterized for accuracy, timeliness, and coverage, and the characterized performance was compared to PECAD operational requirements. The MODIS Image Gallery and the GRLM are more mature and have achieved a semi-operational status, whereas the USDA-FAS MODIS NDVI Database is still evolving and should be considered

A Service Oriented Architecture Approach to Achieve Interoperability between Immunization Information Systems in Iran

PubMed Central

Hosseini, Masoud; Ahmadi, Maryam; Dixon, Brian E.

2014-01-01

Clinical decision support (CDS) systems can support vaccine forecasting and immunization reminders; however, immunization decision-making requires data from fragmented, independent systems. Interoperability and accurate data exchange between immunization information systems (IIS) is an essential factor to utilize Immunization CDS systems. Service oriented architecture (SOA) and Health Level 7 (HL7) are dominant standards for web-based exchange of clinical information. We implemented a system based on SOA and HL7 v3 to support immunization CDS in Iran. We evaluated system performance by exchanging 1500 immunization records for roughly 400 infants between two IISs. System turnaround time is less than a minute for synchronous operation calls and the retrieved immunization history of infants were always identical in different systems. CDS generated reports were accordant to immunization guidelines and the calculations for next visit times were accurate. Interoperability is rare or nonexistent between IIS. Since inter-state data exchange is rare in United States, this approach could be a good prototype to achieve interoperability of immunization information. PMID:25954452

ADESSA: A Real-Time Decision Support Service for Delivery of Semantically Coded Adverse Drug Event Data

PubMed Central

Duke, Jon D.; Friedlin, Jeff

2010-01-01

Evaluating medications for potential adverse events is a time-consuming process, typically involving manual lookup of information by physicians. This process can be expedited by CDS systems that support dynamic retrieval and filtering of adverse drug events (ADE’s), but such systems require a source of semantically-coded ADE data. We created a two-component system that addresses this need. First we created a natural language processing application which extracts adverse events from Structured Product Labels and generates a standardized ADE knowledge base. We then built a decision support service that consumes a Continuity of Care Document and returns a list of patient-specific ADE’s. Our database currently contains 534,125 ADE’s from 5602 product labels. An NLP evaluation of 9529 ADE’s showed recall of 93% and precision of 95%. On a trial set of 30 CCD’s, the system provided adverse event data for 88% of drugs and returned these results in an average of 620ms. PMID:21346964

A Service Oriented Architecture Approach to Achieve Interoperability between Immunization Information Systems in Iran.

PubMed

Hosseini, Masoud; Ahmadi, Maryam; Dixon, Brian E

2014-01-01

Clinical decision support (CDS) systems can support vaccine forecasting and immunization reminders; however, immunization decision-making requires data from fragmented, independent systems. Interoperability and accurate data exchange between immunization information systems (IIS) is an essential factor to utilize Immunization CDS systems. Service oriented architecture (SOA) and Health Level 7 (HL7) are dominant standards for web-based exchange of clinical information. We implemented a system based on SOA and HL7 v3 to support immunization CDS in Iran. We evaluated system performance by exchanging 1500 immunization records for roughly 400 infants between two IISs. System turnaround time is less than a minute for synchronous operation calls and the retrieved immunization history of infants were always identical in different systems. CDS generated reports were accordant to immunization guidelines and the calculations for next visit times were accurate. Interoperability is rare or nonexistent between IIS. Since inter-state data exchange is rare in United States, this approach could be a good prototype to achieve interoperability of immunization information.

Usability evaluation of a web-based support system for people with a schizophrenia diagnosis.

PubMed

van der Krieke, Lian; Emerencia, Ando C; Aiello, Marco; Sytema, Sjoerd

2012-02-06

Routine Outcome Monitoring (ROM) is a systematic way of assessing service users' health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user's physical, psychological, and social condition. While ROM is becoming increasingly important in the mental health care sector, one of its weaknesses is that ROM is not always sufficiently service user-oriented. First, clinicians tend to concentrate on those ROM results that provide information about clinical symptoms and functioning, whereas it has been suggested that a service user-oriented approach needs to focus on personal recovery. Second, service users have limited access to ROM results and they are often not equipped to interpret them. These problems need to be addressed, as access to resources and the opportunity to share decision making has been indicated as a prerequisite for service users to become a more equal partner in communication with their clinicians. Furthermore, shared decision making has been shown to improve the therapeutic alliance and to lead to better care. Our aim is to build a web-based support system which makes ROM results more accessible to service users and to provide them with more concrete and personalized information about their functioning (ie, symptoms, housing, social contacts) that they can use to discuss treatment options with their clinician. In this study, we will report on the usability of the web-based support system for service users with schizophrenia. First, we developed a prototype of a web-based support system in a multidisciplinary project team, including end-users. We then conducted a usability study of the support system consisting of (1) a heuristic evaluation, (2) a qualitative evaluation and (3) a quantitative evaluation. Fifteen service users with a schizophrenia diagnosis and four information and communication technology (ICT) experts participated in the study. The results show that people with a schizophrenia diagnosis were able to use the support system easily. Furthermore, the content of the advice generated by the support system was considered meaningful and supportive. This study shows that the support system prototype has valuable potential to improve the ROM practice and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to prior research into web applications for people with psychotic disorders, in that it shows that this group of end users can work with web-based and computer-based systems, despite the cognitive problems they experience.

Defining products for a new health technology assessment agency in Madrid, Spain: a survey of decision makers.

PubMed

Andradas, Elena; Blasco, Juan-Antonio; Valentín, Beatriz; López-Pedraza, María-José; Gracia, Francisco-Javier

2008-01-01

The aim of this study was to explore the needs and requirements of decision makers in our regional healthcare system for health technology assessment (HTA) products to support portfolio development planning for a new HTA agency in Madrid, Spain. A Delphi study was conducted during 2003. Questionnaires were developed based on a review of products and services offered by other agency members of the International Network of Agencies for Health Technology Assessment, and included preference and prioritization questions to evaluate twenty-two different products and services. The initial Delphi panel involved eighty-seven experts from twenty-one public hospitals, eleven primary healthcare centers, six private hospitals, and eight departments of the Regional Ministry of Health of the Community of Madrid. The global participation rate was 83.9 percent. Ten of the twenty-two possible products were rated of high interest by more than 80 percent of respondents. Important differences in preferences and priorities were detected across different settings. Public hospitals and primary healthcare centers shared a more "micro" perspective, preferring classic technology-centered HTA products, whereas private hospitals and Ministry representatives demanded more "macro" products and services such as organizational model and information system assessments. The high participation rate supports the representativeness of the results for our regional context. The strategic development of an HTA portfolio based on decision makers' needs and requirements as identified in this type of exercise should help achieve a better impact on policy development and decision making.

Conformance Testing: Measurement Decision Rules

NASA Technical Reports Server (NTRS)

Mimbs, Scott M.

2010-01-01

The goal of a Quality Management System (QMS) as specified in ISO 9001 and AS9100 is to provide assurance to the customer that end products meet specifications. Measuring devices, often called measuring and test equipment (MTE), are used to provide the evidence of product conformity to specified requirements. Unfortunately, processes that employ MTE can become a weak link to the overall QMS if proper attention is not given to the measurement process design, capability, and implementation. Documented "decision rules" establish the requirements to ensure measurement processes provide the measurement data that supports the needs of the QMS. Measurement data are used to make the decisions that impact all areas of technology. Whether measurements support research, design, production, or maintenance, ensuring the data supports the decision is crucial. Measurement data quality can be critical to the resulting consequences of measurement-based decisions. Historically, most industries required simplistic, one-size-fits-all decision rules for measurements. One-size-fits-all rules in some cases are not rigorous enough to provide adequate measurement results, while in other cases are overly conservative and too costly to implement. Ideally, decision rules should be rigorous enough to match the criticality of the parameter being measured, while being flexible enough to be cost effective. The goal of a decision rule is to ensure that measurement processes provide data with a sufficient level of quality to support the decisions being made - no more, no less. This paper discusses the basic concepts of providing measurement-based evidence that end products meet specifications. Although relevant to all measurement-based conformance tests, the target audience is the MTE end-user, which is anyone using MTE other than calibration service providers. Topics include measurement fundamentals, the associated decision risks, verifying conformance to specifications, and basic measurement decisions rules.

Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: a study protocol.

PubMed

Jull, Janet; Mazereeuw, Maegan; Sheppard, Amanada; Kewayosh, Alethea; Steiner, Richard; Graham, Ian D

2018-01-01

Tailoring and testing a peer support decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol.First Nations, Inuit and Métis (FNIM) people face higher risks for cancer compared to non-FNIM populations. They also face cultural barriers to health service use. Within non-FNIM populations an approach to health decision making, called shared decision making (SDM), has been found to improve the participation of people in their healthcare. Peer support with SDM further improves these benefits. The purpose of this study is to tailor and test a peer support SDM strategy with community support workers to increase FNIM people's participation in their cancer care.This project has two phases that will be designed and conducted with a Steering Committee that includes members of the FNIM and cancer care communities. First, a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings, and training in the SDM strategy developed for community support workers. Three communities will be supported for participation in the study and community support workers who are peers from each community will be trained to use the SDM strategy.Next, each community support worker will work with a community member who has a diagnosis of cancer or who has supported a family member with cancer. Each community support worker and community member pair will use the SDM strategy. The participation and experience of the community support worker and community member will be evaluated.The research will be used to develop strategies to support people who are making decisions about their health. Tailoring and field-testing the use of a knowledge translation peer support shared decision making strategy with First Nations, Inuit and Métis people making decisions about their cancer care: A study protocol Background First Nations, Inuit and Métis ("FNIM") people face increased cancer risks in relation to general populations and experience barriers to health service use. Shared decision making (SDM) has been found to improve peoples' participation and outcomes in healthcare and peer support with SDM further improves these benefits. The purpose of this study is to tailor and then field test, by and with FNIM communities, a peer support SDM strategy for use in cancer care. Methods This project has 2 theory-driven phases and 5 stages (a-e). A core research team that includes members of the Aboriginal Cancer Control Unit of Cancer Care Ontario communities and academic researchers, will work with a Steering Committee. In phase 1 , (stage a) a peer support SDM strategy will be tailored to meet the needs of cancer system users who are receiving care in urban settings and (stage b), training developed that will i) introduce participant communities to SDM, and ii) train community support workers (CSWs) within these communities. Next (stage c), three communities will be approached for voluntary participation in the study. These communities will be introduced to SDM in community meetings, and if in agreement then CSWs from each community will be recruited to participate in the study. One volunteer CSW from each community will be trained to use the peer support SDM strategy to enable phase 2 (field test of the peer support SDM strategy).During phase 2 (stage d), each CSW will be matched to a volunteer community member who has had a diagnosis of cancer or has supported a family member with cancer and is familiar with Ontario cancer systems. Each CSW-community member pair (3 to 4 pairs/community) will use the tailored peer support SDM strategy; their interaction will be audio-recorded and their participation and experience evaluated (total of 9 to 12 interviews). As well (stage e), data will be collected on health systems' factors related to the use of the peer support SDM strategy. Discussion Findings will develop peer support SDM strategies to enhance participation of FNIM people in cancer care decisions, advance knowledge translation science, and support a proposal to conduct a multi-site implementation trial.

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

PubMed

Lee, Tso-Ying

2017-08-01

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

Intelligent support of e-management for consumer-focused virtual enterprises

NASA Astrophysics Data System (ADS)

Chandra, Charu; Smirnov, Alexander V.

2000-10-01

The interest in consumer-focused virtual enterprises (VE) decision-making problem is growing fast. The purpose of this type of enterprise is to transform incomplete information about customer orders and available resources into-co-ordinated plans for production and replenishment of goods and services in the temporal network formed by collaborating units. This implies that information in the consumer-focused VE can be shared via Internet, Intranet, and Extranet for business-to-consumer (B2C), business-to-business service (B2B-S), and business-to-business goods (B2B-G) transactions. One of the goals of Internet-Based Management (e-management) is to facilitate transfer and sharing of data and knowledge in the context of enterprise collaboration. This paper discusses a generic framework of e-management that integrates intelligent information support group-decision making, and agreement modeling for a VE network. It offers the platform for design and modeling of diverse implementation strategies related to the type of agreement, optimization policies, decision-making strategies, organization structures, and information sharing strategies and mechanisms, and business policies for the VE.

Corporate dashboard for payphone service

NASA Astrophysics Data System (ADS)

Siraj, Fadzilah; Shadan, Hezlin

2015-12-01

Making assured that managements are kept abreast of what is happening in the company is not an easy task. The quantity of data generated by the business process is astonishing large and non-centralized. The challenge facing business organizations is how to extract, load, transform data, and then deliver useful information to key decision makers. The major challenge for the payphone industries is in making a good decision, particularly to increase quality of service, customer satisfaction while achieving high revenue. With current practice, the process is very time consuming and therefore, a systematic and informative corporate dashboard needs to be provided especially for managerial level in supporting their decision making process. This paper proposed a dashboard application design that provides a single-screen display of relevant information such as the phone performance and coin collection reports, as well as generated revenue to enable faster and more effective decision making. The development of the dashboard is divided into requirement, design and implementation phases. The implementation using real data has demonstrated the potential use of the dashboard. The evaluation results indicate that the dashboard can be used as a tool that can support payphone operation works and decision process by providing the analytical analysis of the KPI report and the performance status. In addition, the results can be used as a guideline for the dashboard developer to understand the process and focuses on the key elements and the principle in designing the effective dashboard.

Translating research into practice through user-centered design: An application for osteoarthritis healthcare planning.

PubMed

Carr, Eloise Cj; Babione, Julie N; Marshall, Deborah

2017-08-01

To identify the needs and requirements of the end users, to inform the development of a user-interface to translate an existing evidence-based decision support tool into a practical and usable interface for health service planning for osteoarthritis (OA) care. We used a user-centered design (UCD) approach that emphasized the role of the end-users and is well-suited to knowledge translation (KT). The first phase used a needs assessment focus group (n=8) and interviews (n=5) with target users (health care planners) within a provincial health care organization. The second phase used a participatory design approach, with two small group sessions (n=6) to explore workflow, thought processes, and needs of intended users. The needs assessment identified five design recommendations: ensuring the user-interface supports the target user group, allowing for user-directed data explorations, input parameter flexibility, clear presentation, and provision of relevant definitions. The second phase identified workflow insights from a proposed scenario. Graphs, the need for a visual overview of the data, and interactivity were key considerations to aid in meaningful use of the model and knowledge translation. A UCD approach is well suited to identify health care planners' requirements when using a decision support tool to improve health service planning and management of OA. We believe this is one of the first applications to be used in planning for health service delivery. We identified specific design recommendations that will increase user acceptability and uptake of the user-interface and underlying decision support tool in practice. Our approach demonstrated how UCD can be used to enable knowledge translation. Copyright © 2017 Elsevier B.V. All rights reserved.

Time to decision: the drivers of innovation adoption decisions

NASA Astrophysics Data System (ADS)

Ciganek, Andrew Paul; (Dave) Haseman, William; Ramamurthy, K.

2014-03-01

Organisations desire timeliness. Timeliness facilitates a better responsiveness to changes in an organisation's external environment to either attain or maintain competitiveness. Despite its importance, decision timeliness has not been explicitly examined. Decision timeliness is measured in this study as the time taken to commit to a decision. The research objective is to identify the drivers of decision timeliness in the context of adopting service-oriented architecture (SOA), an innovation for enterprise computing. A research model rooted in the technology-organisation-environment (TOE) framework is proposed and tested with data collected in a large-scale study. The research variables have been examined before in the context of adoption, but their applicability to the timeliness of innovation decision-making has not received much attention and their salience is unclear. The results support multiple hypothesised relationships, including the finding that a risk-oriented organisational culture as well as normative and coercive pressures accelerates decision timeliness. Top management support as well as the traditional innovation attributes (compatibility, relative advantage and complexity/ease-of-use) were not found to be significant when examining their influence on decision timeliness, which appears inconsistent with generally accepted knowledge and deserves further examination.

"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

Integrating ecosystem services into risk management decisions: case study with Spanish citrus and the insecticide chlorpyrifos.

PubMed

Deacon, Samantha; Norman, Steve; Nicolette, Joseph; Reub, Gregory; Greene, Gretchen; Osborn, Rachel; Andrews, Paul

2015-02-01

The European regulatory system for the approval of pesticides includes a thorough evaluation of risks to the environment and is designed to be protective of ecosystems. However, a decision to ban an agrochemical could also potentially have a negative impact on the value of ecosystem services, if resulting changes in crop management are damaging to ecosystems or result in negative socio-economic impacts. To support regulatory decision-making, consideration of ecosystem services to identify best environmental management options could be a way forward. There is generally a growing trend for the consideration of ecosystem services in decision making. Ecosystems provide the conditions for growing food, regulate water and provide wildlife habitats; these, amongst others, are known as ecosystem services. The objectives of this case study were to bring a holistic approach to decision making by valuing the environmental, social and economic benefits derived from the use of chlorpyrifos in Valencian citrus production. Spanish growers harvest between 5 and 6 milliont of citrus annually, worth an estimated €5 to 7 billion in food markets throughout Europe. The approach highlighted the potential for unintended negative consequences of regulatory decisions if the full context is not considered. In this study, rather than a regulatory restriction, the best option was the continued use of chlorpyrifos together with vegetated conservation patches as refuges for non-target insects. The conservation patches offset potential insecticidal impacts to insects whilst maintaining citrus production, farm income and the amenity value of the citrus landscape of Valencia. This was an initial proof-of-concept study and illustrates the importance of a wider perspective; other cases may have different outcomes depending on policies, the pesticide, crop scenarios, farm economics and the region. Copyright © 2014 Elsevier B.V. All rights reserved.

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.

Knowledge representation and management enabling intelligent interoperability - principles and standards.

PubMed

Blobel, Bernd

2013-01-01

Based on the paradigm changes for health, health services and underlying technologies as well as the need for at best comprehensive and increasingly automated interoperability, the paper addresses the challenge of knowledge representation and management for medical decision support. After introducing related definitions, a system-theoretical, architecture-centric approach to decision support systems (DSSs) and appropriate ways for representing them using systems of ontologies is given. Finally, existing and emerging knowledge representation and management standards are presented. The paper focuses on the knowledge representation and management part of DSSs, excluding the reasoning part from consideration.

The Increasing Use of Remote Sensing Data in Studying the Climatological Impacts on Public Health

NASA Astrophysics Data System (ADS)

Kempler, S.; Benedict, K. K.; Ceccato, P.; Golden, M.; Maxwell, S.; Morain, S.; Soebiyanto, R.; Tong, D.

2011-12-01

One of the most fortunate outcomes of the capture and transformation of remote sensing data into applied information is their usefulness and impacts to better understanding climatological impacts on public health. Today, with petabytes of remote sensing data providing global coverage of climatological parameters, public health research and policy decision makers have an unprecedented (and growing) data record that relates the effects of climatic parameters, such as rainfall, heat, soil moisture, etc. to incidences and spread of disease, as well as predictive modeling. In addition, tools and services that specifically serve public health researchers and respondents have grown in response to the needs of the these information users. This presentation provides: A perspective of the use of remote sensing data in public health research; NASA funded systems developed to facilitate specific public health decision and public support services, and: Insights on remote sensing data and information services that are available for public health studies and decision making. After providing a review of the use of remote sensing data, the following specific services will be discussed: - Rainfall, Vegetation and Water Bodies Monitoring for Malaria Surveillance - Heat Evaluation and Assessment - Multi-resolution Nested Dust Forecast - Socioeconomic Data and Application Center (SEDAC) Health Related Data and Services - Goddard Earth Sciences Data and Information Services Center (GES DISC) Health Related Data and Services The purpose of this presentation is to provide a (strong) flavor of the data and information services available to public health research and decision making, to invoke new ways of thinking about how public health work can be accomplished, and stimulate new ideas on how information services can be further utilized.

Referral criteria and clinical decision support: radiological protection aspects for justification.

PubMed

Pérez, M del Rosario

2015-06-01

Advanced imaging technology has opened new horizons for medical diagnostics and improved patient care. However, many procedures are unjustified and do not provide a net benefit. An area of particular concern is the unnecessary use of radiation when clinical evaluation or other imaging modalities could provide an accurate diagnosis. Referral criteria for medical imaging are consensus statements based on the best-available evidence to assist the decision-making process when choosing the best imaging procedure for a given patient. Although they are advisory rather than compulsory, physicians should have good reasons for deviation from these criteria. Voluntary use of referral criteria has shown limited success compared with integration into clinical decision support systems. These systems support good medical practice, can improve health service delivery, and foster safer, more efficient, fair, cost-effective care, thus contributing to the strengthening of health systems. Justification of procedures and optimisation of protection, the two pillars of radiological protection in health care, are implicit in the notion of good medical practice. However, some health professionals are not familiar with these principles, and have low awareness of radiological protection aspects of justification. A stronger collaboration between radiation protection and healthcare communities could contribute to improve the radiation protection culture in medical practice. © The Chartered Institution of Building Services Engineers 2014.

Knowledge of and Attitudes Toward Evidence-Based Guidelines for and Against Clinical Preventive Services: Results from a National Survey.

PubMed

Lantz, Paula M; Evans, W Douglas; Mead, Holly; Alvarez, Carmen; Stewart, Lisa

2016-03-01

Both the underuse and overuse of clinical preventive services relative to evidence-based guidelines are a public health concern. Informed consumers are an important foundation of many components of the Affordable Care Act, including coverage mandates for proven clinical preventive services recommended by the US Preventive Services Task Force. Across sociodemographic groups, however, knowledge of and positive attitudes toward evidence-based guidelines for preventive care are extremely low. Given the demonstrated low levels of consumers' knowledge of and trust in guidelines, coupled with their strong preference for involvement in preventive care decisions, better education and decision-making support for evidence-based preventive services are greatly needed. Both the underuse and overuse of clinical preventive services are a serious public health problem. The goal of our study was to produce population-based national data that could assist in the design of communication strategies to increase knowledge of and positive attitudes toward evidence-based guidelines for clinical preventive services (including the US Preventive Services Task Force, USPSTF) and to reduce uncertainty among patients when guidelines change or are controversial. In late 2013 we implemented an Internet-based survey of a nationally representative sample of 2,529 adults via KnowledgePanel, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and those with less than a high school education were oversampled. We then conducted descriptive statistics and multivariable logistic regression analysis to identify the prevalence of and sociodemographic characteristics associated with key knowledge and attitudinal variables. While 36.4% of adults reported knowing that the Affordable Care Act requires insurance companies to cover proven preventive services without cost sharing, only 7.7% had heard of the USPSTF. Approximately 1 in 3 (32.6%) reported trusting that a government task force would make fair guidelines for preventive services, and 38.2% believed that the government uses guidelines to ration health care. Most of the respondents endorsed the notion that research/scientific evidence and expert medical opinion are important for the creation of guidelines and that clinicians should follow guidelines based on evidence. But when presented with patient vignettes in which a physician made a guideline-based recommendation against a cancer-screening test, less than 10% believed that this recommendation alone, without further dialogue and/or the patient's own research, was sufficient to make such a decision. Given these demonstrated low levels of knowledge and mistrust regarding guidelines, coupled with a strong preference for shared decision making, better consumer education and decision supports for evidence-based guidelines for clinical preventive services are greatly needed. © 2016 Milbank Memorial Fund.

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…

Steps to Success: Helping Women with Alcohol and Drug Problems Move from Welfare to Work.

ERIC Educational Resources Information Center

Rubinstein, Gwen

This report helps state and local decision makers understand the range of services ordinarily needed and provided in alcohol and drug treatment programs serving women and families receiving welfare and how those services support the goals of welfare reform. The model programs profiled here tend to the needs of women on welfare and their families…

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…

Informing clinical policy decision-making practices in ambulance services.

PubMed

Muecke, Sandy; Curac, Nada; Binks, Darryn

2013-12-01

This study aims to identify the processes and frameworks that support an evidence-based approach to clinical policy decision-making practices in ambulance services. This literature review focused on: (i) the setting (pre-hospital); and (ii) the process of evidence translation, for studies published after the year 2000. Searches of Medline, CINAHL and Google were undertaken. Reference lists of eligible publications were searched for relevant articles. A total of 954 articles were identified. Of these, 20 full text articles were assessed for eligibility and seven full text articles met the inclusion criteria. Three provided detailed descriptions of the evidence-based practice processes used to inform ambulance service protocol or guideline development or review. There is little published literature that describes the processes involved, and frameworks required, to inform clinical policy decision making within ambulance services. This review found that processes were iterative and involved collaborations across many internal and external stakeholders. In several jurisdictions, these were coordinated by a dedicated team. Success appears dependent on committed leadership and purposive human and structural resources. Although time consuming, structured processes have been developed in some jurisdictions to assist decision-making processes. Further insight is likely to be obtained from literature published by those from other disciplines. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

Decision Support for Personalized Cloud Service Selection through Multi-Attribute Trustworthiness Evaluation

PubMed Central

Ding, Shuai; Xia, Chen-Yi; Zhou, Kai-Le; Yang, Shan-Lin; Shang, Jennifer S.

2014-01-01

Facing a customer market with rising demands for cloud service dependability and security, trustworthiness evaluation techniques are becoming essential to cloud service selection. But these methods are out of the reach to most customers as they require considerable expertise. Additionally, since the cloud service evaluation is often a costly and time-consuming process, it is not practical to measure trustworthy attributes of all candidates for each customer. Many existing models cannot easily deal with cloud services which have very few historical records. In this paper, we propose a novel service selection approach in which the missing value prediction and the multi-attribute trustworthiness evaluation are commonly taken into account. By simply collecting limited historical records, the current approach is able to support the personalized trustworthy service selection. The experimental results also show that our approach performs much better than other competing ones with respect to the customer preference and expectation in trustworthiness assessment. PMID:24972237

Decision support for personalized cloud service selection through multi-attribute trustworthiness evaluation.

PubMed

Ding, Shuai; Xia, Cheng-Yi; Xia, Chen-Yi; Zhou, Kai-Le; Yang, Shan-Lin; Shang, Jennifer S

2014-01-01

Facing a customer market with rising demands for cloud service dependability and security, trustworthiness evaluation techniques are becoming essential to cloud service selection. But these methods are out of the reach to most customers as they require considerable expertise. Additionally, since the cloud service evaluation is often a costly and time-consuming process, it is not practical to measure trustworthy attributes of all candidates for each customer. Many existing models cannot easily deal with cloud services which have very few historical records. In this paper, we propose a novel service selection approach in which the missing value prediction and the multi-attribute trustworthiness evaluation are commonly taken into account. By simply collecting limited historical records, the current approach is able to support the personalized trustworthy service selection. The experimental results also show that our approach performs much better than other competing ones with respect to the customer preference and expectation in trustworthiness assessment.

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.

Life-Cycle inventory/impact Assessment in the context of Chemical Risk Assessment: An Informatics-driven Scoping Review

EPA Science Inventory

One of the goals of Life-Cycle Assessment (LCA) is to compare the full range of environmental effects assignable to products and services in order to improve processes, support policy and provide a sound “systems-thinking” basis for decision support. How in fact LCA can be incorp...

The emergency patient's participation in medical decision-making.

PubMed

Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

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

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

PubMed

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

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

National Foster Care and Adoption Directory Search

MedlinePlus

... Home Topics Family-Centered Practice Philosophy and Key Elements of Family-Centered Practice Family-Centered Practice Across the Service Continuum Engaging Families Family-Centered Casework Practice Family Group Decision-Making Engaging Communities to Support Families Creating a Family- ...

Improvements and enhancements to LOSPLAN 2009 : summary report.

DOT National Transportation Integrated Search

2011-03-01

LOSPLAN is software that supports the Quality/Level of Service (Q/LOS) Handbook. The Handbook was developed by the Florida Department of Transportation Systems Planning Office with the intention that engineers, planners, and decision makers would use...

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.

Performance measurement integrated information framework in e-Manufacturing

NASA Astrophysics Data System (ADS)

Teran, Hilaida; Hernandez, Juan Carlos; Vizán, Antonio; Ríos, José

2014-11-01

The implementation of Internet technologies has led to e-Manufacturing technologies becoming more widely used and to the development of tools for compiling, transforming and synchronising manufacturing data through the Web. In this context, a potential area for development is the extension of virtual manufacturing to performance measurement (PM) processes, a critical area for decision making and implementing improvement actions in manufacturing. This paper proposes a PM information framework to integrate decision support systems in e-Manufacturing. Specifically, the proposed framework offers a homogeneous PM information exchange model that can be applied through decision support in e-Manufacturing environment. Its application improves the necessary interoperability in decision-making data processing tasks. It comprises three sub-systems: a data model, a PM information platform and PM-Web services architecture. A practical example of data exchange for measurement processes in the area of equipment maintenance is shown to demonstrate the utility of the model.

NWS Alaska Sea Ice Program: Operations and Decision Support Services

NASA Astrophysics Data System (ADS)

Schreck, M. B.; Nelson, J. A., Jr.; Heim, R.

2015-12-01

The National Weather Service's Alaska Sea Ice Program is designed to service customers and partners operating and planning operations within Alaska waters. The Alaska Sea Ice Program offers daily sea ice and sea surface temperature analysis products. The program also delivers a five day sea ice forecast 3 times each week, provides a 3 month sea ice outlook at the end of each month, and has staff available to respond to sea ice related information inquiries. These analysis and forecast products are utilized by many entities around the state of Alaska and nationally for safety of navigation and community strategic planning. The list of current customers stem from academia and research institutions, to local state and federal agencies, to resupply barges, to coastal subsistence hunters, to gold dredgers, to fisheries, to the general public. Due to a longer sea ice free season over recent years, activity in the waters around Alaska has increased. This has led to a rise in decision support services from the Alaska Sea Ice Program. The ASIP is in constant contact with the National Ice Center as well as the United States Coast Guard (USCG) for safety of navigation. In the past, the ASIP provided briefings to the USCG when in support of search and rescue efforts. Currently, not only does that support remain, but our team is also briefing on sea ice outlooks into the next few months. As traffic in the Arctic increases, the ASIP will be called upon to provide more and more services on varying time scales to meet customer needs. This talk will address the many facets of the current Alaska Sea Ice Program as well as delve into what we see as the future of the ASIP.

A-7E Software Module Guide.

DTIC Science & Technology

1981-12-08

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

Ecosystem services in risk assessment and management. ...

EPA Pesticide Factsheets

The ecosystem services (ES) concept holds much promise for environmental decision making. Even so, the concept has yet to gain full traction in the decisions and policies of environmental agencies in the United States, Europe, and elsewhere. Here we examine the opportunities for and implications of including ES in risk assessments and the risk management decisions that they inform. We assert that use of ES will: 1) lead to more comprehensive environmental protection; 2) help to articulate the benefits of environmental decisions, policies, and actions; 3) better inform the derivation of environmental quality standards; 4) enable integration of human health and ecological risk assessment; and 5) facilitate horizontal integration of policies, regulations, and programs. We provide the technical basis and supporting rationale for each assertion, relying on examples taken from experiences in the United States and European Union. Specific recommendations are offered for use of ES in risk assessment and risk management, and issues and challenges to advancing use of ES are described along with some of the science needed to improve the value of the ES concept to environmental protection. This paper is one of 4 papers generated from the 2014 Pellston Workshop “Ecosystem Services, Environmental Stressors and Decision Making,” organized jointly by the Society of Environmental Toxicology and Chemistry and the Ecological Society of America. The main workshop objective was

Observations to support adaptation: Principles, scales and decision-making

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.

2012-12-01

As has been long noted, a comprehensive, coordinated observing system is the backbone of any Earth information system. Demands are increasingly placed on earth observation and prediction systems and attendant services to address the needs of economically and environmentally vulnerable sectors and investments, including energy, water, human health, transportation, agriculture, fisheries, tourism, biodiversity, and national security. Climate services include building capacity to interpret information and recognize standards and limitations of data in the promotion of social and economic development in a changing climate. This includes improving the understanding of climate in the context of a variety of temporal and spatial scales (including the influence of decadal scale forcings and land surface feedbacks on seasonal forecast reliability). Climate data and information are central for developing decision options that are sensitive to climate-related uncertainties and the design of flexible adaptation pathways. Ideally monitoring should be action oriented to support climate risk assessment and adaptation including informing robust decision making to multiple risks over the long term. Based on the experience of global observations programs and empirical research we outline- Challenges in developing effective monitoring and climate information systems to support adaptation. The types of observations of critical importance needed for sector planning to enhance food, water and energy security, and to improve early warning for disaster risk reduction Observations needed for ecosystem-based adaptation including the identification of thresholds, maintenance of biological diversity and land degradation The benefits and limits of linking regional model output to local observations including analogs and verification for adaptation planning To support these goals a robust systems of integrated observations are needed to characterize the uncertainty surrounding emergent risks including overcoming unrealistically precise information demands. While monitoring systems design and operation should be guided by the standards and requirements of management, those who provide information to the system (e.g. hydromet services) should also derive benefits. Drawing on identified information needs to support climate risk management (in drought, water resources and other areas) we outline principles of effective monitoring and develop preliminary strategic guidance for information systems being developed through the GEO, GCOS and Global and national frameworks for climate services. The efficacy of such services are improved by a problem-solving orientation, participatory planning, extension management and improvements in the use and value of existing data to legitimize new investments.

Invasive Species Forecasting System: A Decision Support Tool for the U.S. Geological Survey: FY 2005 Benchmarking Report v.1.6

NASA Technical Reports Server (NTRS)

Stohlgren, Tom; Schnase, John; Morisette, Jeffrey; Most, Neal; Sheffner, Ed; Hutchinson, Charles; Drake, Sam; Van Leeuwen, Willem; Kaupp, Verne

2005-01-01

The National Institute of Invasive Species Science (NIISS), through collaboration with NASA's Goddard Space Flight Center (GSFC), recently began incorporating NASA observations and predictive modeling tools to fulfill its mission. These enhancements, labeled collectively as the Invasive Species Forecasting System (ISFS), are now in place in the NIISS in their initial state (V1.0). The ISFS is the primary decision support tool of the NIISS for the management and control of invasive species on Department of Interior and adjacent lands. The ISFS is the backbone for a unique information services line-of-business for the NIISS, and it provides the means for delivering advanced decision support capabilities to a wide range of management applications. This report describes the operational characteristics of the ISFS, a decision support tool of the United States Geological Survey (USGS). Recent enhancements to the performance of the ISFS, attained through the integration of observations, models, and systems engineering from the NASA are benchmarked; i.e., described quantitatively and evaluated in relation to the performance of the USGS system before incorporation of the NASA enhancements. This report benchmarks Version 1.0 of the ISFS.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service.

PubMed

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee; Yoo, Sooyoung

2015-04-01

To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

Benefit-cost analysis framework for evaluating inter-city transit investment.

DOT National Transportation Integrated Search

2008-10-01

This report describes the development and application of a benefit/cost analysis (BCA) model to support the evaluation of investment decisions for intercity bus services. The model recognizes two principle types of intercity bus benefits: benefits th...

Development of a large bus/small bus decision support tool

DOT National Transportation Integrated Search

2008-02-01

Transit managers continue to strive for greater operating efficiency while maintaining an appropriate balance between cost effectiveness and customer service. Over the past decade, the use of heavy-duty buses smaller than the traditional forty-foot v...

North Cascades Stehekin Valley Vehicle Decision Document.

DOT National Transportation Integrated Search

2007-08-31

This document serves as technical substantiation in support of a procurement for a fleet of vehicles to be used to operate a scheduled shuttle operation with multiple stops at North Cascades National Park Service Complex (NOCA), in the Stehekin Valle...

A Simplified Decision Support Approach for Evaluating Wetlands Ecosystem Services NABS11

EPA Science Inventory

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

Fuzzy-Neural Controller in Service Requests Distribution Broker for SOA-Based Systems

NASA Astrophysics Data System (ADS)

Fras, Mariusz; Zatwarnicka, Anna; Zatwarnicki, Krzysztof

The evolution of software architectures led to the rising importance of the Service Oriented Architecture (SOA) concept. This architecture paradigm support building flexible distributed service systems. In the paper the architecture of service request distribution broker designed for use in SOA-based systems is proposed. The broker is built with idea of fuzzy control. The functional and non-functional request requirements in conjunction with monitoring of execution and communication links are used to distribute requests. Decisions are made with use of fuzzy-neural network.

Integrating Personalized and Community Services for Mobile Travel Planning and Management

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih

Personalized and community services have been noted as keys to enhance and facilitate e-tourism as well as mobile applications. This paper aims at proposing an integrated service framework for combining personalized and community functions to support mobile travel planning and management. Major mobile tourism related planning and decision support functions specified include personalized profile management, information search and notification, evaluation and recommendation, do-it-yourself planning and design, community and collaboration management, auction and negotiation, transaction and payment, as well as trip tracking and quality control. A system implementation process with an example prototype is also presented for illustrating the feasibility and effectiveness of the proposed system framework, process model, and development methodology.

Service provision and use of anticoagulants in atrial fibrillation.

PubMed Central

Sudlow, C. M.; Rodgers, H.; Kenny, R. A.; Thomson, R. G.

1995-01-01

Several large trials have shown that the risk of stroke in patients with non-valvar atrial fibrillation is reduced by treatment with warfarin. Implementing this research evidence requires not only an understanding of the trials' results and of the changes that they imply for clinicians' treatment decisions but also an appreciation of the organisation, quantity, and quality of services required to support these changes. Understanding of these implications is crucial for developing services that allow changes in practice to produce reductions in stroke incidence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' results. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care. Images FIG 1 PMID:7663216

Decision Support from Genetic Algorithms for Ship Collision Avoidance Route Planning and Alerts

NASA Astrophysics Data System (ADS)

Tsou, Ming-Cheng; Kao, Sheng-Long; Su, Chien-Min

When an officer of the watch (OOW) faces complicated marine traffic, a suitable decision support tool could be employed in support of collision avoidance decisions, to reduce the burden and greatly improve the safety of marine traffic. Decisions on routes to avoid collisions could also consider economy as well as safety. Through simulating the biological evolution model, this research adopts the genetic algorithm used in artificial intelligence to find a theoretically safety-critical recommendation for the shortest route of collision avoidance from an economic viewpoint, combining the international regulations for preventing collisions at sea (COLREGS) and the safety domain of a ship. Based on this recommendation, an optimal safe avoidance turning angle, navigation restoration time and navigational restoration angle will also be provided. A Geographic Information System (GIS) will be used as the platform for display and operation. In order to achieve advance notice of alerts and due preparation for collision avoidance, a Vessel Traffic Services (VTS) operator and the OOW can use this system as a reference to assess collision avoidance at present location.

Allocation of home care services by municipalities in Norway: a document analysis.

PubMed

Holm, Solrun G; Mathisen, Terje A; Sæterstrand, Torill M; Brinchmann, Berit S

2017-09-22

In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices. A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients). In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance. Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.

Ecological mechanisms underpinning climate adaptation services.

PubMed

Lavorel, Sandra; Colloff, Matthew J; McIntyre, Sue; Doherty, Michael D; Murphy, Helen T; Metcalfe, Daniel J; Dunlop, Michael; Williams, Richard J; Wise, Russell M; Williams, Kristen J

2015-01-01

Ecosystem services are typically valued for their immediate material or cultural benefits to human wellbeing, supported by regulating and supporting services. Under climate change, with more frequent stresses and novel shocks, 'climate adaptation services', are defined as the benefits to people from increased social ability to respond to change, provided by the capability of ecosystems to moderate and adapt to climate change and variability. They broaden the ecosystem services framework to assist decision makers in planning for an uncertain future with new choices and options. We present a generic framework for operationalising the adaptation services concept. Four steps guide the identification of intrinsic ecological mechanisms that facilitate the maintenance and emergence of ecosystem services during periods of change, and so materialise as adaptation services. We applied this framework for four contrasted Australian ecosystems. Comparative analyses enabled by the operational framework suggest that adaptation services that emerge during trajectories of ecological change are supported by common mechanisms: vegetation structural diversity, the role of keystone species or functional groups, response diversity and landscape connectivity, which underpin the persistence of function and the reassembly of ecological communities under severe climate change and variability. Such understanding should guide ecosystem management towards adaptation planning. © 2014 John Wiley & Sons Ltd.

Capturing information needs of care providers to support knowledge sharing and distributed decision making.

PubMed

Rogers, M; Zach, L; An, Y; Dalrymple, P

2012-01-01

This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a "one-stop shop" for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other care providers. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice. The objective of this case study was to identify the information needs of care providers in order to inform the design of HIT to support knowledge sharing and distributed decision making. A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care. Using this design approach, the researchers identified the information needs of care providers working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among care providers and support better health decisions. We have identified information needs of care providers as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.

Comparison of Two Sources of Clinical Audit Data to Assess the Delivery of Diabetes Care in Aboriginal Communities.

PubMed

Regan, Timothy; Paul, Christine; Ishiguchi, Paul; D'Este, Catherine; Koller, Claudia; Forshaw, Kristy; Noble, Natasha; Oldmeadow, Christopher; Bisquera, Alessandra; Eades, Sandra

2017-10-17

The objective of this study was to determine the concordance between data extracted from two Clinical Decision Support Systems regarding diabetes testing and monitoring at Aboriginal Community Controlled Health Services in Australia. De-identified PenCAT and Communicare Systems data were extracted from the services allocated to the intervention arm of a diabetes care trial, and intra-class correlations for each extracted item were derived at a service level. Strong to very strong correlations between the two data sources were found regarding the total number of patients with diabetes per service (Intra-class correlation [ICC] = 0.99), as well as the number (ICC = 0.98-0.99) and proportion (ICC = 0.96) of patients with diabetes by gender. The correlation was moderate for the number and proportion of Type 2 diabetes patients per service in the group aged 18-34 years (ICC = 0.65 and 0.8-0.82 respectively). Strong to very strong correlations were found for numbers and proportions of patients being tested for diabetes, and for appropriate monitoring of patients known to have diabetes (ICC = 0.998-1.00). This indicated a generally high degree of concordance between whole-service data extracted by the two Clinical Decision Support Systems. Therefore, the less expensive or less complex option (depending on the individual circumstances of the service) may be appropriate for monitoring diabetes testing and care. However, the extraction of data about subgroups of patients may not be interchangeable.

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.

Defense Technology Plan

DTIC Science & Technology

1994-09-01

implementation of the services necessary to support transparent "information pull " operation of decision support systems. This infrastructure will be implemented...technology. Some aspects of this area such as user- pull , mobile and highly distributed operation, bandwidth needs and degree of securihy are Dol)-driven...by a variety of statutory requirements. R&D will provide enhanced mission effectiveness and maintenance of fragile ecosystems. The goalis to develop

Service-Oriented Architecture Approach to MAGTF Logistics Support Systems

DTIC Science & Technology

2013-09-01

Support System-Marine Corps IT Information Technology KPI Key Performance Indicators LCE Logistics Command Element ITV In-transit Visibility LCM...building blocks, options, KPI (key performance indicators), design decisions and the corresponding; the physical attributes which is the second attribute... KPI ) that they impact. h. Layer 8 (Information Architecture) The business intelligence layer and information architecture safeguards the inclusion

Family Quality of Life: Adaptation to Spanish Population of Several Family Support Questionnaires

ERIC Educational Resources Information Center

Balcells-Balcells, A.; Gine, C.; Guardia-Olmos, J.; Summers, J. A.

2011-01-01

Background: The concept of family quality of life has emerged as a decisive construct in the last decades to improve the capabilities of families and to assess the outcomes of the services and supports they get. The goal of this research is to adapt three instruments to the Spanish population: the "Beach Center Family Quality of Life…

Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings

PubMed Central

2011-01-01

Background Clinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders. Methods Semi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Experiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement. Conclusions This study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options. PMID:22151735

Related Services Research for Students With Low-Incidence Disabilities: Implications for Speech-Language Pathologists in Inclusive Classrooms.

PubMed

Giangreco, Michael F

2000-07-01

When speech-language pathologists provide educationally related services for students with lowincidence disabilities who are placed in inclusive classrooms, they are asked to work with a variety of other adults. The ways in which these adults make decisions about individualizing a student's educational program, determine related services, and coordinate their activities have an impact on educational outcomes for students as well as on interprofessional interactions. This article summarizes a team process for making related services decisions called VISTA (Vermont Interdependent Services Team Approach) and a series of nine research studies pertaining to the use and impact of VISTA. It also addresses related topics, such as team size, consumer perspectives, and paraprofessional supports. Five major implications from these studies are offered concerning (a) developing a disposition of being an ongoing learner, (b) developing a shared framework among team members, (c) having a research-based process to build consensus, (d) clarifying roles, and (e) increasing involvement of families and general education teachers.

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.

PubMed

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Service providers' perception of affective influences on decision-making about treatments for chronic pain.

PubMed

Brown, Cary A

2004-01-07

Service providers working with people who have complex health problems like chronic pain are considered at particular risk from the heavy emotional content of these interactions (frustration, guilt, hostility). For the good of service users and in the interests of healthcare workers' own health it is important for them to employ reflective practice acknowledging these issues. Service providers are inculcated to negate the affective domain of their practice despite the growing awareness that wellbeing can no longer be envisioned as a linear (cause and effect) process divorced from socio-cultural influences and attendant values and beliefs. The aim of this report is to examine to what degree service users (SU) and service providers (SP) believe their decisions about treatment importance are influenced by self-image and emotion. These results are extrapolated from a larger study based on a postal questionnaire that went to members of the Pain Society (UK Chapter of IASP) and service users belonging to chronic pain support groups in the North-West of England. The question of interest in this report asked participants to identify their level of agreement with statements about how four themes influence their decision-making about whether a treatment is important. The themes (coherence, purposiveness, self-image and affect) arise from Chapman's model of consciousness and pain. Only 20.5% of service providers rated the influence of self-image (what someone like me would think) as 3 (mostly) or 4 (completely). Service provider rating for the influence of affect (how this treatment makes me feel) were similarly low with only 19.4% of respondents selecting a rating of 3 or 4. In marked contrast, 73.3% of the service users selected self-image and 92.9% selected affect as a strong influence. Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, nor preferable, to divorce emotion from the clinical encounter.

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.

Assisting the U.S. Forest Service in monitoring and managing the Pacific pine marten

NASA Astrophysics Data System (ADS)

Force, A.; Hadley, N.; Howell, B. L.; Holsinger, K.

2017-12-01

Innovative partnerships that bridge institutional sectors may be key in seizing many opportunities for highly effective projects. Adventure Scientists is a nonprofit organization that works in partnership with governments, universities, businesses and other nonprofits to support their need for actionable, research-grade data. In every partnership, it is critical that responsible decision-makers are involved and in place to use the data collected, such as to inform new resource management strategies or regulatory policies. In this presentation, we will highlight our experience working on one such partnership. In 2013, the U.S. Forest Service and Adventure Scientists collaborated on a two-year project to better understand Pacific pine marten (Martes caurina), a small native carnivore, in the Olympic National Forest. In response to the species' recent disappearance, Forest managers needed to gather more accurate data on martens' presence and abundance to support species management. Adventure Scientists was in a unique position to provide the agency this needed data-collection capacity. Volunteers collected data about the marten populations by positioning and monitoring camera traps throughout the area. Utilizing our volunteer-collected data, the U.S. Forest Service was able to inform the management and protection of these threatened species in U.S Forest Service Region 6. This project was also successful in establishing the foundation for an expanded, long-term relationship with the agency, where both parties continue to explore partnership opportunities for Adventure Scientists to collect data system-wide in support of U.S. Forest Service improved land management and policy decisions.

Decision support system for emergency management of oil spill accidents in the Mediterranean Sea

NASA Astrophysics Data System (ADS)

Liubartseva, Svitlana; Coppini, Giovanni; Pinardi, Nadia; De Dominicis, Michela; Lecci, Rita; Turrisi, Giuseppe; Cretì, Sergio; Martinelli, Sara; Agostini, Paola; Marra, Palmalisa; Palermo, Francesco

2016-08-01

This paper presents an innovative web-based decision support system to facilitate emergency management in the case of oil spill accidents, called WITOIL (Where Is The Oil). The system can be applied to create a forecast of oil spill events, evaluate uncertainty of the predictions, and calculate hazards based on historical meteo-oceanographic datasets. To compute the oil transport and transformation, WITOIL uses the MEDSLIK-II oil spill model forced by operational meteo-oceanographic services. Results of the modeling are visualized through Google Maps. A special application for Android is designed to provide mobile access for competent authorities, technical and scientific institutions, and citizens.

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.

An Overview Of The Ecosystem Services Research Program Decision Support Framework

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. Such problems require ways to dee...

75 FR 9005 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-26

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

78 FR 63988 - Clinical Investigator Training Course

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... communication between clinical investigators and FDA; Enhance investigators' understanding of FDA's role in... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-1214... support regulatory decisions. This course is intended to assist clinical investigators in understanding...

OCICATS (Online Community Input Classification to Advance Transportation Services) - a GIS-based decision-support tool.

DOT National Transportation Integrated Search

2016-09-02

Public transportation agencies can obtain large amounts of information regarding timeliness, efficiency, cleanliness, ridership, and other : performance measures. However, these metrics are based on the interests of these agencies and do not necessar...

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

PubMed Central

Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Ève; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Béatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Thérèse; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel; Bigras, Magali

2017-01-01

Introduction Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). Methods and analysis This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs’ qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). Ethics and dissemination This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs’ decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. PROSPERO registration number CRD42015020558. PMID:29133314

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

PubMed

Bujold, Mathieu; Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Eve; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Beatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Therese; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel

2017-11-12

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. CRD42015020558. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Trialling an electronic decision aid for policy developers to support ageing well.

PubMed

Cummings, Elizabeth; Ellis, Leonie; Tin, Eh Eh; Boyer, Kim; Orpin, Peter

2015-01-01

The complex process of developing policies and planning services requires the compilation and collation of evidence from multiple sources. With the increasing numbers of people living longer there will be a high demand for a wide range of aged care services to support people in ageing well. The premise of ageing well is based on providing an ageing population with quality care and resources that support their ongoing needs. These include affordable healthcare, end of life care improvement, mental health services improvement, care and support improvement for people with dementia, and support for healthy ageing. The National Health and Medical Research Council funded a research project to develop a policy tool to provide a framework to assist policy makers and service planners in the area of ageing well in rural and regional Australia. It was identified that development of an electronic version of the policy tool could be useful resulting in a small pilot development being undertaken and tested with policy makers and service planners. This paper describes the development and trialling of a tablet based application used to assess the acceptability of computerised forms for participants actively involved in policy development. It reports on the policy developer's experience of the electronic tool to support ageing well policy making based on evidence.

Socio-Ecohydrologic Agents And Services: Integrating Human And Natural Components To Address Coupled System Resilience

NASA Astrophysics Data System (ADS)

Pavao-zuckerman, M.; Pope, A.; Chan, D.; Curl, K.; Gimblett, H. R.; Hough, M.; House-Peters, L.; Lee, R.; Scott, C. A.

2012-12-01

Riparian corridors in arid regions are highly valued for their relative scarcity, and because healthy riparian systems support high levels of biodiversity, can meet human demand for water and water-related resources and functions. Our team is taking a transdiciplinary social-ecological systems approach to assessing riparian corridor resilience in two watersheds (the San Pedro River in USA and Mexico, and the Rio San Miguel in Mexico) through a project funded by the NSF CNH program ("Strengthening Resilience of Arid Region Riparian Corridors"). Multiple perspectives are integrated in the project, including hydrology, ecology, institutional dynamics, and decision making (at the level of both policy and individual choice), as well as the perspectives of various stakeholder groups and individuals in the watersheds. Here we discuss initial findings that center around linking changes in ecohydrology and livelihoods related to decisions in response to climatic, ecological, and social change. The research team is implementing two approaches to integrate the disparate disciplines participating in the research (and the varied perspectives among the stakeholders in this binational riparian context): (1) ecosystem service assessment, and (2) agent based model simulation. We are developing an ecosystem service perspective that provides a bridge between ecological dynamics in the landscape and varied stakeholder perspectives on the implications of ecohydrology for well-being (economic, cultural, ecological). Services are linked on one hand to the spatial patterns of traits of individuals within species (allowing a more predictive application of ecosystem services as they vary with community change in time), and to stakeholder perspectives (facilitating integration of ecosystem services into our understanding of decision making processes) in a case study in the San Pedro River National Conservation Area. The agent- based model (ABM) approach incorporates the influence of human decision-making on spatially-explicit landscapes in a mechanistic way, taking into account social interaction, adaptation, and decision-making at different levels, allowing individual stakeholders to make decisions based on their unique perceptions of their environment, be it economic, social, or ecological awareness. Initial parameterization of the ABM proceeds from a case study centered in the town of Rayón, Sonora, Mexico, where semi-structured interviews were used to elicit perceptions by water resource users of CNH function, change, and solutions relating to livelihood changes in response to several drivers. In both case studies, we see the potential and limitations for an approach to adaptive management and decision support related to water resources that links ecosystem services and agent-based modeling. Methodologically, synthetic approaches such as these may allow coupling of systems for improved assessment and analysis, while at the same time lack a connection to the perspectives of water users and managers on the ground. There is thus potential for a either a loss of system resilience in the face of external change, or an opportunity to increase system resilience by building off perspectives already in place within these coupled socio-ecohydrologic systems.

The Treatment of cardiovascular Risk in Primary care using Electronic Decision supOrt (TORPEDO) study-intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare.

PubMed

Peiris, David; Usherwood, Tim; Panaretto, Katie; Harris, Mark; Hunt, Jenny; Patel, Bindu; Zwar, Nicholas; Redfern, Julie; Macmahon, Stephen; Colagiuri, Stephen; Hayman, Noel; Patel, Anushka

2012-01-01

Large gaps exist in the implementation of guideline recommendations for cardiovascular disease (CVD) risk management. Electronic decision support (EDS) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia. We have developed HealthTracker, a multifaceted EDS and quality improvement intervention to improve the management of CVD risk. It is hypothesised that the use of HealthTracker over a 12-month period will result in: (1) an increased proportion of patients receiving guideline-indicated measurements of CVD risk factors and (2) an increased proportion of patients at high risk will receive guideline-indicated prescriptions for lowering their CVD risk. Sixty health services (40 general practices and 20 Aboriginal Community Controlled Health Services (ACCHSs) will be randomised in a 1:1 allocation to receive either the intervention package or continue with usual care, stratified by service type, size and participation in existing quality improvement initiatives. The intervention consists of point-of-care decision support; a risk communication interface; a clinical audit tool to assess performance on CVD-related indicators; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance. The control arm will continue with usual care without access to these intervention components. Quantitative data will be derived from cross-sectional samples at baseline and end of study via automated data extraction. Detailed process and economic evaluations will also be conducted. The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee (HREC) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC. Formal agreements with each of the participating sites have been signed. In addition to the usual scientific forums, results will be disseminated via newsletters, study websites, face-to-face feedback forums and workshops. The trial is registered with the Australian Clinical Trials Registry ACTRN 12611000478910.

Facilitating informed choice in prenatal testing: how well are we doing?

PubMed

Marteau, T M; Dormandy, E

2001-01-01

There is a consensus that prenatal testing services need to provide the information and support necessary for women to make informed choices about prenatal testing. Informed choices are those based on relevant information that reflect the decision-maker's values. To date, most research has focused on the information provided to women deciding whether to undergo tests. This has highlighted the poor quality of information provided to many women. There is agreement on the need to provide information on three key aspects of any test: the condition for which testing is being offered, characteristics of the test, and the implications of testing. Very little research has been conducted on decisions after the diagnosis of a fetal abnormality and how information and emotional and decisional support are and should be provided. Research is now needed in four key areas: first, on the optimal ways of organizing services to facilitate choices that are not only based on relevant information, but also reflect the decision-maker's values; second, on the most effective ways of framing information needed for the different decisions involved in prenatal testing; third, on the most effective media in which to deliver information; and, fourth, to identify aspects of counseling that facilitate informed choices following diagnoses of fetal abnormality. If we value women's ability to make informed choices about prenatal tests as highly as we value reliable laboratory tests, evidence-based quality standards need to be developed for the information and support women are given at all stages of the process of prenatal testing.

Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin, Ireland.

PubMed

Whiston, Lucy; Barry, Joe M; Darker, Catherine D

2017-03-01

Identify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics. Researcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland. Patient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant's age, service satisfaction and level of education. Patient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels. The best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

@neurIST - chronic disease management through integration of heterogeneous data and computer-interpretable guideline services.

PubMed

Dunlop, R; Arbona, A; Rajasekaran, H; Lo Iacono, L; Fingberg, J; Summers, P; Benkner, S; Engelbrecht, G; Chiarini, A; Friedrich, C M; Moore, B; Bijlenga, P; Iavindrasana, J; Hose, R D; Frangi, A F

2008-01-01

This paper presents an overview of computerised decision support for clinical practice. The concept of computer-interpretable guidelines is introduced in the context of the @neurIST project, which aims at supporting the research and treatment of asymptomatic unruptured cerebral aneurysms by bringing together heterogeneous data, computing and complex processing services. The architecture is generic enough to adapt it to the treatment of other diseases beyond cerebral aneurysms. The paper reviews the generic requirements of the @neurIST system and presents the innovative work in distributing executable clinical guidelines.

Financing commercial RLVs: Considering government incentives

NASA Astrophysics Data System (ADS)

Greenberg, Joel S.

1997-01-01

There appears to be a national goal to achieve a commercial space transportation industry that provides launch services utilizing a fleet of reusable launch vehicles (RLVs). Because of the combination of large required investment, inadequate rate of return, and perceived high risk, industry has indicated that this goal may not be achievable without government support. What form of government support will likely be necessary? Government programs and policies can effect private sector investment decisions by reducing risk perceptions, reducing capital requirements, and increasing expected rates of return. Different programs and policies will have different impacts. For example, tax policies will affect expected return on investment but are likely to have little or no effect on risk perceptions and magnitude of required investment, whereas anchor tenancy is likely to alter risk perceptions and may increase expected rates of return. This paper is concerned with the development of an approach that may be used to identify packages of government incentives that may be required to influence private sector investment decisions so as to achieve the desired goal of a commercial space transportation industry that provides launch services utilizing a fleet of RLVs. The paper discusses the relationship of government incentive programs and policies to the RLV investment decision.

Stakeholder perspectives on decision-analytic modeling frameworks to assess genetic services policy.

PubMed

Guzauskas, Gregory F; Garrison, Louis P; Stock, Jacquie; Au, Sylvia; Doyle, Debra Lochner; Veenstra, David L

2013-01-01

Genetic services policymakers and insurers often make coverage decisions in the absence of complete evidence of clinical utility and under budget constraints. We evaluated genetic services stakeholder opinions on the potential usefulness of decision-analytic modeling to inform coverage decisions, and asked them to identify genetic tests for decision-analytic modeling studies. We presented an overview of decision-analytic modeling to members of the Western States Genetic Services Collaborative Reimbursement Work Group and state Medicaid representatives and conducted directed content analysis and an anonymous survey to gauge their attitudes toward decision-analytic modeling. Participants also identified and prioritized genetic services for prospective decision-analytic evaluation. Participants expressed dissatisfaction with current processes for evaluating insurance coverage of genetic services. Some participants expressed uncertainty about their comprehension of decision-analytic modeling techniques. All stakeholders reported openness to using decision-analytic modeling for genetic services assessments. Participants were most interested in application of decision-analytic concepts to multiple-disorder testing platforms, such as next-generation sequencing and chromosomal microarray. Decision-analytic modeling approaches may provide a useful decision tool to genetic services stakeholders and Medicaid decision-makers.

A business man views commercial ventures in space.

NASA Technical Reports Server (NTRS)

Scarff, D. D.; Bloom, H. L.

1973-01-01

Paper reviews technical, resource planning and marketing steps an industrial organization must perform in arriving at a decision to undertake space development and production of commercial products or services for Users on the ground. Technical elements are supported by particular examples. Analysis of required resources emphasizes facility and financial inter-relationships between commercial organizations and NASA. Marketing planning covers elements of profitability. Paper addresses questions related to protection of corporate stockholders and public interest, investment decision timing, budget variations. Paper concludes with observations on timeliness of planning shuttle-based commercial ventures and on key industry/NASA problems and decisions.

Does access to a demand-led evidence briefing service improve uptake and use of research evidence by health service commissioners? A controlled before and after study.

PubMed

Wilson, Paul M; Farley, Kate; Bickerdike, Liz; Booth, Alison; Chambers, Duncan; Lambert, Mark; Thompson, Carl; Turner, Rhiannon; Watt, Ian S

2017-02-14

The Health and Social Care Act mandated research use as a core consideration of health service commissioning arrangements in England. We undertook a controlled before and after study to evaluate whether access to a demand-led evidence briefing service improved the use of research evidence by commissioners compared with less intensive and less targeted alternatives. Nine Clinical Commissioning Groups (CCGs) in the North of England received one of three interventions: (A) access to an evidence briefing service; (B) contact plus an unsolicited push of non-tailored evidence; or (C) unsolicited push of non-tailored evidence. Data for the primary outcome measure were collected at baseline and 12 months using a survey instrument devised to assess an organisations' ability to acquire, assess, adapt and apply research evidence to support decision-making. Documentary and observational evidence of the use of the outputs of the service were sought. Over the course of the study, the service addressed 24 topics raised by participating CCGs. At 12 months, the evidence briefing service was not associated with increases in CCG capacity to acquire, assess, adapt and apply research evidence to support decision-making, individual intentions to use research findings or perceptions of CCG relationships with researchers. Regardless of intervention received, participating CCGs indicated that they remained inconsistent in their research-seeking behaviours and in their capacity to acquire research. The informal nature of decision-making processes meant that there was little traceability of the use of evidence. Low baseline and follow-up response rates and missing data limit the reliability of the findings. Access to a demand-led evidence briefing service did not improve the uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Commissioners appear well intentioned but ad hoc users of research. Further research is required on the effects of interventions and strategies to build individual and organisational capacity to use research.

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

PubMed

Nilsson, Tomas; Lindström, Veronica

2016-07-01

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

Base Information Transport Infrastructure Wired (BITI Wired)

DTIC Science & Technology

2016-03-01

Executive DoD - Department of Defense DoDAF - DoD Architecture Framework FD - Full Deployment FDD - Full Deployment Decision FY - Fiscal Year IA...Estimate has been accomplished this period leading to an approved Air Force Service Cost Position in support of the program’s December 2014 FDD milestone...validated to ensure alignment with the business case. This certification is based on my review of the December 2014 Service Cost Position and FDD

The Mediterranean Decision Support System for Marine Safety dedicated to oil slicks predictions

NASA Astrophysics Data System (ADS)

Zodiatis, G.; De Dominicis, M.; Perivoliotis, L.; Radhakrishnan, H.; Georgoudis, E.; Sotillo, M.; Lardner, R. W.; Krokos, G.; Bruciaferri, D.; Clementi, E.; Guarnieri, A.; Ribotti, A.; Drago, A.; Bourma, E.; Padorno, E.; Daniel, P.; Gonzalez, G.; Chazot, C.; Gouriou, V.; Kremer, X.; Sofianos, S.; Tintore, J.; Garreau, P.; Pinardi, N.; Coppini, G.; Lecci, R.; Pisano, A.; Sorgente, R.; Fazioli, L.; Soloviev, D.; Stylianou, S.; Nikolaidis, A.; Panayidou, X.; Karaolia, A.; Gauci, A.; Marcati, A.; Caiazzo, L.; Mancini, M.

2016-11-01

In the Mediterranean sea the risk from oil spill pollution is high due to the heavy traffic of merchant vessels for transporting oil and gas, especially after the recent enlargement of the Suez canal and to the increasing coastal and offshore installations related to the oil industry in general. The basic response to major oil spills includes different measures and equipment. However, in order to strengthen the maritime safety related to oil spill pollution in the Mediterranean and to assist the response agencies, a multi-model oil spill prediction service has been set up, known as MEDESS-4MS (Mediterranean Decision Support System for Marine Safety). The concept behind the MEDESS-4MS service is the integration of the existing national ocean forecasting systems in the region with the Copernicus Marine Environmental Monitoring Service (CMEMS) and their interconnection, through a dedicated network data repository, facilitating access to all these data and to the data from the oil spill monitoring platforms, including the satellite data ones, with the well established oil spill models in the region. The MEDESS-4MS offer a range of service scenarios, multi-model data access and interactive capabilities to suite the needs of REMPEC (Regional Marine Pollution Emergency Response Centre for the Mediterranean Sea) and EMSA-CSN (European Maritime Safety Agency-CleanseaNet).

Air Traffic Management Research at NASA Ames Research Center

NASA Technical Reports Server (NTRS)

Lee, Katharine

2005-01-01

Since the late 1980's, NASA Ames researchers have been investigating ways to improve the air transportation system through the development of decision support automation. These software advances, such as the Center-TRACON Automation System (eTAS) have been developed with teams of engineers, software developers, human factors experts, and air traffic controllers; some ASA Ames decision support tools are currently operational in Federal Aviation Administration (FAA) facilities and some are in use by the airlines. These tools have provided air traffic controllers and traffic managers the capabilities to help reduce overall delays and holding, and provide significant cost savings to the airlines as well as more manageable workload levels for air traffic service providers. NASA is continuing to collaborate with the FAA, as well as other government agencies, to plan and develop the next generation of decision support tools that will support anticipated changes in the air transportation system, including a projected increase to three times today's air-traffic levels by 2025. The presentation will review some of NASA Ames' recent achievements in air traffic management research, and discuss future tool developments and concepts currently under consideration.

DECISION-SUPPORT TOOLS FOR MANAGING WASTEWATER PIPELINE PERFORMANCE IMPROVEMENTS

EPA Science Inventory

Wastewater collection systems are an extensive part of the nation's infrastructure. In the US approximately 150 million people are served by about 19,000 municipal wastewater collection systems representing about 500,000 miles of sewer pipe (not including privately owned service ...

DECISION SUPPORT TOOLS FOR MANAGING WASTEWATER COLLECTION SYSTEMS

EPA Science Inventory

Wastewater collection systems are an extensive part of the nation's infrastructure. In the US approximately 150M people are served by about 19,000 municipal wastewater collection systems representing about 500,000 miles of sewer pipe (not including privately owned service lateria...

DECISION SUPPORT TOOLS FOR MANAGING WASTEWATER PIPELINE PERFORMANCE IMPROVEMENTS

EPA Science Inventory

Wastewater collection systems are an extensive part of the nation's infrastructure. In the US approximately 150 million people are served by about 19,000 municipal wastewater collection systems representing about 500,000 miles of sewer pipe (not including privately owned service ...

An intelligent decision support system for work zone traffic management and planning.

DOT National Transportation Integrated Search

2004-01-01

Periodic resurfacing, rehabilitation, restoration, and reconstruction work is needed on the aging highway system in the state of Ohio to maintain a desired level of service for the traveling public. However, temporary work zones on highways disrupt 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...

Integrating Agriculture and Conservation

USGS Publications Warehouse

Vandever, Mark W.

2010-01-01

The USGS produces the needed science-based information to guide management actions and policy decisions that support wildlife habitat and other environmental services compatible with USDA conservation goals and farm operations. The Policy Analysis and Science Assistance Branch of the Fort Collins Science Center (FORT) has conducted research involving a national landowner survey and numerous short- and long-term evaluations regarding vegetation responses to land management practices. This research helps land and resource managers to make informed decisions and resolve resource management conflicts.

The service blueprint as a tool for designing innovative pharmaceutical services.

PubMed

Holdford, D A; Kennedy, D T

1999-01-01

To describe service blueprints, discuss their need and design, and provide examples of their use in advancing pharmaceutical care. Service blueprints are pictures or maps of service processes that permit the people involved in designing, providing, managing, and using the service to better understand them and deal with them objectively. A service blueprint simultaneously depicts the service process and the roles of consumers, service providers, and supporting services. Service blueprints can be useful in pharmacy because many of the obstacles to pharmaceutical care are a result of insufficient planning by service designers and/or poor communication between those designing services and those implementing them. One consequence of this poor design and communication is that many consumers and third party payers are uninformed about pharmacist roles. Service blueprints can be used by pharmacists to promote the value of pharmaceutical care to consumers and other decision makers. They can also assist in designing better pharmaceutical services. Blueprints are designed by identifying and mapping a process from the consumer's point of view, mapping employee actions and support activities, and adding visible evidence of service at each consumer action step. Key components of service blueprints are consumer actions, "onstage" and "backstage" employee actions, and support processes. Blueprints can help pharmacy managers identify and correct problems with the service process, provide pharmacy employees an opportunity to offer feedback in the planning stages of services, and demonstrate the value of pharmaceutical services to consumers. Service blueprints can be a valuable tool for designing, implementing, and evaluating pharmacy services.

The Cook Agronomy Farm LTAR: Knowledge Intensive Precision Agro-ecology

NASA Astrophysics Data System (ADS)

Huggins, D. R.

2015-12-01

Drowning in data and starving for knowledge, agricultural decision makers require evidence-based information to enlighten sustainable intensification. The agro-ecological footprint of the Cook Agronomy Farm (CAF) Long-Term Agro-ecosystem Research (LTAR) site is embedded within 9.4 million ha of diverse land uses primarily cropland (2.9 million ha) and rangeland (5.3 million ha) that span a wide annual precipitation gradient (150 mm through 1400 mm) with diverse social and natural capital (see Figure). Sustainable intensification hinges on the development and adoption of precision agro-ecological practices that rely on meaningful spatio-temporal data relevant to land use decisions at within-field to regional scales. Specifically, the CAF LTAR will provide the scientific foundation (socio-economical and bio-physical) for enhancing decision support for precision and conservation agriculture and synergistic cropping system intensification and diversification. Long- and short-term perspectives that recognize and assess trade-offs in ecosystem services inherent in any land use decision will be considered so as to promote the development of more sustainable agricultural systems. Presented will be current and future CAF LTAR research efforts required for the development of sustainable agricultural systems including cropping system cycles and flows of nutrients, water, carbon, greenhouse gases and other biotic and abiotic factors. Evaluation criteria and metrics associated with long-term agro-ecosystem provisioning, supporting, and regulating services will be emphasized.

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

What Is the Right RFID for Your Process?

DTIC Science & Technology

2006-01-30

Support Model for Valuing Proposed Improvements in Component Reliability. June 2005. NPS-PM-05-007 Dillard, John T., and Mark E. Nissen...Arlington, VA. 2005. Kang, Keebom, Ken Doerr, Uday Apte, and Michael Boudreau. “Decision Support Models for Valuing Improvements in Component...courses in the Executive and Full-time MBA programs. Areas of Uday’s research interests include managing service operations, supply chain

ISTIMES Integrated System for Transport Infrastructures Surveillance and Monitoring by Electromagnetic Sensing

NASA Astrophysics Data System (ADS)

Argenti, M.; Giannini, V.; Averty, R.; Bigagli, L.; Dumoulin, J.

2012-04-01

The EC FP7 ISTIMES project has the goal of realizing an ICT-based system exploiting distributed and local sensors for non destructive electromagnetic monitoring in order to make critical transport infrastructures more reliable and safe. Higher situation awareness thanks to real time and detailed information and images of the controlled infrastructure status allows improving decision capabilities for emergency management stakeholders. Web-enabled sensors and a service-oriented approach are used as core of the architecture providing a sys-tem that adopts open standards (e.g. OGC SWE, OGC CSW etc.) and makes efforts to achieve full interoperability with other GMES and European Spatial Data Infrastructure initiatives as well as compliance with INSPIRE. The system exploits an open easily scalable network architecture to accommodate a wide range of sensors integrated with a set of tools for handling, analyzing and processing large data volumes from different organizations with different data models. Situation Awareness tools are also integrated in the system. Definition of sensor observations and services follows a metadata model based on the ISO 19115 Core set of metadata elements and the O&M model of OGC SWE. The ISTIMES infrastructure is based on an e-Infrastructure for geospatial data sharing, with a Data Cata-log that implements the discovery services for sensor data retrieval, acting as a broker through static connections based on standard SOS and WNS interfaces; a Decision Support component which helps decision makers providing support for data fusion and inference and generation of situation indexes; a Presentation component which implements system-users interaction services for information publication and rendering, by means of a WEB Portal using SOA design principles; A security framework using Shibboleth open source middleware based on the Security Assertion Markup Language supporting Single Sign On (SSO). ACKNOWLEDGEMENT - The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement n° 225663

Bringing the ecosystem services concept into marine management decisions, supporting ecosystems-based management.

NASA Astrophysics Data System (ADS)

Tweddle, J. F.; Byg, A.; Davies, I.; Gubbins, M.; Irvine, K.; Kafas, A.; Kenter, J.; MacDonald, A.; Murray, R. B. O.; Potts, T.; Slater, A. M.; Wright, K.; Scott, B. E.

2016-02-01

The marine environment is under increasing use, putting pressure on marine ecosystems and increasing competition for space. New activities (e.g. renewable energy developments), evolving marine policies (e.g. implementation of marine protected areas), and climate change may drive changes in biodiversity and resulting ecosystem services (ES) that society and business utilise from coastal and marine systems. A process is needed that integrates ecological assessment of changes with stakeholder perceptions and valuation of ES, whilst balancing ease of application with the ability to deal with complex social-economic-ecological issues. The project "Cooperative participatory assessment of the impact of renewable technology on ecosystem services: CORPORATES" involved natural and social scientists, law and policy experts, and marine managers, with the aim of promoting more integrated decision making using ES concepts in marine management. CORPORATES developed a process to bring ES concepts into stakeholders' awareness. The interactive process, involving 2 workshops, employs interludes of knowledge exchange by experts on ecological processes underpinning ES and on law and policy. These enable mapping of benefits linked to activities, participatory system modelling, and deliberation of policy impacts on different sectors. The workshops were attended by industry representatives, regulatory/advisory partners, and other stakeholders (NGOs, SMEs, recreationalists, local government). Mixed sector groups produced new insights into links between activities and ES, and highlighted cross-sector concerns. Here we present the aspects of the process that successfully built shared understanding between industry and stakeholders of inter-linkages and interactions between ES, benefits, activities, and economic and cultural values. These methods provide an ES-based decision-support model for exchanging societal-ecological knowledge and providing stakeholder interaction in marine planning, supporting ecosystem-based management.

Bringing the ecosystem services concept into marine management decisions, supporting ecosystems-based management.

NASA Astrophysics Data System (ADS)

Tweddle, J. F.; Byg, A.; Davies, I.; Gubbins, M.; Irvine, K.; Kafas, A.; Kenter, J.; MacDonald, A.; Murray, R. B. O.; Potts, T.; Slater, A. M.; Wright, K.; Scott, B. E.

2016-12-01

The marine environment is under increasing use, putting pressure on marine ecosystems and increasing competition for space. New activities (e.g. renewable energy developments), evolving marine policies (e.g. implementation of marine protected areas), and climate change may drive changes in biodiversity and resulting ecosystem services (ES) that society and business utilise from coastal and marine systems. A process is needed that integrates ecological assessment of changes with stakeholder perceptions and valuation of ES, whilst balancing ease of application with the ability to deal with complex social-economic-ecological issues. The project "Cooperative participatory assessment of the impact of renewable technology on ecosystem services: CORPORATES" involved natural and social scientists, law and policy experts, and marine managers, with the aim of promoting more integrated decision making using ES concepts in marine management. CORPORATES developed a process to bring ES concepts into stakeholders' awareness. The interactive process, involving 2 workshops, employs interludes of knowledge exchange by experts on ecological processes underpinning ES and on law and policy. These enable mapping of benefits linked to activities, participatory system modelling, and deliberation of policy impacts on different sectors. The workshops were attended by industry representatives, regulatory/advisory partners, and other stakeholders (NGOs, SMEs, recreationalists, local government). Mixed sector groups produced new insights into links between activities and ES, and highlighted cross-sector concerns. Here we present the aspects of the process that successfully built shared understanding between industry and stakeholders of inter-linkages and interactions between ES, benefits, activities, and economic and cultural values. These methods provide an ES-based decision-support model for exchanging societal-ecological knowledge and providing stakeholder interaction in marine planning, supporting ecosystem-based management.

Using family and staff experiences of a botulinum toxin-A service to improve service quality.

PubMed

Burton, K L O; Bau, K; Lewis, J; Aroyan, K R; Botha, B; Botman, A G M; Stewart, K; Waugh, M-C A; Paget, S P

2017-11-01

The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics. © 2017 John Wiley & Sons Ltd.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service

PubMed Central

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee

2015-01-01

Objectives To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. Methods We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. Results The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. Conclusions We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs. PMID:25995962

HIV and Pregnancy Intentions: Do Services Adequately Respond to Women's Needs?

PubMed Central

Firestone, Rebecca; MacCarthy, Sarah; Ferguson, Laura

2008-01-01

Too little is known about how an HIV diagnosis and access to care and treatment affect women's childbearing intentions. As access to antiretroviral therapy improves, greater numbers of HIV-positive women are living longer, healthier lives, and many want to have children. Effectively supporting women's reproductive decisionmaking in the context of HIV requires understanding how pregnancy, reproduction, and HIV intersect and asking questions that bridge the biomedical and social sciences. Considering women to be at the center of decisions on health policy and service delivery can help provide an appropriate constellation of services. A clear research agenda is needed to create a more coordinated approach to policies and programs supporting the pregnancy intentions of women with HIV. PMID:18703432

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.

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

PubMed

Samsi, Kritika; Manthorpe, Jill

2013-06-01

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

Decision support system for determining Bantuan Siswa Miskin (BSM) receivers with profile matching method

NASA Astrophysics Data System (ADS)

Situmorang, B. H.; Pibriana, E.; Tosida, E. T.

2018-03-01

Bantuan Siswa Miskin (BSM) is a National Programs aimed at eliminating the barriers of poor students participating to school by helping poor students gain access to appropriate education services, prevent dropping out of school, attract poor students back to school, assis students in providing for learning activities, support the Nine Years Basic Education (and even up to senior high school) program, as well as helping to smooth the school programs [1]. Decision Support System is made by applying Profile Matching method to assist teachers or school operators in SMP PGRI Ciasmara in selecting prospective recipients of BSM program and providing recommendations in decision making. Profile Matching is used to compare the actual data value of a profile to be assessed by the expected profile value, so that it can be known the difference of competence (also called GAP). If the resulting value of GAP is smaller then the weight of value will be greater, which means it has a greater chance to be recommended as a potential recipient of the BSM program. Decision Support System for determining BSM receivers is only choosing the right alternatives to receive BSM according to the BSM quota given to SMP PGRI Ciasmara. The right alternatives to receive this BSM is the highest ranking alternatives.

A Conceptual Framework for Decision-making Support in Uncertainty- and Risk-based Diagnosis of Rare Clinical Cases by Specialist Physicians.

PubMed

Santos, Adriano A; Moura, J Antão B; de Araújo, Joseana Macêdo Fechine Régis

2015-01-01

Mitigating uncertainty and risks faced by specialist physicians in analysis of rare clinical cases is something desired by anyone who needs health services. The number of clinical cases never seen by these experts, with little documentation, may introduce errors in decision-making. Such errors negatively affect well-being of patients, increase procedure costs, rework, health insurance premiums, and impair the reputation of specialists and medical systems involved. In this context, IT and Clinical Decision Support Systems (CDSS) play a fundamental role, supporting decision-making process, making it more efficient and effective, reducing a number of avoidable medical errors and enhancing quality of treatment given to patients. An investigation has been initiated to look into characteristics and solution requirements of this problem, model it, propose a general solution in terms of a conceptual risk-based, automated framework to support rare-case medical diagnostics and validate it by means of case studies. A preliminary validation study of the proposed framework has been carried out by interviews conducted with experts who are practicing professionals, academics, and researchers in health care. This paper summarizes the investigation and its positive results. These results motivate continuation of research towards development of the conceptual framework and of a software tool that implements the proposed model.

An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol

PubMed Central

Gagnon, Marie-Pierre; Légaré, France; Fortin, Jean-Paul; Lamothe, Lise; Labrecque, Michel; Duplantie, Julie

2008-01-01

Background E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system. Methods A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels. Results This study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects. Conclusion These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must. PMID:18435853

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

An intelligent decision support system for work zone traffic management and planning : executive summary report.

DOT National Transportation Integrated Search

2004-01-01

Problem: Periodic resurfacing, rehabilitation, restoration, and reconstruction work is needed on the aging highway system in the state of Ohio to maintain a desired level of service for the traveling public. However, temporary work zones on highways ...

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.

A framework for a decision support system for municipal solid waste landfill design.

PubMed

Verge, Ashley; Rowe, R Kerry

2013-12-01

A decision support system (Landfill Advisor or LFAdvisor) was developed to integrate current knowledge of barrier systems into a computer application to assist in landfill design. The program was developed in Visual Basic and includes an integrated database to store information. LFAdvisor presents the choices available for each liner component (e.g. leachate collection system, geomembrane liner, clay liners) and provides advice on their suitability for different situations related to municipal solid waste landfills (e.g. final cover, base liner, lagoon liner). Unique to LFAdvisor, the service life of each engineered component is estimated based on results from the latest research. LFAdvisor considers the interactions between liner components, operating conditions, and the existing site environment. LFAdvisor can be used in the initial stage of design to give designers a good idea of what liner components will likely be required, while alerting them to issues that are likely to arise. A systems approach is taken to landfill design with the ultimate goal of maximising long-term performance and service life.

Is Israel ready for disease management?

PubMed

Linden, Ariel

2006-10-01

Approximately 60% of all worldwide deaths are caused by chronic disease resulting from modifiable health behaviors. In the United States, structured programs tailored to identify and modify health behaviors of patients with chronic illness have grown into a robust industry called disease management. DM is premised upon the basic assumption that health services utilization and morbidity can be reduced for those with chronic illness by augmenting traditional episodic medical care services and support between physician visits. Given that Israel and the U.S. have similar demographics in their chronically ill populations, it would make intuitive sense for Israel to replicate efforts made in the U.S. to incorporate DM strategies. This paper provides a conceptual framework of how DM could be integrated within the current organizational structure of the Israeli healthcare system, which is uniquely conducive to the implementation of DM on a population-wide basis. While ultimately the decision to invest in DM lies with stakeholders at various institutional levels in Israel, this paper is intended to provide direction and support for that decision-making process.

Reliability and Validity of the Lichtenberg Financial Decision Screening Scale.

PubMed

Lichtenberg, Peter A; Teresi, Jeanne A; Ocepek-Welikson, Katja; Eimicke, Joseph P

2017-03-01

The scarcity of empirically validated assessment instruments continues to impede the work of professionals in a number of fields, including medicine, finance, and estate planning; adult protective services; and criminal justice-and, more importantly, it impedes their ability to effectively assist and, in some case, protect their clients. Other professionals (e.g. legal, financial, medical, mental health services) are in a position to prevent financial exploitation and would benefit from access to new instruments. The Lichtenberg Financial Decision Screening Scale (LFDSS) was introduced in 2016, along with evidence for its convergent validity (Lichtenberg et al., 2016). Using a sample of 213 participants, this study investigated the internal consistency of the LFDSS and its criterion validity based on ratings by professionals using the scale. Results demonstrate that the LFDSS has excellent internal consistency and clinical utility properties. This paper provides support for use of the LFDSS as a reliable and valid instrument. The LFDSS and instructions for its use are included in the article, along with information about online tools and support.

Empowering European communities to improve natural resource management for human well-being: the OPPLA web portal & communities of practice

NASA Astrophysics Data System (ADS)

Metzger, M.; Brown, C.; Pérez-Soba, M.; Rounsevell, M.; Verweij, P.; Delbaere, B.; Cojocaru, G.; Saarikoski, H.; Harrison, P.; Zellmer, K.

2014-12-01

The ecosystem services concept is seen by many as a useful paradigm to support decision-making at the complex interface between science, policy and practice. However, to be successful, it requires a strong willingness for collaboration and joint understanding. In support of this aspiration, OPPLA is being developed as a web portal to enable European communities to better manage ecosystems for human well-being and livelihoods. OPPLA will provide access to a variety of online resources such as tools, case studies, lessons learned, videos, manuals and training and educational materials. It will also provide expert forums and spaces for discussions between researchers, practitioners and decision makers. Hence a critical aspect of the success of OPPLA is the co-evolution of communities of practice. An example of a community of practice is the recently launched Ecosystem Services Community - Scotland (ESCom-Scotland; escomscotland.wordpress.com). ESCom-Scotland aims to support better management of Scotland's natural resources by helping to establish a community of practice between individuals and groups involved in the science, policy and practice behind sustainable ecosystem management. It aspires to encourage the sharing of ideas, increase collaboration and to initiate a support network for those engaging with the ecosystem services concept and it will use the OPPLA resources to support these activities. OPPLA is currently at the developmental stage and was instigated by two large European Commission funded research projects: OPERAs (www.operas-project.eu) and OpenNESS (www.openness-project.eu), with a combined budget of ca. €24m. These projects aim to improve understanding of how ecosystem services contribute to human well-being in different social-ecological systems. Research will establish whether, how and under what conditions the ecosystem services concept can move beyond the academic domain towards practical implementation in support of sustainable ecosystem management. New insights, and improved or novel tools and instruments, will be tested in practice in case studies that cover a range of socio-ecological systems across locales, sectors, scales and time. This presentation will discuss the development of OPPLA and the communities of practice that are emerging around it.

The Impact of Stakeholder Preferences on Service User Adherence to Treatments for Schizophrenia and Metabolic Comorbidities.

PubMed

Poremski, Daniel; Sagayadevan, Vathsala D/O; Wang, Peizhi; Lum, Alvin; Subramaniam, Mythily; Ann, Chong Siow

2016-01-01

To determine how stakeholder opinions of treatments influence service user decisions to adhere to courses of actions necessary to treat metabolic conditions. Qualitative open-ended interviews were conducted with 20 service providers, 25 service users, and 9 caregivers. Grounded theory was used to generate an understanding that linked preferences of care with adherence to follow-up treatments. Participants spoke about several considerations when discussing adherence: Resource limitations were the predominant consideration. Social considerations such as stigma and support surfaced in caregiver and service-user interviews. The influence of symptoms, especially their absence could reduce adherence, and organizational considerations related to the opinions they had about the qualifications of professionals. A rational patient model partially organizes our findings, but emotional components related to stigma and the opinion of service providers do not fit well into such a model. If service providers do not consider components of the decision making process which fall outside of the rational patient model, they may incorrectly be leveraging suboptimal values to bring about adherence to treatment plans. Being sensitive to the values of service users and their caregivers may allow service providers to better act on points that may bring about change in non-compliant service users with schizophrenia and metabolic comorbidities.

Integrating NASA Earth Science Enterprise (ESE) Data Into Global Agricultural Decision Support Systems

NASA Astrophysics Data System (ADS)

Teng, W.; Kempler, S.; Chiu, L.; Doraiswamy, P.; Liu, Z.; Milich, L.; Tetrault, R.

2003-12-01

Monitoring global agricultural crop conditions during the growing season and estimating potential seasonal production are critically important for market development of U.S. agricultural products and for global food security. Two major operational users of satellite remote sensing for global crop monitoring are the USDA Foreign Agricultural Service (FAS) and the U.N. World Food Programme (WFP). The primary goal of FAS is to improve foreign market access for U.S. agricultural products. The WFP uses food to meet emergency needs and to support economic and social development. Both use global agricultural decision support systems that can integrate and synthesize a variety of data sources to provide accurate and timely information on global crop conditions. The Goddard Space Flight Center Earth Sciences Distributed Active Archive Center (GES DAAC) has begun a project to provide operational solutions to FAS and WFP, by fully leveraging results from previous work, as well as from existing capabilities of the users. The GES DAAC has effectively used its recently developed prototype TRMM Online Visualization and Analysis System (TOVAS) to provide ESE data and information to the WFP for its agricultural drought monitoring efforts. This prototype system will be evolved into an Agricultural Information System (AIS), which will operationally provide ESE and other data products (e.g., rainfall, land productivity) and services, to be integrated into and thus enhance the existing GIS-based, decision support systems of FAS and WFP. Agriculture-oriented, ESE data products (e.g., MODIS-based, crop condition assessment product; TRMM derived, drought index product) will be input to a crop growth model in collaboration with the USDA Agricultural Research Service, to generate crop condition and yield prediction maps. The AIS will have the capability for remotely accessing distributed data, by being compliant with community-based interoperability standards, enabling easy access to agriculture-related products from other data producers. The AIS? system approach will provide a generic mechanism for easily incorporating new products and making them accessible to users.

Designing an architectural style for dynamic medical Cross-Organizational Workflow management system: an approach based on agents and web services.

PubMed

Bouzguenda, Lotfi; Turki, Manel

2014-04-01

This paper shows how the combined use of agent and web services technologies can help to design an architectural style for dynamic medical Cross-Organizational Workflow (COW) management system. Medical COW aims at supporting the collaboration between several autonomous and possibly heterogeneous medical processes, distributed over different organizations (Hospitals, Clinic or laboratories). Dynamic medical COW refers to occasional cooperation between these health organizations, free of structural constraints, where the medical partners involved and their number are not pre-defined. More precisely, this paper proposes a new architecture style based on agents and web services technologies to deal with two key coordination issues of dynamic COW: medical partners finding and negotiation between them. It also proposes how the proposed architecture for dynamic medical COW management system can connect to a multi-agent system coupling the Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE). The idea is to assist the health professionals such as doctors, nurses and pharmacists with decision making tasks, as determining diagnosis or patient data analysis without stopping their clinical processes in order to act in a coherent way and to give care to the patient.

A transmission security framework for email-based telemedicine.

PubMed

Caffery, Liam J; Smith, Anthony C

2010-01-01

Encryption is used to convert an email message to an unreadable format thereby securing patient privacy during the transmission of the message across the Internet. Two available means of encryption are: public key infrastructure (PKI) used in conjunction with ordinary email and secure hypertext transfer protocol (HTTPS) used by secure web-mail applications. Both of these approaches have advantages and disadvantages in terms of viability, cost, usability and compliance. The aim of this study was develop an instrument to identify the most appropriate means of encrypting email communication for telemedicine. A multi-method approach was used to construct the instrument. Technical assessment and existing bodies of knowledge regarding the utility of PKI were analyzed, along with survey results from users of Queensland Health's Child and Youth Mental Health Service secure web-mail service. The resultant decision support model identified that the following conditions affect the choice of encryption technology: correspondent's risk perception, correspondent's identification to the security afforded by encryption, email-client used by correspondents, the tolerance to human error and the availability of technical resources. A decision support model is presented as a flow chart to identify the most appropriate encryption for a specific email-based telemedicine service.

Primary Care Physicians' Support of Shared Decision Making for Different Cancer Screening Decisions.

PubMed

Elston Lafata, Jennifer; Brown, Richard F; Pignone, Michael P; Ratliff, Scott; Shay, L Aubree

2017-01-01

Despite its widespread advocacy, shared decision making (SDM) is not routinely used for cancer screening. To better understand the implementation barriers, we describe primary care physicians' (PCPs') support for SDM across diverse cancer screening contexts. Surveys were mailed to a random sample of USA-based PCPs. Using multivariable logistic regression analyses, we tested for associations of PCPs' support of SDM with the US Preventive Service Task Force (USPSTF) assigned recommendation grade, assessed whether the decision pertained to not screening older patients, and the PCPs' autonomous v. controlled motivation-orientation for using SDM. PCPs (n = 278) were, on average, aged 52 years, 38% female, and 69% white. Of these, 79% endorsed discussing screening benefits as very important to SDM; 64% for discussing risks; and 31% for agreeing with patient's opinion. PCPs were most likely to rate SDM as very important for colorectal cancer screening in adults aged 50-75 years (69%), and least likely for colorectal cancer screening in adults aged >85 years (34%). Regression results indicated the importance of PCPs' having autonomous or self-determined reasons for engaging in SDM (e.g., believing in the benefits of SDM) (OR = 2.29, 95% CI, 1.87 to 2.79). PCPs' support for SDM varied by USPSTF recommendation grade (overall contrast, X 2 = 14.7; P = 0.0054), with support greatest for A-Grade recommendations. Support for SDM was lower in contexts where decisions pertained to not screening older patients (OR = 0.45, 95% CI, 0.35 to 0.56). It is unknown whether PCPs' perceptions of the importance of SDM behaviors differs with specific screening decisions or the potential limited ability to generalize findings. Our results highlight the need to document SDM benefits and consider the specific contextual challenges, such as the level of uncertainty or whether evidence supports recommending/not recommending screening, when implementing SDM across an array of cancer screening contexts. © The Author(s) 2016.

Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review.

PubMed

Haynes, R Brian; Wilczynski, Nancy L

2010-02-05

Computerized clinical decision support systems are information technology-based systems designed to improve clinical decision-making. As with any healthcare intervention with claims to improve process of care or patient outcomes, decision support systems should be rigorously evaluated before widespread dissemination into clinical practice. Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake. The objective of this research was to form a partnership of healthcare providers, managers, and researchers to review randomized controlled trials assessing the effects of computerized decision support for six clinical application areas: primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, chronic disease management, diagnostic test ordering and interpretation, and acute care management; and to identify study characteristics that predict benefit. The review was undertaken by the Health Information Research Unit, McMaster University, in partnership with Hamilton Health Sciences, the Hamilton, Niagara, Haldimand, and Brant Local Health Integration Network, and pertinent healthcare service teams. Following agreement on information needs and interests with decision-makers, our earlier systematic review was updated by searching Medline, EMBASE, EBM Review databases, and Inspec, and reviewing reference lists through 6 January 2010. Data extraction items were expanded according to input from decision-makers. Authors of primary studies were contacted to confirm data and to provide additional information. Eligible trials were organized according to clinical area of application. We included randomized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a computerized clinical decision support system compared with patient care without such a system. Data will be summarized using descriptive summary measures, including proportions for categorical variables and means for continuous variables. Univariable and multivariable logistic regression models will be used to investigate associations between outcomes of interest and study specific covariates. When reporting results from individual studies, we will cite the measures of association and p-values reported in the studies. If appropriate for groups of studies with similar features, we will conduct meta-analyses. A decision-maker-researcher partnership provides a model for systematic reviews that may foster knowledge translation and uptake.

When Informationists Get Involved: the CHICA-GIS Project.

PubMed

Whipple, Elizabeth C; Odell, Jere D; Ralston, Rick K; Liu, Gilbert C

2013-01-01

Child Health Improvement through Computer Automation (CHICA) is a computer decision support system (CDSS) that interfaces with existing electronic medical record systems (EMRS) and delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. "Delivering Geospatial Intelligence to Health Care Professionals (CHICA-GIS)" (1R01LM010923-01) expands the medical application of Geographic Information Systems (GIS) by integrating a geographic information system with CHICA. To provide knowledge management support for CHICA-GIS, three informationists at the Indiana University School of Medicine were awarded a supplement from the National Library Medicine. The informationists will enhance CHICA-GIS by: improving the accuracy and accessibility of information, managing and mapping the knowledge which undergirds the CHICA-GIS decision support tool, supporting community engagement and consumer health information outreach, and facilitating the dissemination of new CHICA-GIS research results and services.

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.

Improving Access to Pediatric Cardiology in Cape Verde via a Collaborative International Telemedicine Service.

PubMed

Lapão, Luís Velez; Correia, Artur

2015-01-01

This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians.

Economic aspects of a therapy and support service for people with long-term stroke and aphasia.

PubMed

van der Gaag, Anna; Brooks, Richard

2008-01-01

This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005). The purpose of this part of the study was to investigate the feasibility of undertaking economic appraisal in a voluntary sector service providing therapy for people with aphasia and their families. The costs of delivering therapy and support services were calculated. These costs were compared with the costs of equivalent services in the National Health Service (NHS). The EQ-5D health-related quality of life instrument was used to calculate quality-adjusted life years (QALYs). The cost of delivering therapy was lower than expected for a customized service of this nature. The study generated cost data for delivering therapy services, allowing some comparisons to be made with equivalent services in NHS settings. QALY data were generated for a sample of 25 clients on one of the programmes. The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes.

Structure of 311 service requests as a signature of urban location

PubMed Central

Wang, Lingjing; Qian, Cheng; Kats, Philipp; Kontokosta, Constantine; Sobolevsky, Stanislav

2017-01-01

While urban systems demonstrate high spatial heterogeneity, many urban planning, economic and political decisions heavily rely on a deep understanding of local neighborhood contexts. We show that the structure of 311 Service Requests enables one possible way of building a unique signature of the local urban context, thus being able to serve as a low-cost decision support tool for urban stakeholders. Considering examples of New York City, Boston and Chicago, we demonstrate how 311 Service Requests recorded and categorized by type in each neighborhood can be utilized to generate a meaningful classification of locations across the city, based on distinctive socioeconomic profiles. Moreover, the 311-based classification of urban neighborhoods can present sufficient information to model various socioeconomic features. Finally, we show that these characteristics are capable of predicting future trends in comparative local real estate prices. We demonstrate 311 Service Requests data can be used to monitor and predict socioeconomic performance of urban neighborhoods, allowing urban stakeholders to quantify the impacts of their interventions. PMID:29040314

Structure of 311 service requests as a signature of urban location.

PubMed

Wang, Lingjing; Qian, Cheng; Kats, Philipp; Kontokosta, Constantine; Sobolevsky, Stanislav

2017-01-01

While urban systems demonstrate high spatial heterogeneity, many urban planning, economic and political decisions heavily rely on a deep understanding of local neighborhood contexts. We show that the structure of 311 Service Requests enables one possible way of building a unique signature of the local urban context, thus being able to serve as a low-cost decision support tool for urban stakeholders. Considering examples of New York City, Boston and Chicago, we demonstrate how 311 Service Requests recorded and categorized by type in each neighborhood can be utilized to generate a meaningful classification of locations across the city, based on distinctive socioeconomic profiles. Moreover, the 311-based classification of urban neighborhoods can present sufficient information to model various socioeconomic features. Finally, we show that these characteristics are capable of predicting future trends in comparative local real estate prices. We demonstrate 311 Service Requests data can be used to monitor and predict socioeconomic performance of urban neighborhoods, allowing urban stakeholders to quantify the impacts of their interventions.

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel

PubMed Central

Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J.

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel. PMID:29389965

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel.

PubMed

Malmborg, Katja; Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel.

Don't panic--prepare: towards crisis-aware models of emergency department operations.

PubMed

Ceglowski, Red; Churilov, Leonid; Wasserheil, Jeff

2005-12-01

The existing models of Emergency Department (ED) operations that are based on the "flow-shop" management logic do not provide adequate decision support in dealing with the ED overcrowding crises. A conceptually different crisis-aware approach to ED modelling and operational decision support is introduced in this paper. It is based on Perrow's theory of "normal accidents" and calls for recognizing the inevitable nature of ED overcrowding crises within current health system setup. Managing the crisis before it happens--a standard approach in crisis management area--should become an integral part of ED operations management. The potential implications of adopting such a crisis-aware perspective for health services research and ED management are outlined.

Aggregation of Environmental Model Data for Decision Support

NASA Astrophysics Data System (ADS)

Alpert, J. C.

2013-12-01

Weather forecasts and warnings must be prepared and then delivered so as to reach their intended audience in good time to enable effective decision-making. An effort to mitigate these difficulties was studied at a Workshop, 'Sustaining National Meteorological Services - Strengthening WMO Regional and Global Centers' convened, June , 2013, by the World Bank, WMO and the US National Weather Service (NWS). The skill and accuracy of atmospheric forecasts from deterministic models have increased and there are now ensembles of such models that improve decisions to protect life, property and commerce. The NWS production of numerical weather prediction products result in model output from global and high resolution regional ensemble forecasts. Ensembles are constructed by changing the initial conditions to make a 'cloud' of forecasts that attempt to span the space of possible atmospheric realizations which can quantify not only the most likely forecast, but also the uncertainty. This has led to an unprecedented increase in data production and information content from higher resolution, multi-model output and secondary calculations. One difficulty is to obtain the needed subset of data required to estimate the probability of events, and report the information. The calibration required to reliably estimate the probability of events, and honing of threshold adjustments to reduce false alarms for decision makers is also needed. To meet the future needs of the ever-broadening user community and address these issues on a national and international basis, the weather service implemented the NOAA Operational Model Archive and Distribution System (NOMADS). NOMADS provides real-time and retrospective format independent access to climate, ocean and weather model data and delivers high availability content services as part of NOAA's official real time data dissemination at its new NCWCP web operations center. An important aspect of the server's abilities is to aggregate the matrix of model output offering access to probability and calibrating information for real time decision making. The aggregation content server reports over ensemble component and forecast time in addition to the other data dimensions of vertical layer and position for each variable. The unpacking, organization and reading of many binary packed files is accomplished most efficiently on the server while weather element event probability calculations, the thresholds for more accurate decision support, or display remain for the client. Our goal is to reduce uncertainty for variables of interest, e.g, agricultural importance. The weather service operational GFS model ensemble and short range ensemble forecasts can make skillful probability forecasts to alert users if and when their selected weather events will occur. A description of how this framework operates and how it can be implemented using existing NOMADS content services and applications is described.

A sequential decision framework for increasing college students' support for organ donation and organ donor registration.

PubMed

Peltier, James W; D'Alessandro, Anthony M; Dahl, Andrew J; Feeley, Thomas Hugh

2012-09-01

Despite the fact that college students support social causes, this age group has underparticipated in organ donor registration. Little research attention has been given to understanding deeper, higher-order relationships between the antecedent attitudes toward and perceptions of organ donation and registration behavior. To test a process model useful for understanding the sequential ordering of information necessary for moving college students along a hierarchical decision-making continuum from awareness to support to organ donor registration. The University of Wisconsin organ procurement organization collaborated with the Collegiate American Marketing Association on a 2-year grant funded by the US Health Resources and Services Administration. A total of 981 association members responded to an online questionnaire. The 5 antecedent measures were awareness of organ donation, need acknowledgment, benefits of organ donation, social support, and concerns about organ donation. The 2 consequence variables were support for organ donation and organ donation registration. Structural equation modeling indicated that 5 of 10 direct antecedent pathways led significantly into organ donation support and registration. The impact of the nonsignificant variables was captured via indirect effects through other decision variables. Model fit statistics were good: the goodness of fit index was .998, the adjusted goodness of fit index was .992, and the root mean square error of approximation was .001. This sequential decision-making model provides insight into the need to enhance the acceptance of organ donation and organ donor registration through a series of communications to move people from awareness to behavior.

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

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

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

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

Gaining support from health disciplines and other stakeholders.

PubMed

Murphy, Jeannette

2004-01-01

The Health industry employs health professionals from many disciplines all of whom need to have a basic understanding of health informatics principles and how information technologies may be used to improved health service delivery and patient/community/population health outcomes. This is not well understood by the workforce as a whole resulting in a low demand for health informatics education. Many health service managers and policy makers do not appreciate the power and potential usefulness of all health related information and the many technologies now available. This impacts on decisions regarding their acquisition, implementation and staff training/education support. This chapter includes recommended strategies on how to best overcome such knowledge deficits so that greater support for Health Informatics education is achieved.

Influences on women's decision making about intrauterine device use in Madagascar.

PubMed

Gottert, Ann; Jacquin, Karin; Rahaivondrafahitra, Bakoly; Moracco, Kathryn; Maman, Suzanne

2015-04-01

We explored influences on decision making about intrauterine device (IUD) use among women in the Women's Health Project (WHP), managed by Population Services International in Madagascar. We conducted six small group photonarrative discussions (n=18 individuals) and 12 individual in-depth interviews with women who were IUD users and nonusers. All participants had had contact with WHP counselors in three sites in Madagascar. Data analysis involved creating summaries of each transcript, coding in Atlas.ti and then synthesizing findings in a conceptual model. We identified three stages of women's decision making about IUD use, and specific forms of social support that seemed helpful at each stage. During the first stage, receiving correct information from a trusted source such as a counselor conveys IUD benefits and corrects misinformation, but lingering fears about the method often appeared to delay method adoption among interested women. During the second stage, hearing testimony from satisfied users and receiving ongoing emotional support appeared to help alleviate these fears. During the third stage, accompaniment by a counselor or peer seemed to help some women gain confidence to go to the clinic to receive the IUD. Identifying and supplying the types of social support women find helpful at different stages of the decision-making process could help program managers better respond to women's staged decision-making process about IUD use. This qualitative study suggests that women in Madagascar perceive multiple IUD benefits but also fear the method even after misinformation is corrected, leading to a staged decision-making process about IUD use. Programs should identify and supply the types of social support that women find helpful at each stage of decision making. Copyright © 2015 Elsevier Inc. All rights reserved.

A coupled human-natural system to assess the operational value of weather and climate services for agriculture

NASA Astrophysics Data System (ADS)

Li, Yu; Giuliani, Matteo; Castelletti, Andrea

2017-09-01

Recent advances in weather and climate (W&C) services are showing increasing forecast skills over seasonal and longer timescales, potentially providing valuable support in informing decisions in a variety of economic sectors. Quantifying this value, however, might not be straightforward as better forecast quality does not necessarily imply better decisions by the end users, especially when forecasts do not reach their final users, when providers are not trusted, or when forecasts are not appropriately understood. In this study, we contribute an assessment framework to evaluate the operational value of W&C services for informing agricultural practices by complementing traditional forecast quality assessments with a coupled human-natural system behavioural model which reproduces farmers' decisions. This allows a more critical assessment of the forecast value mediated by the end users' perspective, including farmers' risk attitudes and behavioural factors. The application to an agricultural area in northern Italy shows that the quality of state-of-the-art W&C services is still limited in predicting the weather and the crop yield of the incoming agricultural season, with ECMWF annual products simulated by the IFS/HOPE model resulting in the most skillful product in the study area. However, we also show that the accuracy of estimating crop yield and the probability of making optimal decisions are not necessarily linearly correlated, with the overall assessment procedure being strongly impacted by the behavioural attitudes of farmers, which can produce rank reversals in the quantification of the W&C services operational value depending on the different perceptions of risk and uncertainty.

Abstracts of Master of Military Art and Science (MMAS) Theses and Special Studies 1964-1976

DTIC Science & Technology

1976-01-01

Missions. They are listed below in a probable chronological order of appli- cation. 1. Undertake self-preparation to become familiar with the concept of...analyst. Familiarity with these tools has the tendency to reduce the reluc- tance sometimes evidenced by the military decision-maker to include such...the fundamentals of combat service support, initiating a branch immaterial logistics familiarization course, teaching a Senior Officer Combat Service

Developing User-Driven Climate Information Services to Build Resilience Amongst Groups at Risk of Drought and Flood in Arid and Semi-Arid Land Counties in Kenya

NASA Astrophysics Data System (ADS)

Githungo, W. N.; Shaka, A.; Kniveton, D.; Muithya, L.; Powell, R.; Visman, E. L.

2014-12-01

The Arid and Semi-Arid Land (ASAL) counties of Kitui and Makueni in Kenya are experiencing increasing climate variability in seasonal rainfall, including changes in the onset, cessation and distribution of the two principal rains upon which the majority of the population's small-holder farmers and livestock keepers depend. Food insecurity is prevalent with significant numbers also affected by flooding during periods of intense rainfall. As part of a multi-partner Adaptation Consortium, Kenya Meteorological Services (KMS) are developing Climate Information Services (CIS) which can better support decision making amongst the counties' principal livelihoods groups and across County Government ministries. Building on earlier pilots and stakeholder discussion, the system combines the production of climate information tailored for transmission via regional and local radio stations with the establishment of a new SMS service. SMS are provided through a network of CIS intermediaries drawn from across key government ministries, religious networks, non-governmental and community groups, aiming to achieve one SMS recipient per 3-500 people. It also introduces a demand-led, premium-rate SMS weather information service which is designed to be self-financing in the long term. Supporting the ongoing process of devolution, KMS is downscaling national forecasts for each county, and providing seasonal, monthly, weekly and daily forecasts, as well as warnings of weather-related hazards. Through collaboration with relevant ministries, government bodies and research institutions, including livestock, agriculture, drought management and health, technical advisories are developed to provide guidance on application of the climate information. The system seeks to provide timely, relevant information which can enable people to use weather and climate information to support decisions which protect life and property and build resilience to ongoing climate variability and future change.

Uncertainty of Monetary Valued Ecosystem Services – Value Transfer Functions for Global Mapping

PubMed Central

Schmidt, Stefan; Manceur, Ameur M.; Seppelt, Ralf

2016-01-01

Growing demand of resources increases pressure on ecosystem services (ES) and biodiversity. Monetary valuation of ES is frequently seen as a decision-support tool by providing explicit values for unconsidered, non-market goods and services. Here we present global value transfer functions by using a meta-analytic framework for the synthesis of 194 case studies capturing 839 monetary values of ES. For 12 ES the variance of monetary values could be explained with a subset of 93 study- and site-specific variables by utilizing boosted regression trees. This provides the first global quantification of uncertainties and transferability of monetary valuations. Models explain from 18% (water provision) to 44% (food provision) of variance and provide statistically reliable extrapolations for 70% (water provision) to 91% (food provision) of the terrestrial earth surface. Although the application of different valuation methods is a source of uncertainty, we found evidence that assuming homogeneity of ecosystems is a major error in value transfer function models. Food provision is positively correlated with better life domains and variables indicating positive conditions for human well-being. Water provision and recreation service show that weak ownerships affect valuation of other common goods negatively (e.g. non-privately owned forests). Furthermore, we found support for the shifting baseline hypothesis in valuing climate regulation. Ecological conditions and societal vulnerability determine valuation of extreme event prevention. Valuation of habitat services is negatively correlated with indicators characterizing less favorable areas. Our analysis represents a stepping stone to establish a standardized integration of and reporting on uncertainties for reliable and valid benefit transfer as an important component for decision support. PMID:26938447

Reengineering health care: management systems for survivors.

PubMed

Griffith, J R

1994-01-01

To survive in the coming era, health care organizations must support the powerful concepts of continuous quality improvement with better internal management systems that include: (1) new processes for making decisions from mission to clinical guidelines; (2) hoshin planning, which emphasizes strong financial management and innovation to meet customer needs; (3) new organizations that make cross-disciplinary teams as important as traditional clinical support services; and (4) expanded information covering several new dimensions, including enhanced analytic capability, and supporting both traditional organization and cross-disciplinary teams.

Perceived influence, decision-making and access to information in family services as factors of parental empowerment: a cross-sectional study of parents with young children.

PubMed

Vuorenmaa, Maaret; Halme, Nina; Perälä, Marja-Leena; Kaunonen, Marja; Åstedt-Kurki, Päivi

2016-06-01

Parental empowerment is known to increase parents' resources and to reduce stress, and therefore to improve family well-being. Professionals working in family services (child health clinics, school health care, day care, preschool and primary school) encounter families in various everyday settings and can significantly support parental empowerment. This study aimed (i) to identify associations between parental empowerment and demographic and family service characteristics (i.e. parents' participation and perceived influence, decision-making and access to information) and (ii) to identify predictors of maternal and paternal empowerment. Study design was cross-sectional. Participants were mothers (n = 571) and fathers (n = 384) of children aged 0-9 who were selected by stratified random sampling in 2009. Associations were analysed by t-test, one-way analysis of variance and multiple linear regression analysis. Sufficient perceived influence and joint decision-making by family and professionals on family service appointments emerged as significant variables of increased parental empowerment. Access to adequate information about municipal services was also associated with high empowerment. These family service characteristics were associated with parents' sense that they were able to manage in everyday life and had influence on specific service situations and family services in general. Mothers with a child aged under 3 or a child in home care or primary school, and fathers with a lower education feel less empowered in family services than other parents. Knowledge about the factors associated with parental empowerment can contribute to further reinforce parental empowerment, help identify parents who need special attention and contribute to the development of family services. © 2015 Nordic College of Caring Science.

Considering Affective Responses towards Environments for Enhancing Location Based Services

NASA Astrophysics Data System (ADS)

Huang, H.; Gartner, G.; Klettner, S.; Schmidt, M.

2014-04-01

A number of studies in the field of environmental psychology show that humans perceive and evaluate their surroundings affectively. Some places are experienced as unsafe, while some others as attractive and interesting. Experiences from daily life show that many of our daily behaviours and decision-making are often influenced by this kind of affective responses towards environments. Location based services (LBS) are often designed to assist and support people's behaviours and decision-making in space. In order to provide services with high usefulness (usability and utility), LBS should consider these kinds of affective responses towards environments. This paper reports on the results of a research project, which studies how people's affective responses towards environments can be modelled and acquired, as well as how LBS can benefit by considering these affective responses. As one of the most popular LBS applications, mobile pedestrian navigation systems are used as an example for illustration.

Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial

PubMed Central

2013-01-01

Background Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients’ decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. Methods/design A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. Discussion Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. Trial registration ClinicalTrials.gov: NCT01876173 PMID:24148851

Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial.

PubMed

Carroll, Sandra L; McGillion, Michael; Stacey, Dawn; Healey, Jeff S; Browne, Gina; Arthur, Heather M; Thabane, Lehana

2013-10-22

Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients' decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. ClinicalTrials.gov: NCT01876173.

An Evaluation of the Decision-Making Capacity Assessment Model.

PubMed

Brémault-Phillips, Suzette C; Parmar, Jasneet; Friesen, Steven; Rogers, Laura G; Pike, Ashley; Sluggett, Bryan

2016-09-01

The Decision-Making Capacity Assessment (DMCA) Model includes a best-practice process and tools to assess DMCA, and implementation strategies at the organizational and assessor levels to support provision of DMCAs across the care continuum. A Developmental Evaluation of the DMCA Model was conducted. A mixed methods approach was used. Survey ( N = 126) and focus group ( N = 49) data were collected from practitioners utilizing the Model. Strengths of the Model include its best-practice and implementation approach, applicability to independent practitioners and inter-professional teams, focus on training/mentoring to enhance knowledge/skills, and provision of tools/processes. Post-training, participants agreed that they followed the Model's guiding principles (90%), used problem-solving (92%), understood discipline-specific roles (87%), were confident in their knowledge of DMCAs (75%) and pertinent legislation (72%), accessed consultative services (88%), and received management support (64%). Model implementation is impeded when role clarity, physician engagement, inter-professional buy-in, accountability, dedicated resources, information sharing systems, and remuneration are lacking. Dedicated resources, job descriptions inclusive of DMCAs, ongoing education/mentoring supports, access to consultative services, and appropriate remuneration would support implementation. The DMCA Model offers practitioners, inter-professional teams, and organizations a best-practice and implementation approach to DMCAs. Addressing barriers and further contextualizing the Model would be warranted.

An Evaluation of the Decision-Making Capacity Assessment Model

PubMed Central

Brémault-Phillips, Suzette C.; Parmar, Jasneet; Friesen, Steven; Rogers, Laura G.; Pike, Ashley; Sluggett, Bryan

2016-01-01

Background The Decision-Making Capacity Assessment (DMCA) Model includes a best-practice process and tools to assess DMCA, and implementation strategies at the organizational and assessor levels to support provision of DMCAs across the care continuum. A Developmental Evaluation of the DMCA Model was conducted. Methods A mixed methods approach was used. Survey (N = 126) and focus group (N = 49) data were collected from practitioners utilizing the Model. Results Strengths of the Model include its best-practice and implementation approach, applicability to independent practitioners and inter-professional teams, focus on training/mentoring to enhance knowledge/skills, and provision of tools/processes. Post-training, participants agreed that they followed the Model’s guiding principles (90%), used problem-solving (92%), understood discipline-specific roles (87%), were confident in their knowledge of DMCAs (75%) and pertinent legislation (72%), accessed consultative services (88%), and received management support (64%). Model implementation is impeded when role clarity, physician engagement, inter-professional buy-in, accountability, dedicated resources, information sharing systems, and remuneration are lacking. Dedicated resources, job descriptions inclusive of DMCAs, ongoing education/mentoring supports, access to consultative services, and appropriate remuneration would support implementation. Conclusions The DMCA Model offers practitioners, inter-professional teams, and organizations a best-practice and implementation approach to DMCAs. Addressing barriers and further contextualizing the Model would be warranted. PMID:27729947

A multi-service data management platform for scientific oceanographic products

NASA Astrophysics Data System (ADS)

D'Anca, Alessandro; Conte, Laura; Nassisi, Paola; Palazzo, Cosimo; Lecci, Rita; Cretì, Sergio; Mancini, Marco; Nuzzo, Alessandra; Mirto, Maria; Mannarini, Gianandrea; Coppini, Giovanni; Fiore, Sandro; Aloisio, Giovanni

2017-02-01

An efficient, secure and interoperable data platform solution has been developed in the TESSA project to provide fast navigation and access to the data stored in the data archive, as well as a standard-based metadata management support. The platform mainly targets scientific users and the situational sea awareness high-level services such as the decision support systems (DSS). These datasets are accessible through the following three main components: the Data Access Service (DAS), the Metadata Service and the Complex Data Analysis Module (CDAM). The DAS allows access to data stored in the archive by providing interfaces for different protocols and services for downloading, variables selection, data subsetting or map generation. Metadata Service is the heart of the information system of the TESSA products and completes the overall infrastructure for data and metadata management. This component enables data search and discovery and addresses interoperability by exploiting widely adopted standards for geospatial data. Finally, the CDAM represents the back-end of the TESSA DSS by performing on-demand complex data analysis tasks.

A study on building data warehouse of hospital information system.

PubMed

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

2011-08-01

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

Improving Civil-Military Information Sharing in Peace Support Operations Using a Service-Oriented Approach

DTIC Science & Technology

2011-06-01

solutions that operate reliable under adverse conditions including a bandwidth-limited environment, and provide them with customised information...236 Klein, G. (1998) Sources of Power: How people make decisions, MIT Press, Cambridge, Mass ., USA, 1998 NATO (2007) NATO Architecture Framework

Market Analysis for Expansion of Surgical Services at USAF Medical Center Wright-Patterson.

DTIC Science & Technology

1991-04-22

Rockville, Maryland: Aspen Malhotra , Naresh K . (1989) Decision Support Systems for Health Care Marketing Managers, Journal of Health Care Marketing Vol 9...information processing, analysis, storage, and distribution. Authors including Nickels (1978), Kropf and Greenberg (1984), Keckley (1988) and Malhotra (1989

EnviroAtlas: Incorporation of Community-Scale Data for Additional Communities

EPA Science Inventory

EnviroAtlas is ORD’s online spatial decision support tool for viewing and analyzing the supply, demand, and drivers of change related to natural and built infrastructure at multiple scales for the nation. Maps and text identify known relationships between the goods and services ...

Cloud-based mobility management in heterogeneous wireless networks

NASA Astrophysics Data System (ADS)

Kravchuk, Serhii; Minochkin, Dmytro; Omiotek, Zbigniew; Bainazarov, Ulan; Weryńska-Bieniasz, RóŻa; Iskakova, Aigul

2017-08-01

Mobility management is the key feature that supports the roaming of users between different systems. Handover is the essential aspect in the development of solutions supporting mobility scenarios. The handover process becomes more complex in a heterogeneous environment compared to the homogeneous one. Seamlessness and reduction of delay in servicing the handover calls, which can reduce the handover dropping probability, also require complex algorithms to provide a desired QoS for mobile users. A challenging problem to increase the scalability and availability of handover decision mechanisms is discussed. The aim of the paper is to propose cloud based handover as a service concept to cope with the challenges that arise.

A Wireless Sensor Network-Based Approach with Decision Support for Monitoring Lake Water Quality.

PubMed

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

2015-11-19

Online monitoring and water quality analysis of lakes are urgently needed. A feasible and effective approach is to use a Wireless Sensor Network (WSN). Lake water environments, like other real world environments, present many changing and unpredictable situations. To ensure flexibility in such an environment, the WSN node has to be prepared to deal with varying situations. This paper presents a WSN self-configuration approach for lake water quality monitoring. The approach is based on the integration of a semantic framework, where a reasoner can make decisions on the configuration of WSN services. We present a WSN ontology and the relevant water quality monitoring context information, which considers its suitability in a pervasive computing environment. We also propose a rule-based reasoning engine that is used to conduct decision support through reasoning techniques and context-awareness. To evaluate the approach, we conduct usability experiments and performance benchmarks.

Public attitudes and values in priority setting.

PubMed

Peacock, Stuart J

2015-01-01

There is growing recognition that critical decisions concerning investments in new health care technologies and services should incorporate society's values along with the scientific evidence. From a normative perspective, public engagement can help realize the democratic ideals of legitimacy, transparency, and accountability. On a more pragmatic level, public engagement can help stakeholders understand the degree of popular support for policy options, and may enhance public trust in decision-making processes. To better understand public attitudes and values relating to priority setting in health care, researchers and decision-makers will have to employ a range of quantitative and qualitative approaches, drawing on different disciplines and methodological traditions.

Older women's responses and decisions after a fall: The work of getting "back to normal".

PubMed

Bergeron, Caroline D; Friedman, Daniela B; Messias, DeAnne K Hilfinger; Spencer, S Melinda; Miller, Susan C

2016-12-01

In this descriptive qualitative research, we examined older women's responses and decisions after experiencing a fall. Falls were unexpected, sudden events that heightened these women's awareness of their physical, emotional, spiritual, and social independence. Interviewees reported assessing personal, physical, and emotional needs; feeling burdened by the extra work; trying to get back to normal; seeking and obtaining assistance and spiritual support; avoiding specific people, objects, and places; planning ahead; and putting the fall out of mind. Consideration of older women's post-fall responses and decisions should be incorporated into fall prevention and management programs, services, and clinical recommendations.

Decision analysis to support development of the Glen Canyon Dam long-term experimental and management plan

USGS Publications Warehouse

Runge, Michael C.; LaGory, Kirk E.; Russell, Kendra; Balsom, Janet R.; Butler, R. Alan; Coggins,, Lewis G.; Grantz, Katrina A.; Hayse, John; Hlohowskyj, Ihor; Korman, Josh; May, James E.; O'Rourke, Daniel J.; Poch, Leslie A.; Prairie, James R.; VanKuiken, Jack C.; Van Lonkhuyzen, Robert A.; Varyu, David R.; Verhaaren, Bruce T.; Veselka, Thomas D.; Williams, Nicholas T.; Wuthrich, Kelsey K.; Yackulic, Charles B.; Billerbeck, Robert P.; Knowles, Glen W.

2016-01-07

The results of the decision analysis are meant to serve as only one of many sources of information that can be used to evaluate the alternatives proposed in the Environmental Impact Statement. These results only focus on those resource goals for which quantitative performance metrics could be formulated and evaluated; there are other important aspects of the resource goals that also need to be considered. Not all the stakeholders who were invited to participate in the decision analysis chose to do so; thus, the Bureau of Reclamation, National Park Service, and U.S. Department of Interior may want to consider other input.

Publication, discovery and interoperability of Clinical Decision Support Systems: A Linked Data approach.

PubMed

Marco-Ruiz, Luis; Pedrinaci, Carlos; Maldonado, J A; Panziera, Luca; Chen, Rong; Bellika, J Gustav

2016-08-01

The high costs involved in the development of Clinical Decision Support Systems (CDSS) make it necessary to share their functionality across different systems and organizations. Service Oriented Architectures (SOA) have been proposed to allow reusing CDSS by encapsulating them in a Web service. However, strong barriers in sharing CDS functionality are still present as a consequence of lack of expressiveness of services' interfaces. Linked Services are the evolution of the Semantic Web Services paradigm to process Linked Data. They aim to provide semantic descriptions over SOA implementations to overcome the limitations derived from the syntactic nature of Web services technologies. To facilitate the publication, discovery and interoperability of CDS services by evolving them into Linked Services that expose their interfaces as Linked Data. We developed methods and models to enhance CDS SOA as Linked Services that define a rich semantic layer based on machine interpretable ontologies that powers their interoperability and reuse. These ontologies provided unambiguous descriptions of CDS services properties to expose them to the Web of Data. We developed models compliant with Linked Data principles to create a semantic representation of the components that compose CDS services. To evaluate our approach we implemented a set of CDS Linked Services using a Web service definition ontology. The definitions of Web services were linked to the models developed in order to attach unambiguous semantics to the service components. All models were bound to SNOMED-CT and public ontologies (e.g. Dublin Core) in order to count on a lingua franca to explore them. Discovery and analysis of CDS services based on machine interpretable models was performed reasoning over the ontologies built. Linked Services can be used effectively to expose CDS services to the Web of Data by building on current CDS standards. This allows building shared Linked Knowledge Bases to provide machine interpretable semantics to the CDS service description alleviating the challenges on interoperability and reuse. Linked Services allow for building 'digital libraries' of distributed CDS services that can be hosted and maintained in different organizations. Copyright © 2016 Elsevier Inc. All rights reserved.

The Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES): Enhancing Collaboration to Support Science-Based Decision-Making

NASA Astrophysics Data System (ADS)

Duke, C. S.; Quach, K.; Jackson, S. T.

2015-12-01

The Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) offers major opportunities to enhance scientific collaboration and advance global environmental sustainability. IPBES was established in 2012 as an independent intergovernmental body dedicated to assessing the state of the planet's biodiversity, its ecosystems, and the essential services they provide to society. IPBES has four functions: 1) identify and prioritize key scientific information needed for policymakers and catalyze efforts to generate new knowledge by engaging relevant scientific, policy and funding organizations; 2) perform regular and timely assessments of knowledge on biodiversity and ecosystem services and their interlinkages; 3) support policy formulation and implementation by identifying policy-relevant tools and methodologies; and 4) prioritize key capacity-building needs to improve the science-policy interface and catalyze related financing. To date, IPBES has brought together representatives of 124 countries at three annual plenary meetings and numerous panel meetings about specific assessments. This presentation will summarize IPBES' opportunities and achievements to date. These include a conceptual framework for IPBES processes and products, an assessment of the status of pollination and pollinators associated with food production, draft reports on scenario analyses and capacity building, and scoping for assessments of land degradation and restoration and of biodiversity in five regions of the world. IPBES provides natural and social scientists and other experts with important opportunities to support collaborative, science-based environmental decision-making at global to local scales. The presentation will conclude by describing opportunities to participate as expert panel members, contributors to assessments, and reviewers.

Climate services for society: origins, institutional arrangements, and design elements for an evaluation framework

PubMed Central

Vaughan, Catherine; Dessai, Suraje

2014-01-01

Climate services involve the generation, provision, and contextualization of information and knowledge derived from climate research for decision making at all levels of society. These services are mainly targeted at informing adaptation to climate variability and change, widely recognized as an important challenge for sustainable development. This paper reviews the development of climate services, beginning with a historical overview, a short summary of improvements in climate information, and a description of the recent surge of interest in climate service development including, for example, the Global Framework for Climate Services, implemented by the World Meteorological Organization in October 2012. It also reviews institutional arrangements of selected emerging climate services across local, national, regional, and international scales. By synthesizing existing literature, the paper proposes four design elements of a climate services evaluation framework. These design elements include: problem identification and the decision-making context; the characteristics, tailoring, and dissemination of the climate information; the governance and structure of the service, including the process by which it is developed; and the socioeconomic value of the service. The design elements are intended to serve as a guide to organize future work regarding the evaluation of when and whether climate services are more or less successful. The paper concludes by identifying future research questions regarding the institutional arrangements that support climate services and nascent efforts to evaluate them. PMID:25798197

Climate services for society: origins, institutional arrangements, and design elements for an evaluation framework.

PubMed

Vaughan, Catherine; Dessai, Suraje

2014-09-01

Climate services involve the generation, provision, and contextualization of information and knowledge derived from climate research for decision making at all levels of society. These services are mainly targeted at informing adaptation to climate variability and change, widely recognized as an important challenge for sustainable development. This paper reviews the development of climate services, beginning with a historical overview, a short summary of improvements in climate information, and a description of the recent surge of interest in climate service development including, for example, the Global Framework for Climate Services, implemented by the World Meteorological Organization in October 2012. It also reviews institutional arrangements of selected emerging climate services across local, national, regional, and international scales. By synthesizing existing literature, the paper proposes four design elements of a climate services evaluation framework. These design elements include: problem identification and the decision-making context; the characteristics, tailoring, and dissemination of the climate information; the governance and structure of the service, including the process by which it is developed; and the socioeconomic value of the service. The design elements are intended to serve as a guide to organize future work regarding the evaluation of when and whether climate services are more or less successful. The paper concludes by identifying future research questions regarding the institutional arrangements that support climate services and nascent efforts to evaluate them.

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.

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

PubMed Central

Teng, Flora; Mitton, Craig; MacKenzie, Jennifer

2007-01-01

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

Communal Participation in Payment for Environmental Services (PES): Unpacking the Collective Decision to Enroll

NASA Astrophysics Data System (ADS)

Murtinho, Felipe; Hayes, Tanya

2017-06-01

Payment for Environmental Service programs are increasingly applied in communal settings where resource users collectively join the program and agree to limit their shared use of a common-property resource. Who decides to join PES and the degree to which community members agree with the collective decision is critical for the success of said programs. Yet, we have limited understanding of the factors that influence communal participation and the collective decision process. This paper examines communal participation in a national payment for conservation program in Ecuador. We use quantitative and qualitative analysis to (i) identify the attributes of the communities that participate (or not), and factors that facilitate participation ( n = 67), and (ii) assess household preference and alignment with the collective decision to participate ( n = 212). Household participation preferences indicate varying degrees of consensus with the collective decision to participate, with those using the resource less likely to support participation. At the communal level, however, our results indicate that over time, those communities that depend more heavily on their resource systems may ultimately choose to participate. Our findings suggest that communal governance structures and outside organizations may be instrumental in gaining participation in resource-dependent communities and building consensus. Findings also point to the need for further research on communal decision-processes to ensure that the collective decision is based on an informed and democratic process.

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan

PubMed Central

Teich, Jonathan M.; Osheroff, Jerome A.; Pifer, Eric A.; Sittig, Dean F.; Jenders, Robert A.

2005-01-01

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

Process service quality evaluation based on Dempster-Shafer theory and support vector machine.

PubMed

Pei, Feng-Que; Li, Dong-Bo; Tong, Yi-Fei; He, Fei

2017-01-01

Human involvement influences traditional service quality evaluations, which triggers an evaluation's low accuracy, poor reliability and less impressive predictability. This paper proposes a method by employing a support vector machine (SVM) and Dempster-Shafer evidence theory to evaluate the service quality of a production process by handling a high number of input features with a low sampling data set, which is called SVMs-DS. Features that can affect production quality are extracted by a large number of sensors. Preprocessing steps such as feature simplification and normalization are reduced. Based on three individual SVM models, the basic probability assignments (BPAs) are constructed, which can help the evaluation in a qualitative and quantitative way. The process service quality evaluation results are validated by the Dempster rules; the decision threshold to resolve conflicting results is generated from three SVM models. A case study is presented to demonstrate the effectiveness of the SVMs-DS method.

Using Satellite-Based Earth Science Data in a Public Health Decision-Support System to Track and Forecast Pollen Events

NASA Astrophysics Data System (ADS)

Hudspeth, W. B.; Budge, A.

2013-12-01

There is widespread recognition within the public health community that ongoing changes in climate are expected to increasingly pose threats to human health. Environmentally induced health risks to populations with respiratory illnesses are a growing concern globally. Of particular concern are dust and smoke events carrying PM2.5 and PM10 particle sizes, ozone, and pollen. There is considerable interest in documenting the precise linkages between changing patterns in the climate and how these shifts impact the prevalence of respiratory illnesses. The establishment of these linkages can drive the development of early warning and forecasting systems to alert health care professionals of impending air-quality events. As a component of a larger NASA-funded project on Integration of Airborne Dust Prediction Systems and Vegetation Phenology to Track Pollen for Asthma Alerts in Public Health Decision Support Systems, the Earth Data Analysis Center (EDAC) at the University of New Mexico, is developing web-based visualization and analysis services for forecasting pollen concentration data. This decision-support system, New Mexico's Environmental Public Health Tracking System (NMEPHTS), funded by the Centers for Disease Control (CDC) Environmental Public Health Tracking Network (EPHTN), aims to improve health awareness and services by linking health effects data with levels and frequency of environmental exposure. The forecast of atmospheric events with high pollen concentrations has employed a modified version of the DREAM (Dust Regional Atmospheric Model, a verified model for atmospheric dust transport modeling. In this application, PREAM (Pollen Regional Atmospheric Model) models pollen emission using a MODIS-derived phenology of Juniperus spp. communities. Model outputs are verified and validated with ground-based records of pollen release timing and quantities. Outputs of the PREAM model are post-processed and archived in EDAC's Geographic Storage, Transformation, and Retrieval Engine (GStore) database. The GStore geospatial services platform provides general purpose web services based upon the REST service model, and is capable of data discovery, access, and publication functions, metadata delivery functions, data transformation, and auto-generated OGC services for those data products that can support those services. These services are in turn ingested by New Mexico's EPHTN where end users in the public health community can then assess environmental-pubic health data associations. Advances in web mapping and related technologies open new doors for data providers and users that can deliver data and information in near-real time. In the public health community these technologies are being used to enhance disease and syndromic surveillance systems, visualize environmentally-related events such as pollen and dust events, and to provide focused mapping and analysis capabilities on the desktop. Here we present the current results of the project, and will focus on the challenges encountered in providing reliable and accurate forecast of pollen concentrations, as well as the experience of integrating output results and services into end user applications that can provide timely and meaningful alerts and forecasts.

78 FR 17633 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF AGRICULTURE Rural Housing Service Notice of Request for Extension of a Currently... Support Staff, Housing and Community Facilities Programs, U.S. Department of Agriculture, Stop 0761, 1400... on the quality of the human environment during agency planning and decision-making processes. For...

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

EPA Science Inventory

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

What Can Local Foundations Do to Support Youth Service System Change Efforts?

ERIC Educational Resources Information Center

Weah, Wokie; Pope, Marcus

2013-01-01

Making sound decisions in funding youth-serving organizations can be greatly enhanced by implementing a comprehensive and inclusive learning process that embraces the perspectives of and input from a variety of stakeholders, including program staff and leadership, various community partners, and, most important, the youth. Youthprise effectively…

A Call for Strategic Planning: The Two-Year College Imperative.

ERIC Educational Resources Information Center

Masoner, David J.; Essex, Nathan, L.

1987-01-01

Addresses the imperative for strategic and tactical planning to support the viability of the two-year college. Describes a process for approaching strategic planning, comprising the following steps: self-identification, self-analysis, analysis of service area, informed decision making, and the development of a marketing plan. (CBC)

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...

75 FR 60488 - Self-Regulatory Organizations; Municipal Securities Rulemaking Board; Order Granting Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... decisions. Data elements with respect to the SHORT subscription service that would be provided through the... information about technical data elements to support transmission and data-integrity processes between the... Securities and Exchange Commission (``Commission''), pursuant to Section 19(b)(1) of the Securities [[Page...

Security and Communication Improve Community Trust

ERIC Educational Resources Information Center

Schneiderman, Mark

2015-01-01

Using student information in schools is nothing new nor is the reliance on information technologies supported by external service providers. What is new is the adoption of innovations like cloud computing and data analytics that are increasing teacher and family data access, creating actionable information to drive instruction and decision making,…

Asian Indian Students: Moving beyond Myths and Adopting Effective Practices

ERIC Educational Resources Information Center

Parikh, Sejal B.

2009-01-01

This article describes the Asian Indian population and how the myth of the model minority can influence students' access to support services. It is important for school counselors to understand how this minority group experience stressors related to academics, career decision making, and personal/social development. Effective interventions and…

Incorporating SAT® Writing into Admission and Placement Decisions

ERIC Educational Resources Information Center

Shaw, Emily

2010-01-01

Presented at the College Board National Forum in Washington, D.C., October 2010. This presentation examines the recent national validity evidence that supports the use of SAT Writing in college admissions and English placement. Additionally it includes information on the College Board's free online Admitted Class Evaluation Service (ACES) system,…

Realizing the Potential of Ecosystem Services: A Framework for Relating Ecological Changes to Economic Benefits

EPA Science Inventory

An analysis framework to link ecological change to economic benefits for multiple stakeholders requires several key components. First, since we aim to support policy decisions, the framework should link a factor that can be controlled or influenced by policy (discharge limit, ca...

75 FR 28255 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

... Center). AHRQ is the lead agency charged with supporting research designed to improve the quality of... are designed to help these decision makers use research evidence to maximize the benefits of health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency...

75 FR 52347 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-25

... Center). AHRQ is the lead agency charged with supporting research designed to improve the quality of... are designed to help these decision makers use research evidence to maximize the benefits of health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency...

75 FR 44796 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-29

... Center). AHRQ is the lead agency charged with supporting research designed to improve the quality of... are designed to help these decision makers use research evidence to maximize the benefits of health... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency...

Promoting Children's Ethical Development through Social and Emotional Learning

ERIC Educational Resources Information Center

Devaney, Elizabeth; O'Brien, Mary Utne; Tavegia, Mary; Resnik, Hank

2005-01-01

Although few educators, youth development practitioners, and student support services personnel question the importance of helping children to develop the skills necessary to be successful in the workplace, make ethical decisions, and be engaged and contributing citizens, these skills are rarely taught explicitly and effectively. The pressures of…

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…

A systematic review and summarization of the recommendations and research surrounding Curriculum-Based Measurement of oral reading fluency (CBM-R) decision rules.

PubMed

Ardoin, Scott P; Christ, Theodore J; Morena, Laura S; Cormier, Damien C; Klingbeil, David A

2013-02-01

Research and policy have established that data are necessary to guide decisions within education. Many of these decisions are made within problem solving and response to intervention frameworks for service delivery. Curriculum-Based Measurement in Reading (CBM-R) is a widely used data collection procedure within those models of service delivery. Although the evidence for CBM-R as a screening and benchmarking procedure has been summarized multiple times in the literature, there is no comprehensive review of the evidence for its application to monitor and evaluate individual student progress. The purpose of this study was to identify and summarize the psychometric and empirical evidence for CBM-R as it is used to monitor and evaluate student progress. There was an emphasis on the recommended number of data points collected during progress monitoring and interpretive guidelines. The review identified 171 journal articles, chapters, and instructional manuals using online search engines and research databases. Recommendations and evidence from 102 documents that met the study criteria were evaluated and summarized. Results indicate that most decision-making practices are based on expert opinion and that there is very limited psychometric or empirical support for such practices. There is a lack of published evidence to support program evaluation and progress monitoring with CBM-R. More research is required to inform data collection procedures and interpretive guidelines. Copyright © 2012 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.

PubMed

Keesara, Sirina R; Juma, Pamela A; Harper, Cynthia C

2015-08-20

Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

PubMed Central

Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2018-01-01

Background: Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Methods: Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Results: Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Conclusion: Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face. PMID:29764105

Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer.

PubMed

Beaver, Kinta; Williamson, Susan; Briggs, Jean

2016-02-01

Neo-adjuvant chemotherapy is recommended for 'inoperable' locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer. A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from 'well' to 'ill', information needs and decision making, needing support and empathy, impact on family, and creating a new 'normal'. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached. Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

PubMed

Brandling, J; Kirby, K; Black, S; Voss, S; Benger, J

2017-07-25

There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.

Involved, inputting or informing: "Shared" decision making in adult mental health care.

PubMed

Bradley, Eleanor; Green, Debra

2018-02-01

A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Climate Change and Sea Level Rise: A Challenge to Science and Society

NASA Astrophysics Data System (ADS)

Plag, H.

2009-12-01

Society is challenged by the risk of an anticipated rise of coastal Local Sea Level (LSL) as a consequence of future global warming. Many low-lying and often subsiding and densely populated coastal areas are under risk of increased inundation, with potentially devastating consequences for the global economy, society, and environment. Faced with a trade-off between imposing the very high costs of coastal protection and adaptation upon today's national economies and leaving the costs of potential major disasters to future generations, governments and decision makers are in need of scientific support for the development of mitigation and adaptation strategies for the coastal zone. Low-frequency to secular changes in LSL are the result of many interacting Earth system processes. The complexity of the Earth system makes it difficult to predict Global Sea Level (GSL) rise and, even more so, LSL changes over the next 100 to 200 years. Humans have re-engineered the planet and changed major features of the Earth surface and the atmosphere, thus ruling out extrapolation of past and current changes into the future as a reasonable approach. The risk of rapid changes in ocean circulation and ice sheet mass balance introduces the possibility of unexpected changes. Therefore, science is challenged with understanding and constraining the full range of plausible future LSL trajectories and with providing useful support for informed decisions. In the face of largely unpredictable future sea level changes, monitoring of the relevant processes and development of a forecasting service on realistic time scales is crucial as decision support. Forecasting and "early warning" for LSL rise would have to aim at decadal time scales, giving coastal managers sufficient time to react if the onset of rapid changes would require an immediate response. The social, environmental, and economic risks associated with potentially large and rapid LSL changes are enormous. Therefore, in the light of the current uncertainties and the unpredictable nature of some of the forcing processes for LSL changes, the focus of scientific decision support may have to shift from projections of LSL trajectories on century time scales to the development of models and monitoring systems for a forecasting service on decadal time scales. The requirements for such a LSL forecasting service and the current obstacles will be discussed.

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.

Spatially explicit decision support for selecting translocation areas for Mojave desert tortoises

USGS Publications Warehouse

Heaton, Jill S.; Nussear, Kenneth E.; Esque, Todd C.; Inman, Richard D.; Davenport, Frank; Leuteritz, Thomas E.; Medica, Philip A.; Strout, Nathan W.; Burgess, Paul A.; Benvenuti, Lisa

2008-01-01

Spatially explicit decision support systems are assuming an increasing role in natural resource and conservation management. In order for these systems to be successful, however, they must address real-world management problems with input from both the scientific and management communities. The National Training Center at Fort Irwin, California, has expanded its training area, encroaching U.S. Fish and Wildlife Service critical habitat set aside for the Mojave desert tortoise (Gopherus agassizii), a federally threatened species. Of all the mitigation measures proposed to offset expansion, the most challenging to implement was the selection of areas most feasible for tortoise translocation. We developed an objective, open, scientifically defensible spatially explicit decision support system to evaluate translocation potential within the Western Mojave Recovery Unit for tortoise populations under imminent threat from military expansion. Using up to a total of 10 biological, anthropogenic, and/or logistical criteria, seven alternative translocation scenarios were developed. The final translocation model was a consensus model between the seven scenarios. Within the final model, six potential translocation areas were identified.

NASA Applied Sciences Program Rapid Prototyping Results and Conclusions

NASA Astrophysics Data System (ADS)

Cox, E. L.

2007-12-01

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

Extensions to regret-based decision curve analysis: an application to hospice referral for terminal patients.

PubMed

Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin

2011-12-23

Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned.

Extensions to Regret-based Decision Curve Analysis: An application to hospice referral for terminal patients

PubMed Central

2011-01-01

Background Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. Methods We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. Results The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. Conclusions We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned. PMID:22196308

Improving Agricultural Productivity in Tonga through Ensuring Data Availability and Enhancing Agro-meteorological Services

NASA Astrophysics Data System (ADS)

Kim, K. H.

2015-12-01

The project was first conceived in the Global Framework for Climate Services Regional Consultation in the Cook Islands in March 2014. In this meeting, key officials from the Ministry of Agriculture and Food, Forests, and Fisheries and the Tonga Meteorological Services had a meeting with the APEC Climate Center scientists with the idea to collaborate on a joint project. The project evolved to include the following components: assessment of users' needs and capacities, development of an agricultural database, research on the core relationships between agriculture and climate through modeling and field trials, and the development and delivery of agro-meteorological services. Envisioned outputs include a 2-7 day warning for pests and diseases, a suite of tools supporting decisions on planting dates and crop varieties, and other advisory services derived from seasonal climate forecasts. As one of the climate adaptation projects under its Pacific Island portfolio, the project will deliver urgent information services for Tongan agricultural growers and exporters. The project comes into greater importance and urgency, as the 2014 drought event resulted in the destruction of 80% of squash in Tonga, a main export crop from which the country derives foreign exchange earnings. Since 2014, some of the project achievements include the first agro-met data collection in Tonga, the development of an agricultural DB management system that houses archived agriculture data, and key meetings with stakeholders to ensure alignment of the project objectives and design with the interests of the Tongan government and other stakeholders. In addition, rigorous scientific research through modeling and field trials has been conducted to address the twin goals of supporting Tonga's economy as well as food security. Based on the findings from the research, tools will be developed to translate the science into knowledge that supports decisions on the farm scale.