Caring for seniors living with dementia means caring for their caregivers too.

PubMed

Poirier, Annie; Voyer, Philippe; Légaré, France; Morin, Michèle; Witteman, Holly O; Kröger, Edeltraut; Martineau, Bernard; Rodríguez, Charo; Giguere, Anik Mc

2018-01-22

To improve the care of seniors living with dementia, current initiatives typically target better identification and treatment of the patient. Our recent survey, however, shows we should also focus more on the needs of the informal caregivers who care for this population in primary care settings. This three-round Delphi survey sought caregivers' views on the most frequent and difficult decisions that seniors with dementia, their informal caregivers, and health care providers face in primary care settings in the province of Quebec. Respondents consisted of 31 health care professionals, informal caregivers, managers, representatives of community-based organizations devoted to these seniors, and clinical researchers involved in the organization of care or services to seniors with dementia. When we asked respondents to rank 27 common but difficult decisions involving benefit/harm trade-offs, 83% ranked the decision to choose an option to reduce the burden of informal caregivers as one of the five most important decisions. Choosing a treatment to manage agitation, aggression or psychotic symptoms followed closely, with 79% of respondents selecting it as one of the five most important decisions. Our results point to the importance of attending to the needs of informal caregivers and improving the management of behavioural and psychological symptoms of dementia.

Application of decision science to resilience management in Jamaica Bay

USGS Publications Warehouse

Eaton, Mitchell; Fuller, Angela K.; Johnson, Fred A.; Hare, M. P.; Stedman, Richard C.; Sanderson, E.W.; Solecki, W. D.; Waldman, J.R.; Paris, A. S.

2016-01-01

This book highlights the growing interest in management interventions designed to enhance the resilience of the Jamaica Bay socio-ecological system. Effective management, whether the focus is on managing biological processes or human behavior or (most likely) both, requires decision makers to anticipate how the managed system will respond to interventions (i.e., via predictions or projections). In systems characterized by many interacting components and high uncertainty, making probabilistic predictions is often difficult and requires careful thinking not only about system dynamics, but also about how management objectives are specified and the analytic method used to select the preferred action(s). Developing a clear statement of the problem(s) and articulation of management objectives is often best achieved by including input from managers, scientists and other stakeholders affected by the decision through a process of joint problem framing (Marcot and others 2012; Keeney and others 1990). Using a deliberate, coherent and transparent framework for deciding among management alternatives to best meet these objectives then ensures a greater likelihood for successful intervention. Decision science provides the theoretical and practical basis for developing this framework and applying decision analysis methods for making complex decisions under uncertainty and risk.

Fuzzy indicator approach: development of impact factor of soil amendments

USDA-ARS?s Scientific Manuscript database

Soil amendments have been shown to be useful for improving soil condition, but it is often difficult to make management decisions as to their usefulness. Utilization of Fuzzy Set Theory is a promising method for decision support associated with utilization of soil amendments. In this article a tool ...

Integrative complexity of wildfire management: development of a scale

Treesearch

Joshua Carroll; Alan Bright

2007-01-01

Wildfire in the West has become a controversial natural resource issue that has divided the public's perceptions regarding its management, and forest managers are now faced with the difficult task of making sound decisions while balancing these varying concerns. Two widely used wildfi re management practices are prescribed fire and mechanical thinning. In order to...

Fish stocking in protected areas: summary of a workshop

Treesearch

Paul Stephen Corn; Roland A. Knapp

2000-01-01

Native and nonnative sport fish have been introduced into the majority of historically fishless lakes in wilderness, generating conflicts between managing wilderness as natural ecosystems and providing opportunities for recreation. Managers faced with controversial and difficult decisions about how to manage wilderness lakes may not always have ready access to research...

Enhancement of Ecosystem Services through Active Management of a Eutrophic Area of the Florida Everglades

EPA Science Inventory

Ecosystem services of wetlands are relevant when considering management decisions and assessing restoration success. However, many services (e.g., biochemistry, wildlife habitat) are difficult to quantify and value (e.g., monetize), requiring non-use valuations (e.g., indicators)...

Configuration Management, Capacity Planning Decision Support, Modeling and Simulation

DTIC Science & Technology

1988-12-01

flow includes both top-down and bottom-up requirements. The flow also includes hardware, software and transfer acquisition, installation, operation ... management and upgrade as required. Satisfaction of a users needs and requirements is a difficult and detailed process. The key assumptions at this

Integrating LANDIS model and a multi-criteria decision-making approach to evaluate cumulative effects of forest management in the Missouri Ozarks, USA

Treesearch

Zong Bo Shang; Hong S. He; Weimin Xi; Stephen R. Shifley; Brian J. Palik

2012-01-01

Public forest management requires consideration of numerous objectives including protecting ecosystem health, sustaining habitats for native communities, providing sustainable forest products, and providing noncommodity ecosystem services. It is difficult to evaluate the long-term, cumulative effects and tradeoffs these and other associated management objectives. To...

Leaders' Perceptions of Mobile Technology in the Workplace

ERIC Educational Resources Information Center

Wood, Kristin R.

2012-01-01

Leaders have limited understanding regarding mobile technology (Ramo & Edenius, 2008). However, with over 1 billion users (Meeker, Devitt & Wu, 2011), managers are tasked with making leadership decisions regarding technology adoption, management and use. Leaders may find this difficult to undertake given the limited body of knowledge in…

Teaching versus Living: Managerial Decision Making in the Gray

ERIC Educational Resources Information Center

Soltes, Eugene

2017-01-01

Preparing students for the consequential ethical decisions that they will face in their careers is among the most difficult tasks of management education. I describe some of these challenges based on my book "Why They Do It: Inside the Mind of the White-Collar Criminal" and recent work in behavioral ethics. I explore why some decisions…

Managing in a Culture of Debate: Enhancing Administrative Effectiveness through Procedural Fairness

ERIC Educational Resources Information Center

Moshavi, Dan; Standifird, Stephen

2017-01-01

The contestability of ideas is at the heart of a healthy academic institution. As a result, administrators face the challenge of making and implementing difficult decisions in an environment that is designed to explicitly create thoughtful discord. We argue that procedural fairness--explaining how and why important decisions are made--is an…

Decision aids for multiple-decision disease management as affected by weather input errors.

PubMed

Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

2011-06-01

Many disease management decision support systems (DSSs) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation, or estimation from off-site sources, may affect model calculations and management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

Management Information Systems Research.

DTIC Science & Technology

Research on management information systems is illusive in many respects. Part of the basic research problem in MIS stems from the absence of standard...decision making. But the transition from these results to the realization of ’satisfactory’ management information systems remains difficult indeed. The...paper discusses several aspects of research on management information systems and reviews a selection of efforts that appear significant for future progress. (Author)

A management-oriented framework for selecting metrics used to assess habitat- and path-specific quality in spatially structured populations

USGS Publications Warehouse

Nicol, Sam; Wiederholt, Ruscena; Diffendorfer, James E.; Mattsson, Brady; Thogmartin, Wayne E.; Semmens, Darius J.; Laura Lopez-Hoffman,; Norris, Ryan

2016-01-01

Mobile species with complex spatial dynamics can be difficult to manage because their population distributions vary across space and time, and because the consequences of managing particular habitats are uncertain when evaluated at the level of the entire population. Metrics to assess the importance of habitats and pathways connecting habitats in a network are necessary to guide a variety of management decisions. Given the many metrics developed for spatially structured models, it can be challenging to select the most appropriate one for a particular decision. To guide the management of spatially structured populations, we define three classes of metrics describing habitat and pathway quality based on their data requirements (graph-based, occupancy-based, and demographic-based metrics) and synopsize the ecological literature relating to these classes. Applying the first steps of a formal decision-making approach (problem framing, objectives, and management actions), we assess the utility of metrics for particular types of management decisions. Our framework can help managers with problem framing, choosing metrics of habitat and pathway quality, and to elucidate the data needs for a particular metric. Our goal is to help managers to narrow the range of suitable metrics for a management project, and aid in decision-making to make the best use of limited resources.

Proof in the Pattern: Librarians Follow the Corporate Sector toward More Data-Driven Management

ERIC Educational Resources Information Center

Nicholson, Scott

2006-01-01

As demands on libraries continue to grow, outpacing budget increases, more librarians are forced to make difficult decisions about what materials and services stay and go. Charles R. McClure has written that many librarians use an "adhocracy" method to make these decisions, relying on no data or simple aggregates in determining a course of action.…

Information and knowledge management in support of sustainable forestry: a review

Treesearch

H. Michael Rauscher; Daniel L. Schmoldt; Harald Vacik

2007-01-01

For individuals, organizations and nations, success and even survival depend upon making good decisions. Doing so can be extremely difficult when problems are not well structured and situations are complex, as they are for natural resource management. Recent advances in computer technology coupled with the increase in accessibility brought about by the...

Chapter 13: Applying GTR 220 Concepts on the Sagehen Experimental Forest

Treesearch

P. Stine; S. Conway

2012-01-01

Applying science to the practice of forest management is a difficult process. Scientific results tend to be expressed in terms such as variances, confidence intervals, and probability distributions. Rarely does science provide unequivocal information, yet land managers must make definitive decisions on the ground. The General Technical Report "An Ecosystem...

Bayesian Decision Support

NASA Astrophysics Data System (ADS)

Berliner, M.

2017-12-01

Bayesian statistical decision theory offers a natural framework for decision-policy making in the presence of uncertainty. Key advantages of the approach include efficient incorporation of information and observations. However, in complicated settings it is very difficult, perhaps essentially impossible, to formalize the mathematical inputs needed in the approach. Nevertheless, using the approach as a template is useful for decision support; that is, organizing and communicating our analyses. Bayesian hierarchical modeling is valuable in quantifying and managing uncertainty such cases. I review some aspects of the idea emphasizing statistical model development and use in the context of sea-level rise.

Adaptive management in the U.S. National Wildlife Refuge System: Science-management partnerships for conservation delivery

USGS Publications Warehouse

Moore, C.T.; Lonsdorf, E.V.; Knutson, M.G.; Laskowski, H.P.; Lor, S.K.

2011-01-01

Adaptive management is an approach to recurrent decision making in which uncertainty about the decision is reduced over time through comparison of outcomes predicted by competing models against observed values of those outcomes. The National Wildlife Refuge System (NWRS) of the U.S. Fish and Wildlife Service is a large land management program charged with making natural resource management decisions, which often are made under considerable uncertainty, severe operational constraints, and conditions that limit ability to precisely carry out actions as intended. The NWRS presents outstanding opportunities for the application of adaptive management, but also difficult challenges. We describe two cooperative programs between the Fish and Wildlife Service and the U.S. Geological Survey to implement adaptive management at scales ranging from small, single refuge applications to large, multi-refuge, multi-region projects. Our experience to date suggests three important attributes common to successful implementation: a vigorous multi-partner collaboration, practical and informative decision framework components, and a sustained commitment to the process. Administrators in both agencies should consider these attributes when developing programs to promote the use and acceptance of adaptive management in the NWRS. ?? 2010 .

Mapping Flood Reduction Benefits of Potential Wetlands Restoration

EPA Science Inventory

Public officials and environmental managers face difficult decisions when allocating funds to prioritize the most beneficial wetlands conservation or restoration projects, and often face difficulty even characterizing benefits. One benefit of natural and constructed wetlands is t...

Deciding to buy expensive technology. The case of biliary lithotripsy.

PubMed

Weingart, S N

1995-01-01

Acquiring expensive, new medical technology requires an evaluation of the efficacy and effectiveness, safety, profitability, feasibility, and risk of a project in the context of the hospital's social responsibility and institutional strategy. A case study of the decision to bring biliary lithotripsy to Strong Memorial Hospital illustrates how these criteria offer managers a coherent approach to difficult and consequential decisions about acquiring medical technology.

Mapping forest soil organic matter on New Jersey's coastal plain

Treesearch

Brian J. Clough; Edwin J. Green; Richard B. Lathrop

2012-01-01

Managing forest soil organic matter (SOM) stocks is a vital strategy for reducing the impact of anthropogenic carbon dioxide emissions. However, the SOM pool is highly variable, and developing accurate estimates to guide management decisions has remained a difficult task. We present the results of a spatial model designed to map soil organic matter for all forested...

Review and recommendations for climate change vulnerability assessment approaches with examples from the Southwest

Treesearch

M. Friggens; K. Bagne; D. Finch; D. Falk; J. Triepke; A. Lynch

2013-01-01

Climate change creates new challenges for resource managers and decision-makers with broad and often complex effects that make it difficult to accurately predict and design management actions to minimize undesirable impacts. We review pertinent information regarding methods and approaches used to conduct climate change vulnerability assessments to reveal assumptions...

Climate change effects in El Yunque National Forest, Puerto Rico, and the Caribbean region

Treesearch

Lisa Nicole Jennings; Jamison Douglas; Emrys Treasure; Grizelle González

2014-01-01

Understanding the current and expected future conditions of natural resources under a changing climate is essential to making informed management decisions. However, the ever increasing volume of useful scientific information about climate change makes it difficult for managers and planners to effectively sort through and apply the emerging science. This report...

Multi-objective game-theory models for conflict analysis in reservoir watershed management.

PubMed

Lee, Chih-Sheng

2012-05-01

This study focuses on the development of a multi-objective game-theory model (MOGM) for balancing economic and environmental concerns in reservoir watershed management and for assistance in decision. Game theory is used as an alternative tool for analyzing strategic interaction between economic development (land use and development) and environmental protection (water-quality protection and eutrophication control). Geographic information system is used to concisely illustrate and calculate the areas of various land use types. The MOGM methodology is illustrated in a case study of multi-objective watershed management in the Tseng-Wen reservoir, Taiwan. The innovation and advantages of MOGM can be seen in the results, which balance economic and environmental concerns in watershed management and which can be interpreted easily by decision makers. For comparison, the decision-making process using conventional multi-objective method to produce many alternatives was found to be more difficult. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Difficult Airway Society 'ADEPT' guidance on selecting airway devices: the basis of a strategy for equipment evaluation.

PubMed

Pandit, J J; Popat, M T; Cook, T M; Wilkes, A R; Groom, P; Cooke, H; Kapila, A; O'Sullivan, E

2011-08-01

Faced with the concern that an increasing number of airway management devices were being introduced into clinical practice with little or no prior evidence of their clinical efficacy or safety, the Difficult Airway Society formed a working party (Airway Device Evaluation Project Team) to establish a process by which the airway management community within the profession could itself lead a process of formal device/equipment evaluation. Although there are several national and international regulations governing which products can come on to the market and be legitimately sold, there has hitherto been no formal professional guidance relating to how products should be selected (i.e. purchased). The Airway Device Evaluation Project Team's first task was to formulate such advice, emphasising evidence-based principles. Team discussions led to a definition of the minimum level of evidence needed to make a pragmatic decision about the purchase or selection of an airway device. The Team concluded that this definition should form the basis of a professional standard, guiding those with responsibility for selecting airway devices. We describe how widespread adoption of this professional standard can act as a driver to create an infrastructure in which the required evidence can be obtained. Essential elements are that: (i) the Difficult Airway Society facilitates a coherent national network of research-active units; and (ii) individual anaesthetists in hospital trusts play a more active role in local purchasing decisions, applying the relevant evidence and communicating their purchasing decisions to the Difficult Airway Society. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Evaluation of a rule base for decision making in general practice.

PubMed Central

Essex, B; Healy, M

1994-01-01

BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

A CASE STUDY OF SOILS IN THE U.S.

EPA Science Inventory

Assessment of environmental condition is critical to wise management and policy decisions. However, for some concerns such as sustainability, it is difficult to assess environmental condition because it involves disparate social objectives and an understanding of complex ecologic...

Evaluating taboo trade-offs in ecosystems services and human well-being.

PubMed

Daw, Tim M; Coulthard, Sarah; Cheung, William W L; Brown, Katrina; Abunge, Caroline; Galafassi, Diego; Peterson, Garry D; McClanahan, Tim R; Omukoto, Johnstone O; Munyi, Lydiah

2015-06-02

Managing ecosystems for multiple ecosystem services and balancing the well-being of diverse stakeholders involves different kinds of trade-offs. Often trade-offs involve noneconomic and difficult-to-evaluate values, such as cultural identity, employment, the well-being of poor people, or particular species or ecosystem structures. Although trade-offs need to be considered for successful environmental management, they are often overlooked in favor of win-wins. Management and policy decisions demand approaches that can explicitly acknowledge and evaluate diverse trade-offs. We identified a diversity of apparent trade-offs in a small-scale tropical fishery when ecological simulations were integrated with participatory assessments of social-ecological system structure and stakeholders' well-being. Despite an apparent win-win between conservation and profitability at the aggregate scale, food production, employment, and well-being of marginalized stakeholders were differentially influenced by management decisions leading to trade-offs. Some of these trade-offs were suggested to be "taboo" trade-offs between morally incommensurable values, such as between profits and the well-being of marginalized women. These were not previously recognized as management issues. Stakeholders explored and deliberated over trade-offs supported by an interactive "toy model" representing key system trade-offs, alongside qualitative narrative scenarios of the future. The concept of taboo trade-offs suggests that psychological bias and social sensitivity may exclude key issues from decision making, which can result in policies that are difficult to implement. Our participatory modeling and scenarios approach has the potential to increase awareness of such trade-offs, promote discussion of what is acceptable, and potentially identify and reduce obstacles to management compliance.

Knowledge Quality Functions for Rule Discovery

DTIC Science & Technology

1994-09-01

Managers in many organizations finding themselves in the possession of large and rapidly growing databases are beginning to suspect the information in their...missing values (Smyth and Goodman, 1992, p. 303). Decision trees "tend to grow very large for realistic applications and are thus difficult to interpret...by humans" (Holsheimer, 1994, p. 42). Decision trees also grow excessively complicated in the presence of noisy databases (Dhar and Tuzhilin, 1993, p

Documenting Public Values for River Ecosystem Services

EPA Science Inventory

The value to society of environmental changes is difficult to assess, and thus challenging to include in environmental management decisions. This presentation will first provide an overview of how framing these values in an ecosystem services perspective can facilitate the proces...

Modeling the impacts of wetland restoration in former cranberry farms on nitrogen removal

EPA Science Inventory

In population-dense Massachusetts (USA) acquiring historical wetlands for ecological restoration efforts can be difficult and expensive. Retiring cranberry bogs create a rare opportunity to restore historical wetlands. Environmental managers face important decisions about how to ...

Fire, Earth and Wind: Managing Risk in Today's Schools Part 2--The Environment

ERIC Educational Resources Information Center

Weeks, Richard

2010-01-01

Because school business officials are pushed to make difficult decisions quickly when it comes to risk management, they should be aware of the issues associated with environmental safety. School business officials are integral members of the teams that handle crises--big and small--in the school district. A crisis may be as straightforward as the…

The value of decision tree analysis in planning anaesthetic care in obstetrics.

PubMed

Bamber, J H; Evans, S A

2016-08-01

The use of decision tree analysis is discussed in the context of the anaesthetic and obstetric management of a young pregnant woman with joint hypermobility syndrome with a history of insensitivity to local anaesthesia and a previous difficult intubation due to a tongue tumour. The multidisciplinary clinical decision process resulted in the woman being delivered without complication by elective caesarean section under general anaesthesia after an awake fibreoptic intubation. The decision process used is reviewed and compared retrospectively to a decision tree analytical approach. The benefits and limitations of using decision tree analysis are reviewed and its application in obstetric anaesthesia is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fish stocking in protected areas: Summary of a workshop

USGS Publications Warehouse

Corn, Paul Stephen; Knapp, Roland A.

2000-01-01

Native and nonnative sport fish have been introduced into the majority of historically fishless lakes in wilderness, generating conflicts between managing wilderness as natural ecosystems and providing opportunities for recreation. Managers faced with controversial and difficult decisions about how to manage wilderness lakes may not always have ready access to research relevant to these decisions. To address this problem, and to expose scientists to the concerns and constraints of managers and wilderness users, a workshop was held in October 1998 at the Flathead Lake Biological Station in Polson, Montana. Participants included 43 scientists, state and federal managers, wilderness users and advocates and students. Four subject areas were addressed: federal, state, tribal and user perspectives, community and ecosystem effects, species effects and management recommendations. Papers from the workshop are being developed for an issue of the journal Ecosystems.

A Case History of the Science and Management Collaboration in Understanding Hypoxia Events in Long Bay, South Carolina, USA

NASA Astrophysics Data System (ADS)

Sanger, Denise; Hernandez, Debra; Libes, Susan; Voulgaris, George; Davis, Braxton; Smith, Erik; Shuford, Rebecca; Porter, Dwayne; Koepfler, Eric; Bennett, Joseph

2010-09-01

Communication of knowledge between the scientific and management communities is a difficult process complicated by the distinctive nature of professional career goals of scientists and decision-makers. This article provides a case history highlighting a collaboration between the science and management communities that resulted from a response to a 2004 hypoxia, or low dissolved oxygen, event in Long Bay, off Myrtle Beach, South Carolina. A working group of scientists and decision-makers was established at the time of the event and has continued to interact to develop a firm understanding of the drivers responsible for hypoxia formation in Long Bay. Several factors were found to be important to ensure that these collaborative efforts were productive: (1) genuine interest in collaboratively working across disciplines to examine a problem; (2) commitment by agency leadership, decision-makers, and researchers to create successful communication mechanisms; (3) respect for each others’ perspectives and an understanding how science and management are performed and that they are not mutually exclusive; (4) networking among researchers and decision-makers to ensure appropriate team members are involved in the process; (5) use of decision-maker input in the formulation of research and monitoring projects; and (6) commitment of resources for facilitation to ensure that researchers and decision-makers are communicating effectively.

Managing the Risks of Climate Change and Terrorism

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

Rosa, Eugene; Dietz, Tom; Moss, Richard H.

2012-04-07

Society has difficult decisions to make about how best to allocate its resources to ensure future sustainability. Risk assessment can be a valuable tool: it has long been used to support decisions to address environmental problems. But in a time when the risks to sustainability range from climate change to terrorism, applying risk assessment to sustainability will require careful rethinking. For new threats, we will need a new approach to risk assessment.

Strategic planning in radiology.

PubMed

Gill, Ileana E; Ondategui-Parra, Silvia; Nathanson, Eric; Seiferth, Jeremy; Ros, Pablo R

2005-04-01

As radiology continues to evolve and grow, radiologists must be concerned with preparing radiology for the future. Decisions in capital investments, mergers, outpatient diagnostic clinics, and payment and liability issues will require practicing radiologists to develop and follow up managerial, interpersonal, and learning skills that were not as necessary in the past. To become adept in the new radiology environment and be able to manage change and deal with difficult decisions, radiologists need to acquire a background in strategy.

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

PubMed

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

2004-01-01

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

FROM ASSESSMENT TO POLICY--LESSONS LEARNED FROM THE U.S. NATIONAL ASSESSMENT (Journal Article)

EPA Science Inventory

The process of translating scientific information into timely and useful insights that inform policy and resource management decisions, despite the existence of uncertainties, is a difficult and challenging task. Policy-focused assessment is one approach to achieving this end. ...

FROM ASSESSMENT TO POLICY: LESSONS LEARNED FROM THE U.S. NATIONAL ASSESSMENT

EPA Science Inventory

The process of translating scientific information into timely and useful insights that inform policy and resource management decisions, despite the existence of uncertainties, is a difficult and challenging task. Policy-focused assessment is one approach to achieving this end. I...

The Key Pieces of the Career Survival and Success Puzzle.

ERIC Educational Resources Information Center

Simonetti, Jack L.

1999-01-01

Analysis of career-success factors identified by 5,000 managers yielded 10 key pieces: excellent performance record, communication skills, interpersonal skills, personality, skill currency, significant work experiences, power, ability to withstand pressure, ability to make difficult decisions, and having a mentor. (SK)

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.

Evaluating taboo trade-offs in ecosystems services and human well-being

PubMed Central

Coulthard, Sarah; Cheung, William W. L.; Brown, Katrina; Abunge, Caroline; Galafassi, Diego; Peterson, Garry D.; McClanahan, Tim R.; Omukoto, Johnstone O.; Munyi, Lydiah

2015-01-01

Managing ecosystems for multiple ecosystem services and balancing the well-being of diverse stakeholders involves different kinds of trade-offs. Often trade-offs involve noneconomic and difficult-to-evaluate values, such as cultural identity, employment, the well-being of poor people, or particular species or ecosystem structures. Although trade-offs need to be considered for successful environmental management, they are often overlooked in favor of win-wins. Management and policy decisions demand approaches that can explicitly acknowledge and evaluate diverse trade-offs. We identified a diversity of apparent trade-offs in a small-scale tropical fishery when ecological simulations were integrated with participatory assessments of social–ecological system structure and stakeholders’ well-being. Despite an apparent win-win between conservation and profitability at the aggregate scale, food production, employment, and well-being of marginalized stakeholders were differentially influenced by management decisions leading to trade-offs. Some of these trade-offs were suggested to be “taboo” trade-offs between morally incommensurable values, such as between profits and the well-being of marginalized women. These were not previously recognized as management issues. Stakeholders explored and deliberated over trade-offs supported by an interactive “toy model” representing key system trade-offs, alongside qualitative narrative scenarios of the future. The concept of taboo trade-offs suggests that psychological bias and social sensitivity may exclude key issues from decision making, which can result in policies that are difficult to implement. Our participatory modeling and scenarios approach has the potential to increase awareness of such trade-offs, promote discussion of what is acceptable, and potentially identify and reduce obstacles to management compliance. PMID:26038547

[How much business management does a surgeon need?].

PubMed

Bork, U; Koch, M; Büchler, M W; Weitz, J

2010-08-01

The present day healthcare system in Germany is rapidly changing, even more so after the introduction of diagnosis-related groups. The basic requirements for every surgeon remain manual skills, a profound clinical knowledge and the ability for clinical decision-making even in difficult situations. However, these key elements of surgical education no longer fulfill the requirements for today's leaders in surgery. New requirements, consisting of administrative duties, strategic decision-making and department management are too complex to be made only intuitively. Nowadays surgeons also need a profound education in management skills and knowledge of economic mechanisms in order to run an efficient, profitable, patient-oriented surgical department. Every surgeon who aims at obtaining a leadership position should acquire the necessary knowledge and skills.

Intelligent data management for real-time spacecraft monitoring

NASA Technical Reports Server (NTRS)

Schwuttke, Ursula M.; Gasser, Les; Abramson, Bruce

1992-01-01

Real-time AI systems have begun to address the challenge of restructuring problem solving to meet real-time constraints by making key trade-offs that pursue less than optimal strategies with minimal impact on system goals. Several approaches for adapting to dynamic changes in system operating conditions are known. However, simultaneously adapting system decision criteria in a principled way has been difficult. Towards this end, a general technique for dynamically making such trade-offs using a combination of decision theory and domain knowledge has been developed. Multi-attribute utility theory (MAUT), a decision theoretic approach for making one-time decisions is discussed and dynamic trade-off evaluation is described as a knowledge-based extension of MAUT that is suitable for highly dynamic real-time environments, and provides an example of dynamic trade-off evaluation applied to a specific data management trade-off in a real-world spacecraft monitoring application.

Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

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

The Rapid Benefit Indicators (RBI) Approach: A Process for Assessing the Social Benefits of Ecological Restoration

EPA Science Inventory

Environmental managers face difficult decisions about allocating resources to the most beneficial projects. Focusing solely on ecological outcomes can lead to missed opportunities to provide social benefits, yet few methods exist to easily compare the social benefits of ecologica...

Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting.

PubMed

Carpenter, Stephanie M; Yates, J Frank; Preston, Stephanie D; Chen, Lydia

2016-01-01

Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed.

Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting

PubMed Central

Carpenter, Stephanie M.; Yates, J. Frank; Preston, Stephanie D.; Chen, Lydia

2016-01-01

Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional “coherence shifting,” the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed. PMID:26986752

Robust Decision Making Approach to Managing Water Resource Risks (Invited)

NASA Astrophysics Data System (ADS)

Lempert, R.

2010-12-01

The IPCC and US National Academies of Science have recommended iterative risk management as the best approach for water management and many other types of climate-related decisions. Such an approach does not rely on a single set of judgments at any one time but rather actively updates and refines strategies as new information emerges. In addition, the approach emphasizes that a portfolio of different types of responses, rather than any single action, often provides the best means to manage uncertainty. Implementing an iterative risk management approach can however prove difficult in actual decision support applications. This talk will suggest that robust decision making (RDM) provides a particularly useful set of quantitative methods for implementing iterative risk management. This RDM approach is currently being used in a wide variety of water management applications. RDM employs three key concepts that differentiate it from most types of probabilistic risk analysis: 1) characterizing uncertainty with multiple views of the future (which can include sets of probability distributions) rather than a single probabilistic best-estimate, 2) employing a robustness rather than an optimality criterion to assess alternative policies, and 3) organizing the analysis with a vulnerability and response option framework, rather than a predict-then-act framework. This talk will summarize the RDM approach, describe its use in several different types of water management applications, and compare the results to those obtained with other methods.

Front-Line Physicians' Satisfaction with Information Systems in Hospitals.

PubMed

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.

Integrating Water Quality and River Rehabilitation Management - A Decision-Analytical Perspective

NASA Astrophysics Data System (ADS)

Reichert, P.; Langhans, S.; Lienert, J.; Schuwirth, N.

2009-04-01

Integrative river management involves difficult decisions about alternative measures to improve their ecological state. For this reason, it seems useful to apply knowledge from the decision sciences to support river management. We discuss how decision-analytical elements can be employed for designing an integrated river management procedure. An important aspect of this procedure is to clearly separate scientific predictions of the consequences of alternatives from objectives to be achieved by river management. The key elements of the suggested procedure are (i) the quantitative elicitation of the objectives from different stakeholder groups, (ii) the compilation of the current scientific knowledge about the consequences of the effects resulting from suggested measures in the form of a probabilistic mathematical model, and (iii) the use of these predictions and valuations to prioritize alternatives, to uncover conflicting objectives, to support the design of better alternatives, and to improve the transparency of communication about the chosen management strategy. The development of this procedure led to insights regarding necessary steps to be taken for rational decision-making in river management, to guidelines about the use of decision-analytical techniques for performing these steps, but also to new insights about the application of decision-analytical techniques in general. In particular, the consideration of the spatial distribution of the effects of measures and the potential added value of connected rehabilitated river reaches leads to favoring measures that have a positive effect beyond a single river reach. As these effects only propagate within the river network, this results in a river basin oriented management concept as a consequence of a rational decision support procedure, rather than as an a priori management paradigm. There are also limitations to the support that can be expected from the decision-analytical perspective. It will not provide the societal values that are driving prioritization in river management, it will only support their elicitation and rational use. This is particularly important for the assessment of micro-pollutants because of severe limitations in scientific knowledge of their effects on river ecosystems. This makes the influence of pollution by micro-pollutants on prioritization of measures strongly dependent on the weight of the precautionary principle relative to other societal objectives of river management.

Filter membrane-based automated therapeutic plasma exchange: a report of two cases from Nigeria.

PubMed

Arogundade, Fatiu A; Sanusi, Abubakr A; Akinbodewa, Akinwunmi A; Hassan, Muzamil O; Omotosho, Bolanle O; Balogun, Rasheed A; Akinsola, Adewale

2013-02-01

These case reports demonstrated the diagnostic dilemma encountered in patients with systemic lupus erythematosus and thrombotic thrombocytopenic purpura particularly in settings with limited diagnostic facilities and laboratory support. The similarities in the diagnostic criteria for both conditions make clear distinction as well as management decisions difficult. We present the difficulties encountered with both the diagnosis and the management of these two patients that were managed in our facility. Copyright © 2013 Wiley Periodicals, Inc.

Uncertainty Categorization, Modeling, and Management for Regional Water Supply Planning

NASA Astrophysics Data System (ADS)

Fletcher, S.; Strzepek, K. M.; AlSaati, A.; Alhassan, A.

2016-12-01

Many water planners face increased pressure on water supply systems from growing demands, variability in supply and a changing climate. Short-term variation in water availability and demand; long-term uncertainty in climate, groundwater storage, and sectoral competition for water; and varying stakeholder perspectives on the impacts of water shortages make it difficult to assess the necessity of expensive infrastructure investments. We categorize these uncertainties on two dimensions: whether they are the result of stochastic variation or epistemic uncertainty, and whether the uncertainties can be described probabilistically or are deep uncertainties whose likelihood is unknown. We develop a decision framework that combines simulation for probabilistic uncertainty, sensitivity analysis for deep uncertainty and Bayesian decision analysis for uncertainties that are reduced over time with additional information. We apply this framework to two contrasting case studies - drought preparedness in Melbourne, Australia and fossil groundwater depletion in Riyadh, Saudi Arabia - to assess the impacts of different types of uncertainty on infrastructure decisions. Melbourne's water supply system relies on surface water, which is impacted by natural variation in rainfall, and a market-based system for managing water rights. Our results show that small, flexible investment increases can mitigate shortage risk considerably at reduced cost. Riyadh, by contrast, relies primarily on desalination for municipal use and fossil groundwater for agriculture, and a centralized planner makes allocation decisions. Poor regional groundwater measurement makes it difficult to know when groundwater pumping will become uneconomical, resulting in epistemic uncertainty. However, collecting more data can reduce the uncertainty, suggesting the need for different uncertainty modeling and management strategies in Riyadh than in Melbourne. We will categorize the two systems and propose appropriate decision making under uncertainty methods from the state of the art. We will compare the efficiency of alternative approaches to the two case studies. Finally, we will present a hybrid decision analytic tool to address the synthesis of uncertainties.

Data warehousing as a healthcare business solution.

PubMed

Scheese, R

1998-02-01

Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.

Fungicide residue identification and discrimination using a conducting polymer electronic-nose

Treesearch

Alphus D. Wilson

2013-01-01

The identification of fungicide residues on crop foliage is necessary to make periodic pest management decisions. The determination of fungicide residue identities currently is difficult and time consuming using conventional chemical analysis methods such as gas chromatography-mass spectroscopy. Different fungicide types produce unique electronic aroma signature...

Learning to See the (W)holes

ERIC Educational Resources Information Center

Burns, Barbara A.; Jordan, Thomas M.

2006-01-01

Business managers are faced with complex decisions involving a wide range of issues--technical, social, environmental, and financial--and their interaction. Our education system focuses heavily on presenting structured problems and teaching students to apply a set of tools or methods to solve these problems. Yet the most difficult thing to teach…

Graph-based analysis of connectivity in spatially-explicit population models: HexSim and the Connectivity Analysis Toolkit

EPA Science Inventory

Background / Question / Methods Planning for the recovery of threatened species is increasingly informed by spatially-explicit population models. However, using simulation model results to guide land management decisions can be difficult due to the volume and complexity of model...

Staggering successes amid controversy in California water management

NASA Astrophysics Data System (ADS)

Lund, J. R.

2012-12-01

Water in California has always been important and controversial, and it probably always will be. California has a large, growing economy and population in a semi-arid climate. But California's aridity, hydrologic variability, and water controversies have not precluded considerable economic successes. The successes of California's water system have stemmed from the decentralization of water management with historically punctuated periods of more centralized strategic decision-making. Decentralized management has allowed California's water users to efficiently explore incremental solutions to water problems, ranging from early local development of water systems (such as Hetch Hetchy, Owens Valley, and numerous local irrigation projects) to more contemporary efforts at water conservation, water markets, wastewater reuse, and conjunctive use of surface and groundwater. In the cacophony of local and stakeholder interests, strategic decisions have been more difficult, and consequently occur less frequently. California state water projects and Sacramento Valley flood control are examples where decades of effort, crises, floods and droughts were needed to mobilize local interests to agree to major strategic decisions. Currently, the state is faced with making strategic environmental and water management decisions regarding its deteriorating Sacramento-San Joaquin Delta. Not surprisingly, human uncertainties and physical and fiscal non-stationarities dominate this process.

Trade-off decisions in distribution utility management

NASA Astrophysics Data System (ADS)

Slavickas, Rimas Anthony

As a result of the "unbundling" of traditional monopolistic electricity generation and transmission enterprises into a free-market economy, power distribution utilities are faced with very difficult decisions pertaining to electricity supply options and quality of service to the customers. The management of distribution utilities has become increasingly complex, versatile, and dynamic to the extent that conventional, non-automated management tools are almost useless and obsolete. This thesis presents a novel and unified approach to managing electricity supply options and quality of service to customers. The technique formulates the problem in terms of variables, parameters, and constraints. An advanced Mixed Integer Programming (MIP) optimization formulation is developed together with novel, logical, decision-making algorithms. These tools enable the utility management to optimize various cost components and assess their time-trend impacts, taking into account the intangible issues such as customer perception, customer expectation, social pressures, and public response to service deterioration. The above concepts are further generalized and a Logical Proportion Analysis (LPA) methodology and associated software have been developed. Solutions using numbers are replaced with solutions using words (character strings) which more closely emulate the human decision-making process and advance the art of decision-making in the power utility environment. Using practical distribution utility operation data and customer surveys, the developments outlined in this thesis are successfully applied to several important utility management problems. These involve the evaluation of alternative electricity supply options, the impact of rate structures on utility business, and the decision of whether to continue to purchase from a main grid or generate locally (partially or totally) by building Non-Utility Generation (NUG).

Discrete event simulation for healthcare organizations: a tool for decision making.

PubMed

Hamrock, Eric; Paige, Kerrie; Parks, Jennifer; Scheulen, James; Levin, Scott

2013-01-01

Healthcare organizations face challenges in efficiently accommodating increased patient demand with limited resources and capacity. The modern reimbursement environment prioritizes the maximization of operational efficiency and the reduction of unnecessary costs (i.e., waste) while maintaining or improving quality. As healthcare organizations adapt, significant pressures are placed on leaders to make difficult operational and budgetary decisions. In lieu of hard data, decision makers often base these decisions on subjective information. Discrete event simulation (DES), a computerized method of imitating the operation of a real-world system (e.g., healthcare delivery facility) over time, can provide decision makers with an evidence-based tool to develop and objectively vet operational solutions prior to implementation. DES in healthcare commonly focuses on (1) improving patient flow, (2) managing bed capacity, (3) scheduling staff, (4) managing patient admission and scheduling procedures, and (5) using ancillary resources (e.g., labs, pharmacies). This article describes applicable scenarios, outlines DES concepts, and describes the steps required for development. An original DES model developed to examine crowding and patient flow for staffing decision making at an urban academic emergency department serves as a practical example.

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

NASA Astrophysics Data System (ADS)

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

2004-12-01

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

Two cases of cerebral aneurysms in HIV+ children.

PubMed

Fulmer, B B; Dillard, S C; Musulman, E M; Palmer, C A; Oakes, J

1998-01-01

Two cases of fusiform cerebral aneurysms in human immunodeficiency virus (HIV) positive children are presented. To our knowledge, only 9 patients with this association have been reported. One of our patients represents the first report of a patient with an aneurysm associated with varicella-zoster vasculitis. One patient presented with a subarachnoid hemorrhage, Hunt-Hess grade IV, and posed difficult surgical management. The other patient suffered a cerebral infarct with a resulting hemiparesis. The first patient had a ventriculostomy placed, initially improved, and subsequently died from rebleeding. The second patient improved with medical management. AIDS arteriopathy, and specifically fusiform aneurysms, are being increasingly reported. The various presentations of this surgically challenging entity in light of other AIDS-related syndromes pose difficult management decisions. On occasion, the intracranial aneurysm may be the initial form of presentation as was present in our first patient.

Community resilience and decision theory challenges for catastrophic events.

PubMed

Cox, Louis Anthony

2012-11-01

Extreme and catastrophic events pose challenges for normative models of risk management decision making. They invite development of new methods and principles to complement existing normative decision and risk analysis. Because such events are rare, it is difficult to learn about them from experience. They can prompt both too little concern before the fact, and too much after. Emotionally charged and vivid outcomes promote probability neglect and distort risk perceptions. Aversion to acting on uncertain probabilities saps precautionary action; moral hazard distorts incentives to take care; imperfect learning and social adaptation (e.g., herd-following, group-think) complicate forecasting and coordination of individual behaviors and undermine prediction, preparation, and insurance of catastrophic events. Such difficulties raise substantial challenges for normative decision theories prescribing how catastrophe risks should be managed. This article summarizes challenges for catastrophic hazards with uncertain or unpredictable frequencies and severities, hard-to-envision and incompletely described decision alternatives and consequences, and individual responses that influence each other. Conceptual models and examples clarify where and why new methods are needed to complement traditional normative decision theories for individuals and groups. For example, prospective and retrospective preferences for risk management alternatives may conflict; procedures for combining individual beliefs or preferences can produce collective decisions that no one favors; and individual choices or behaviors in preparing for possible disasters may have no equilibrium. Recent ideas for building "disaster-resilient" communities can complement traditional normative decision theories, helping to meet the practical need for better ways to manage risks of extreme and catastrophic events. © 2012 Society for Risk Analysis.

Managing harvest and habitat as integrated components

USGS Publications Warehouse

Osnas, Erik; Runge, Michael C.; Mattsson, Brady J.; Austin, Jane E.; Boomer, G. S.; Clark, R. G.; Devers, P.; Eadie, J. M.; Lonsdorf, E. V.; Tavernia, Brian G.

2014-01-01

In 2007, several important initiatives in the North American waterfowl management community called for an integrated approach to habitat and harvest management. The essence of the call for integration is that harvest and habitat management affect the same resources, yet exist as separate endeavours with very different regulatory contexts. A common modelling framework could help these management streams to better understand their mutual effects. Particularly, how does successful habitat management increase harvest potential? Also, how do regional habitat programmes and large-scale harvest strategies affect continental population sizes (a metric used to express habitat goals)? In the ensuing five years, several projects took on different aspects of these challenges. While all of these projects are still on-going, and are not yet sufficiently developed to produce guidance for management decisions, they have been influential in expanding the dialogue and producing some important emerging lessons. The first lesson has been that one of the more difficult aspects of integration is not the integration across decision contexts, but the integration across spatial and temporal scales. Habitat management occurs at local and regional scales. Harvest management decisions are made at a continental scale. How do these actions, taken at different scales, combine to influence waterfowl population dynamics at all scales? The second lesson has been that consideration of the interface of habitat and harvest management can generate important insights into the objectives underlying the decision context. Often the objectives are very complex and trade-off against one another. The third lesson follows from the second – if an understanding of the fundamental objectives is paramount, there is no escaping the need for a better understanding of human dimensions, specifically the desires of hunters and nonhunters and the role they play in conservation. In the end, the compelling question is how to better understand, guide and justify decisions about conservation investments in waterfowl management. Future efforts to integrate harvest and habitat management will include completion of the species-specific case-studies, initiation of policy discussions around how to integrate the decision contexts and governing institutions, and possible consideration of a new level of integration – integration of harvest and habitats management decisions across waterfowl stocks.

Postfire communications: the influence of site visits on local support.

Treesearch

Eric L. Toman; Bruce Shindler; Jim Absher; Sarah McCaffrey

2008-01-01

The prevalence of large wildfires has increased in recent years. In many cases, agency personnel have little prior experience to draw from to organize their postfire response to uncharacteristically large events. However, local residents look to resource managers to provide the necessary leadership to work through these difficult decisions. In particular, methods to...

Crown fuel spatial variability and predictability of fire spread

Treesearch

Russell A. Parsons; Jeremy Sauer; Rodman R. Linn

2010-01-01

Fire behavior predictions, as well as measures of uncertainty in those predictions, are essential in operational and strategic fire management decisions. While it is becoming common practice to assess uncertainty in fire behavior predictions arising from variability in weather inputs, uncertainty arising from the fire models themselves is difficult to assess. This is...

Developing Digital Dashboard Management for Learning System Dynamic Cooperative Simulation Behavior of Indonesia. (Study on Cooperative Information Organization in the Ministry of Cooperatives and SME)

NASA Astrophysics Data System (ADS)

Eni, Yuli; Aryanto, Rudy

2014-03-01

There are problems being experienced by the Ministry of cooperatives and SME (Small and Medium Enterprise) including the length of time in the decision by the Government to establish a policy that should be taken for local cooperatives across the province of Indonesia. The decision-making process is still analyzed manually, so that sometimes the decisions taken are also less appropriate, effective and efficient. The second problem is the lack of monitoring data cooperative process province that is too much, making it difficult for the analysis of dynamic information to be useful. Therefore the authors want to fix the system that runs by using digital dashboard management system supported by the modeling of system dynamics. In addition, the author also did the design of a system that can support the system. Design of this system is aimed to ease the experts, head, and the government to decide (DSS - Decision Support System) accurately effectively and efficiently, because in the system are raised alternative simulation in a description of the decision to be taken and the result from the decision. The system is expected to be designed dan simulated can ease and expedite the decision making. The design of dynamic digital dashboard management conducted by method of OOAD (Objects Oriented Analysis and Design) complete with UML notation.

Valuing information for sewer replacement decisions.

PubMed

van Riel, Wouter; Langeveld, Jeroen; Herder, Paulien; Clemens, François

Decision-making for sewer asset management is partially based on intuition and often lacks explicit argumentation, hampering decision transparency and reproducibility. This is not to be preferred in light of public accountability and cost-effectiveness. It is unknown to what extent each decision criterion is appreciated by decision-makers. Further insight into this relative importance improves understanding of decision-making of sewer system managers. As such, a digital questionnaire (response ratio 43%), containing pairwise comparisons between 10 relevant information sources, was sent to all 407 municipalities in the Netherlands to analyse the relative importance and assess whether a shared frame of reasoning is present. Thurstone's law of comparative judgment was used for analysis, combined with several consistency tests. Results show that camera inspections were valued highest, while pipe age was considered least important. The respondents were pretty consistent per individual and also showed consistency as a group. This indicated a common framework of reasoning among the group. The feedback of the group showed, however, the respondents found it difficult to make general comparisons without having a context. This indicates decision-making in practice is more likely to be steered by other mechanisms than purely combining information sources.

Adaptation by Stealth: Understanding climate information use across scales and decision spaces in water management in the United States

NASA Astrophysics Data System (ADS)

Kirchhoff, C.; Vang Rasmussen, L.; Lemos, M. C.

2016-12-01

While there has been considerable focus on understanding how factors related to the creation of climate knowledge affect its uptake and use, less attention has been paid to the actors, decisions, and processes through which climate information supports, or fails to support, action. This is particularly the case concerning how different scales of decision-making influence information uptake. In this study, we seek to understand how water and resource managers' decision space influences climate information use in two Great Lakes watersheds. We find that despite the availability of tailored climate information, actual use of information in decision making remains low. Reasons include: a) lack of willingness to place climate on agendas because local managers perceive climate change as politically risky and a difficult and intangible problem; b) lack of formal mandate or authority at the city and county scale to translate climate information into on-the-ground action, c) problems with the information itself, and d) perceived lack of demand for climate information by those managers who have the mandate and authority (e.g. at the state level) to use (or help others use) climate information. Our findings suggest that 1) climate scientists and information brokers should produce information that meets a range of decision needs and reserve intensive tailoring efforts for decision makers who have authority and willingness to employ climate information, 2) without support from higher levels of decision-making (e.g. state) it is unlikely that climate information use for adaptation decisions will accelerate significantly in the next few years, and 3) the trend towards adopting more sustainability and resilience practices over climate-specific actions should be supported as an important component of the climate adaptation repertoire.

Management of locally invasive well-differentiated thyroid cancer.

PubMed

Ark, Nebil; Zemo, Sessunu; Nolen, David; Holsinger, F Christopher; Weber, Randal S

2008-01-01

Thyroid carcinoma invasion of the aerodigestive tract and recurrent laryngeal nerve (RLN) are important factors with increase in morbidity and mortality. Primary treatment is surgery; the decision about the extent of surgery is difficult, because preserving function is as essential as removal of the tumor. This article discusses the literature relating to the assessment of disease, surgical management, and adjuvant therapy for invasive thyroid cancer of the aerodigestive tract and RLN and makes suggestions based on the authors' experience.

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

NASA Astrophysics Data System (ADS)

Flaming, Susan C.

2007-12-01

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

Informed actions: where to cost effectively manage multiple threats to species to maximize return on investment.

PubMed

Auerbach, Nancy A; Tulloch, Ayesha I T; Possingham, Hugh P

Conservation practitioners, faced with managing multiple threats to biodiversity and limited funding, must prioritize investment in different management actions. From an economic perspective, it is routine practice to invest where the highest rate of return is expected. This return-on-investment (ROI) thinking can also benefit species conservation, and researchers are developing sophisticated approaches to support decision-making for cost-effective conservation. However, applied use of these approaches is limited. Managers may be wary of “black-box” algorithms or complex methods that are difficult to explain to funding agencies. As an alternative, we demonstrate the use of a basic ROI analysis for determining where to invest in cost-effective management to address threats to species. This method can be applied using basic geographic information system and spreadsheet calculations. We illustrate the approach in a management action prioritization for a biodiverse region of eastern Australia. We use ROI to prioritize management actions for two threats to a suite of threatened species: habitat degradation by cattle grazing, and predation by invasive red foxes (Vulpes vulpes). We show how decisions based on cost-effective threat management depend upon how expected benefits to species are defined and how benefits and costs co-vary. By considering a combination of species richness, restricted habitats, species vulnerability, and costs of management actions, small investments can result in greater expected benefit compared with management decisions that consider only species richness. Furthermore, a landscape management strategy that implements multiple actions is more efficient than managing only for one threat, or more traditional approaches that don't consider ROI. Our approach provides transparent and logical decision support for prioritizing different actions intended to abate threats associated with multiple species; it is of use when managers need a justifiable and repeatable approach to investment.

Fort Collins Science Center- Policy Analysis and Science Assistance Branch : Integrating social, behavioral, economic and biological sciences

USGS Publications Warehouse

2010-01-01

The Fort Collins Science Center's Policy Analysis and Science Assistance (PASA) Branch is a team of approximately 22 scientists, technicians, and graduate student researchers. PASA provides unique capabilities in the U.S. Geological Survey by leading projects that integrate social, behavioral, economic, and biological analyses in the context of human-natural resource interactions. Resource planners, managers, and policymakers in the U.S. Departments of the Interior (DOI) and Agriculture (USDA), State and local agencies, as well as international agencies use information from PASA studies to make informed natural resource management and policy decisions. PASA scientists' primary functions are to conduct both theoretical and applied social science research, provide technical assistance, and offer training to advance performance in policy relevant research areas. Management and research issues associated with human-resource interactions typically occur in a unique context, involve difficult to access populations, require knowledge of both natural/biological science in addition to social science, and require the skill to integrate multiple science disciplines. In response to these difficult contexts, PASA researchers apply traditional and state-of-the-art social science methods drawing from the fields of sociology, demography, economics, political science, communications, social-psychology, and applied industrial organization psychology. Social science methods work in concert with our rangeland/agricultural management, wildlife, ecology, and biology capabilities. The goal of PASA's research is to enhance natural resource management, agency functions, policies, and decision-making. Our research is organized into four broad areas of study.

Multicriteria decision analysis applied to Glen Canyon Dam

USGS Publications Warehouse

Flug, M.; Seitz, H.L.H.; Scott, J.F.

2000-01-01

Conflicts in water resources exist because river-reservoir systems are managed to optimize traditional benefits (e.g., hydropower and flood control), which are historically quantified in economic terms, whereas natural and environmental resources, including in-stream and riparian resources, are more difficult or impossible to quantify in economic terms. Multicriteria decision analysis provides a quantitative approach to evaluate resources subject to river basin management alternatives. This objective quantification method includes inputs from special interest groups, the general public, and concerned individuals, as well as professionals for each resource considered in a trade-off analysis. Multicriteria decision analysis is applied to resources and flow alternatives presented in the environmental impact statement for Glen Canyon Dam on the Colorado River. A numeric rating and priority-weighting scheme is used to evaluate 29 specific natural resource attributes, grouped into seven main resource objectives, for nine flow alternatives enumerated in the environmental impact statement.

Expert opinion and controversies in sports and musculoskeletal medicine: concussion in the young athlete.

PubMed

Standaert, Christopher J; Herring, Stanley A; Cantu, Robert C

2007-08-01

Concussion is a common injury in young athletes and can be very challenging for clinicians to diagnose and manage. Debate exists over not only the incidence of long-term risks of multiple concussions but also the potential for catastrophic outcomes after sports-related head injury. Decisions on returning athletes to competition can be difficult, and there are limited prospective data on which to make these decisions. This has resulted in the existence of a number of published guidelines and consensus statements on the management of concussion in athletes. Athletes sustaining a concussion need appropriate on-field care and structured follow-up. Baseline cognitive assessments can be helpful, but clinicians must be aware that head trauma may result in a wide array of clinical signs and symptoms. Delivery of care and decisions on return to play need to be based on an individual assessment of the affected athlete.

Remote access to medical specialists: home care interactive patient management system

NASA Astrophysics Data System (ADS)

Martin, Peter J.; Draghic, Nicole; Wiesmann, William P.

1999-07-01

Diabetes management involves constant care and rigorous compliance. Glucose control is often difficult to maintain and onset of complications further compound health care needs. Status can be further hampered by geographic isolation from immediate medical infrastructures. The Home Care Interactive Patient Management System is an experimental telemedicine program that could improve chronic illness management through Internet-based applications. The goal of the system is to provide a customized, integrated approach to diabetes management to supplement and coordinate physician protocol while supporting routine patient activity, by supplying a set of customized automated services including health data collection, transmission, analysis and decision support.

Noneconomic factors influencing scrap metal disposition decisions at DOE and NRC-licensed nuclear facilities

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

Ewen, M.D.; Robinson, L.A.

1997-02-01

The U.S. Environmental Protection Agency (EPA) is currently developing radiation protection standards for scrap metal, which will establish criteria for the unconditional clearance of scrap from nuclear facilities. In support of this effort, Industrial Economics, Incorporated is assessing the costs and benefits attributable to the rulemaking. The first step in this analysis is to develop an in-depth understanding of the factors influencing scrap disposition decisions, so that one can predict current and future practices under existing requirements and compare them to the potential effects of EPA`s rulemaking. These baseline practices are difficult to predict due to a variety of factors.more » First, because decommissioning activities are just beginning at many sites, current practices do not necessarily provide an accurate indicator of how these practices may evolve as site managers gain experience with related decisions. Second, a number of different regulations and policies apply to these decisions, and the interactive effects of these requirements can be difficult to predict. Third, factors other than regulatory constraints and costs may have a significant effect on related decisions, such as concerns about public perceptions. In general, research suggests that these factors tend to discourage the unconditional clearance of scrap metal.« less

WHAT ARE THE BEST MEANS TO ASSESS CONTAMINANT TRANSPORT AND BIODEGRADATION AND MOVE TOWARD CLOSURE, USING APPROPRIATE SITE-SPECIFIC RISK EVALUATIONS?

EPA Science Inventory

Site remedy and closure decisions are made from a mixture of site data, literature values, and model results. Often assessment of this information is difficult for State Agency case managers because conventional approaches to site characterization do not yield a clear and strai...

Vicious circles in inflammatory bowel disease.

PubMed

Sonnenberg, Amnon; Collins, Judith F

2006-10-01

Inflammatory bowel disease can present with a bewildering array of disease manifestations whose overall impact on patient health is difficult to disentangle. The multitude of disease complications and therapeutic side effects result in conflicting ideas on how to best manage a patient. The aim of the study is to test the usefulness of influence diagrams in resolving conflicts centered on managing complex disease processes. The influences of a disease process and the ensuing medical interventions on the health of a patient with inflammatory bowel disease are modeled by an influence diagram. Patient health is the focal point of multiple influences affecting its overall strength. Any downstream influence represents the focal point of other preceding upstream influences. The mathematics underlying the influence diagram is similar to that of a decision tree. Its formalism allows one to consider additive and inhibitory influences and include in the same analysis qualitatively different types of parameters, such as diagnoses, complications, side effects, and therapeutic outcomes. Three exemplary cases are presented to illustrate the potential use of influence diagrams. In all three case scenarios, Crohn's disease resulted in disease manifestations that seemingly interfered with its own therapy. The presence of negative feedback loops rendered the management of each case particularly challenging. The analyses by influence diagrams revealed subtle interactions among the multiple influences and their joint contributions to the patient's overall health that would have been difficult to appreciate by verbal reasoning alone. Influence diagrams represent a decision tool that is particularly suited to improve decision-making in inflammatory bowel disease. They highlight key factors of a complex disease process and help to assess their quantitative interactions.

Anaesthetic management in Gorlin-Goltz syndrome.

PubMed

Gosavi, Kundan S; Mundada, Surbhi D

2012-07-01

Gorlin-Goltz syndrome is a rare autosomal-dominant syndrome related to mutation in "Patched" tumour suppressor gene on chromosome 9. Basocellular carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri are its major features, along with more than 100 minor features. Odontogenic cysts, notorious for recurrence, can make endotracheal intubation difficult, requiring modification of the standard intubation technique. We report such a case managed successfully by awake fibreoptic intubation. Direct laryngoscopy under anaesthesia later confirmed that it was a good decision.

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Survival tactics for managing the hospital marketing effort.

PubMed

Schaupp, D L; Ponzurick, T G; Schaupp, F W

1994-01-01

Hospital marketing is an intricate and complex process. Especially difficult is the transition the hospital marketer must make from designing marketing strategies to implementing those strategies. This transition usually causes the marketer to call upon a different set of skills. These skills involve managing the personnel needed to implement the designed marketing strategy. Unfortunately, little in the way of formal training is provided the marketer for developing these management skills. Therefore, the authors have comprised a series of tactical procedures designed to assist the hospital marketer to survive this transition. Using these tactics for decision-making guidelines may help to improve the management of the hospital's marketing effort.

Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

PubMed

Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

2005-06-01

This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

Knowledge as a Service at the Point of Care.

PubMed

Shellum, Jane L; Freimuth, Robert R; Peters, Steve G; Nishimura, Rick A; Chaudhry, Rajeev; Demuth, Steve J; Knopp, Amy L; Miksch, Timothy A; Milliner, Dawn S

2016-01-01

An electronic health record (EHR) can assist the delivery of high-quality patient care, in part by providing the capability for a broad range of clinical decision support, including contextual references (e.g., Infobuttons), alerts and reminders, order sets, and dashboards. All of these decision support tools are based on clinical knowledge; unfortunately, the mechanisms for managing rules, order sets, Infobuttons, and dashboards are often unrelated, making it difficult to coordinate the application of clinical knowledge to various components of the clinical workflow. Additional complexity is encountered when updating enterprise-wide knowledge bases and delivering the content through multiple modalities to different consumers. We present the experience of Mayo Clinic as a case study to examine the requirements and implementation challenges related to knowledge management across a large, multi-site medical center. The lessons learned through the development of our knowledge management and delivery platform will help inform the future development of interoperable knowledge resources.

Knowledge as a Service at the Point of Care

PubMed Central

Shellum, Jane L.; Freimuth, Robert R.; Peters, Steve G.; Nishimura, Rick A.; Chaudhry, Rajeev; Demuth, Steve J.; Knopp, Amy L.; Miksch, Timothy A.; Milliner, Dawn S.

2016-01-01

An electronic health record (EHR) can assist the delivery of high-quality patient care, in part by providing the capability for a broad range of clinical decision support, including contextual references (e.g., Infobuttons), alerts and reminders, order sets, and dashboards. All of these decision support tools are based on clinical knowledge; unfortunately, the mechanisms for managing rules, order sets, Infobuttons, and dashboards are often unrelated, making it difficult to coordinate the application of clinical knowledge to various components of the clinical workflow. Additional complexity is encountered when updating enterprise-wide knowledge bases and delivering the content through multiple modalities to different consumers. We present the experience of Mayo Clinic as a case study to examine the requirements and implementation challenges related to knowledge management across a large, multi-site medical center. The lessons learned through the development of our knowledge management and delivery platform will help inform the future development of interoperable knowledge resources. PMID:28269911

Evolving Spaces in Landscape Management: Linking Spatial Information for Effective Decision-Making

ERIC Educational Resources Information Center

Ravindranath, R.; Singh, Subrata

2005-01-01

Community, in the policy context, is defined on the basis of fixed in place socio-political unit having residential proximity to the resource or according to state recognized political units. With the boundaries drawn at the village level and the custodial rights of the common lands vested with various departments of the state, it is difficult on…

Keeping wilderness wild: increasing effectiveness with limited resources

Treesearch

Linda Merigliano; Bryan Smith

2000-01-01

Wilderness managers are forced to make increasingly difficult decisions about where to focus limited resources. Traditionally, areas of high visitor use and high impact are prioritized over areas of light use and light impact. However, areas that contain little to no human impact and contain the qualities that lead to the area’s designation as wilderness are most...

A Change Management Approach to Enhance Facility Maintenance Programs

DTIC Science & Technology

2014-03-27

dependent on the particular research effort and the researcher’s experience. Large groups tend to increase the decision quality but can be difficult...consolidate SME opinions on facility maintenance criteria. The Delphi method utilizes numerous questionnaire rounds to capitalize on a group think...effort provides the discussion and conclusions, recommendations, and suggestions for follow on research . 9 II. Literature Review This

Managing Medicaid managed care: are states becoming prudent purchasers?

PubMed

Fossett, J W; Goggin, M; Hall, J S; Johnston, J; Plein, L C; Roper, R; Weissert, C

2000-01-01

This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve.

Thinking outside the lines: Parks and the quality of life in area communities

USGS Publications Warehouse

Taylor, J.G.; Burkardt, N.; Caughlan, L.; Lamb, B.L.

2000-01-01

Many national parks, national forests, and other public land units exist in highly changeable regional environments. Often the parks and forests themselves serve as important catalysts of change in the levels of tourism, outdoor recreation participation, and contribution of traveling publics to local and regional economies. Resource managers are called upon to protect lands in their jurisdictions while juggling a variety of inputs and expectations. In each agency, resource decisions are bound by law and agency policy. In this context, the decision space of the national park manager is quite different from that of those in multiple-use land management agencies. Management actions must stand up, not only to law and policy and to scientific scrutiny, but they must also be sensitive to the needs of residents in surrounding communities, to county and state governing bodies, and to visitors from across the nation and around the world. Balancing these needs while protecting resources in an ongoing challenge made more difficult as the mix of stakeholders growsa?|

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

PubMed

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

2013-12-15

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

The economic value of drought information: Application to water resources management decisions in Spain

NASA Astrophysics Data System (ADS)

Garrote, Luis; Sordo, Alvaro; Iglesias, Ana

2016-04-01

Information is valuable when it improves decision-making (e.g., actions can be adjusted to better suit the situation at hand) and enables the mitigation of damage. However, quantifying the value of information is often difficult. Here we explore a general approach to understand the economic value of drought information for water managers framing our approach in the precautionary principle that reminds us that uncertainty is not a reason to postpone or avoid action. We explore how decision making can disregard uncertain effects, taking a short-term approach and focusing instead on the certain costs and benefits of taking action. Two main questions arise: How do we know that advanced drought information is actually helping decisions?; and What is the value of information in the decision process? The approach is applied to several regulated water resources systems in Spain. It first views drought information as a factor in the decision process which can be used by water managers to reduce uncertainty. Second, the value of drought information is the expected gain in a decision outcome (utility) from using additional information. Finally, the gains of improved information are compared with the information collection costs. Here we estimate the value by taking into account the accuracy of the drought information, the subjective probabilities about the value, analyzed as Bayesian probabilities, and the ability or skill of the stakeholders to apply the drought information to modify their actions. Since information may be considered a public good (non-rivalry and non-excludability), it may justify public policy in the provision of information, considering social costs and benefits. The application of the framework to the Spanish case studies shows that information benefits exceeds to costs when drought frequency is 20-40% above normal values; below these values uncertainty in the decisions dominate the results; above these values, the management decisions are limited even with perfect information.

Multicriteria Decision Framework for Cybersecurity Risk Assessment and Management.

PubMed

Ganin, Alexander A; Quach, Phuoc; Panwar, Mahesh; Collier, Zachary A; Keisler, Jeffrey M; Marchese, Dayton; Linkov, Igor

2017-09-05

Risk assessors and managers face many difficult challenges related to novel cyber systems. Among these challenges are the constantly changing nature of cyber systems caused by technical advances, their distribution across the physical, information, and sociocognitive domains, and the complex network structures often including thousands of nodes. Here, we review probabilistic and risk-based decision-making techniques applied to cyber systems and conclude that existing approaches typically do not address all components of the risk assessment triplet (threat, vulnerability, consequence) and lack the ability to integrate across multiple domains of cyber systems to provide guidance for enhancing cybersecurity. We present a decision-analysis-based approach that quantifies threat, vulnerability, and consequences through a set of criteria designed to assess the overall utility of cybersecurity management alternatives. The proposed framework bridges the gap between risk assessment and risk management, allowing an analyst to ensure a structured and transparent process of selecting risk management alternatives. The use of this technique is illustrated for a hypothetical, but realistic, case study exemplifying the process of evaluating and ranking five cybersecurity enhancement strategies. The approach presented does not necessarily eliminate biases and subjectivity necessary for selecting countermeasures, but provides justifiable methods for selecting risk management actions consistent with stakeholder and decisionmaker values and technical data. Published 2017. This article is a U.S. Government work and is in the public domain in the U.S.A.

Setting Priorities for Monitoring and Managing Non-native Plants: Toward a Practical Approach.

PubMed

Koch, Christiane; Jeschke, Jonathan M; Overbeck, Gerhard E; Kollmann, Johannes

2016-09-01

Land managers face the challenge to set priorities in monitoring and managing non-native plant species, as resources are limited and not all non-natives become invasive. Existing frameworks that have been proposed to rank non-native species require extensive information on their distribution, abundance, and impact. This information is difficult to obtain and often not available for many species and regions. National watch or priority lists are helpful, but it is questionable whether they provide sufficient information for environmental management on a regional scale. We therefore propose a decision tree that ranks species based on more simple albeit robust information, but still provides reliable management recommendations. To test the decision tree, we collected and evaluated distribution data from non-native plants in highland grasslands of Southern Brazil. We compared the results with a national list from the Brazilian Invasive Species Database for the state to discuss advantages and disadvantages of the different approaches on a regional scale. Out of 38 non-native species found, only four were also present on the national list. If management would solely rely on this list, many species that were identified as spreading based on the decision tree would go unnoticed. With the suggested scheme, it is possible to assign species to active management, to monitoring, or further evaluation. While national lists are certainly important, management on a regional scale should employ additional tools that adequately consider the actual risk of non-natives to become invasive.

Anaesthetic management in Gorlin-Goltz syndrome

PubMed Central

Gosavi, Kundan S; Mundada, Surbhi D

2012-01-01

Gorlin-Goltz syndrome is a rare autosomal-dominant syndrome related to mutation in “Patched” tumour suppressor gene on chromosome 9. Basocellular carcinomas, odontogenic keratocysts, palmar and/or plantar pits and ectopic calcifications of the falx cerebri are its major features, along with more than 100 minor features. Odontogenic cysts, notorious for recurrence, can make endotracheal intubation difficult, requiring modification of the standard intubation technique. We report such a case managed successfully by awake fibreoptic intubation. Direct laryngoscopy under anaesthesia later confirmed that it was a good decision. PMID:23087465

Program Manager: The Journal of the Defense Systems Management College. Volume 15, Number 6, November-December 1986.

DTIC Science & Technology

1986-12-01

Power, Less Noise - 11 Quality Teams Assure Success - 16 Progeram Motagier (ISSN 0199-7114) is published Air Conditioner for Vests -16 bimonthly by...decision- Our Team Plays Better makers are The Naval Surface Weapons Center probably as heavy has been a key link in the difficult now as at any time...Administration examine what we in the weapons business know our we are doing, why we are doing it, and team plays better because you’re on it. whether

Balancing habitat delivery for breeding marsh birds and nonbreeding waterfowl: An integrated waterbird management and monitoring approach at Clarence Cannon National Wildlife Refuge, Missouri

USGS Publications Warehouse

Loges, Brian W.; Lyons, James E.; Tavernia, Brian G.

2017-08-23

The Clarence Cannon National Wildlife Refuge (CCNWR) in the Mississippi River flood plain of eastern Missouri provides high quality emergent marsh and moist-soil habitat benefitting both nesting marsh birds and migrating waterfowl. Staff of CCNWR manipulate water levels and vegetation in the 17 units of the CCNWR to provide conditions favorable to these two important guilds. Although both guilds include focal species at multiple planning levels and complement objectives to provide a diversity of wetland community types and water regimes, additional decision support is needed for choosing how much emergent marsh and moist-soil habitat should be provided through annual management actions.To develop decision guidance for balanced delivery of high-energy waterfowl habitat and breeding marsh bird habitat, two measureable management objectives were identified: nonbreeding Anas Linnaeus (dabbling duck) use-days and Rallus elegans (king rail) occupancy of managed units. Three different composite management actions were identified to achieve these objectives. Each composite management action is a unique combination of growing season water regime and soil disturbance. The three composite management actions are intense moist-soil management (moist-soil), intermediate moist-soil (intermediate), and perennial management, which idles soils disturbance (perennial). The two management objectives and three management options were used in a multi-criteria decision analysis to indicate resource allocations and inform annual decision making. Outcomes of the composite management actions were predicted in two ways and multi-criteria decision analysis was used with each set of predictions. First, outcomes were predicted using expert-elicitation techniques and a panel of subject matter experts. Second, empirical data from the Integrated Waterbird Management and Monitoring Initiative collected between 2010 and 2013 were used; where data were lacking, expert judgment was used. Also, a Bayesian decision model was developed that can be updated with monitoring data in an adaptive management framework.Optimal resource allocations were identified in the form of portfolios of composite management actions for the 17 units in the framework. A constrained optimization (linear programming) was used to maximize an objective function that was based on the sum of dabbling duck and king rail utility. The constraints, which included management costs and a minimum energetic carrying capacity (total moist-soil acres), were applied to balance habitat delivery for dabbling ducks and king rails. Also, the framework was constrained in some cases to apply certain management actions of interest to certain management units; these constraints allowed for a variety of hypothetical Habitat Management Plans, including one based on output from a hydrogeomorphic study of the refuge. The decision analysis thus created numerous refuge-wide scenarios, each representing a unique mix of options (one for each of 17 units) and associated benefits (i.e., outcomes with respect to two management objectives).Prepared in collaboration with the U.S. Fish and Wildlife Service, the decision framework presented here is designed as a decision-aiding tool for CCNWR managers who ultimately make difficult decisions each year with multiple objectives, multiple management units, and the complexity of natural systems. The framework also provides a way to document hypotheses about how the managed system functions. Furthermore, the framework identifies specific monitoring needs and illustrates precisely how monitoring data will be used for decision-aiding and adaptive management.

Use Of Thermography In The Diagnostics Of Energy Use In Multifamily Dwellings.

NASA Astrophysics Data System (ADS)

Gadsby, Kenneth J.; Harrje, David T.

1984-03-01

Rising energy costs have placed a heavy burden on multifamily complex managers in recent years. To reduce energy expenditures these managers are then faced with making difficult decisions as to which building retrofits will prove to be most cost-effective. The Building Energy Research Group at Princeton University has embarked on the development of analysis procedures that will provide these managers with a prioritized list of energy conservation opportunities (ECOs). The case studies presented here illustrate the importance of thermography in this analysis procedure, its impact on the inspection time, and the value of the information gained. The infrared scan often eliminates large areas of the thermal envelope from further inspection and aids the analyst in locating energy losses through construction that would otherwise be difficult to find. Not only does thermography guide us in the choice of ECOs but it also provides us with information that should lead to the construction of better buildings in the future.

Integrated wetland management for waterfowl and shorebirds at Mattamuskeet National Wildlife Refuge, North Carolina

USGS Publications Warehouse

Tavernia, Brian G.; Stanton, John D.; Lyons, James E.

2017-11-22

Mattamuskeet National Wildlife Refuge (MNWR) offers a mix of open water, marsh, forest, and cropland habitats on 20,307 hectares in coastal North Carolina. In 1934, Federal legislation (Executive Order 6924) established MNWR to benefit wintering waterfowl and other migratory bird species. On an annual basis, the refuge staff decide how to manage 14 impoundments to benefit not only waterfowl during the nonbreeding season, but also shorebirds during fall and spring migration. In making these decisions, the challenge is to select a portfolio, or collection, of management actions for the impoundments that optimizes use by the three groups of birds while respecting budget constraints. In this study, a decision support tool was developed for these annual management decisions.Within the decision framework, there are three different management objectives: shorebird-use days during fall and spring migrations, and waterfowl-use days during the nonbreeding season. Sixteen potential management actions were identified for impoundments; each action represents a combination of hydroperiod and vegetation manipulation. Example hydroperiods include semi-permanent and seasonal drawdowns, and vegetation manipulations include mechanical-chemical treatment, burning, disking, and no action. Expert elicitation was used to build a Bayesian Belief Network (BBN) model that predicts shorebird- and waterfowl-use days for each potential management action. The BBN was parameterized for a representative impoundment, MI-9, and predictions were re-scaled for this impoundment to predict outcomes at other impoundments on the basis of size. Parameter estimates in the BBN model can be updated using observations from ongoing monitoring that is part of the Integrated Waterbird Management and Monitoring (IWMM) program.The optimal portfolio of management actions depends on the importance, that is, weights, assigned to the three objectives, as well as the budget. Five scenarios with a variety of objective weights and budgets were developed. Given the large number of possible portfolios (1614), a heuristic genetic algorithm was used to identify a management action portfolio that maximized use-day objectives while respecting budget constraints. The genetic algorithm identified a portfolio of management actions for each of the five scenarios, enabling refuge staff to explore the sensitivity of their management decisions to objective weights and budget constraints.The decision framework developed here provides a transparent, defensible, and testable foundation for decision making at MNWR. The BBN model explicitly structures and parameterizes a mental model previously used by an expert to assign management actions to the impoundments. With ongoing IWMM monitoring, predictions from the model can be tested, and model parameters updated, to reflect empirical observations. This framework is intended to be a living document that can be updated to reflect changes in the decision context (for example, new objectives or constraints, or new models to compete with the current BBN model). Rather than a mandate to refuge staff, this framework is intended to be a decision support tool; tool outputs can become part of the deliberations of refuge staff when making difficult management decisions for multiple objectives.

Development of a patient passport in asthma management.

PubMed

Newell, Karen; Basi, Tajindar; Hume, Shenagh

2014-10-21

This article outlines the development, testing and evaluation of an asthma patient passport (APP). The APP was designed specifically for patients with severe and difficult-to-manage asthma. This patient group tends not to access emergency services when needed, potentially putting life at risk. These individuals prefer to self-manage rather than expose themselves to feelings of vulnerability in the emergency department (ED). The aims of the project were to save lives by ensuring these patients attend the ED, to improve patient experience in the ED and to assist healthcare professionals in their clinical decision making, enabling them to deliver appropriate and individualised emergency treatment.

Management of Complications of Distal Radius Fractures

PubMed Central

Chung, Kevin C.; Mathews, Alexandra L.

2015-01-01

Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius. PMID:25934197

Public health decisions: Actions and consequences☆

PubMed Central

Pohl, H.R.; Jones, D.E.; Holler, J.S.; Murray, H.E.

2017-01-01

The goal of public health is to promote the best possible health for the whole population. Public health issues are numerous and can be unbelievably complex in form, scope, and possible consequence. Most public health decisions involve assessing several different options, weighing the respective benefits and risks of those options, and making difficult decisions that hopefully provide the greatest benefit to the affected populations. Many risk management decisions involve a variety of societal factors which modify risk assessment choices. The purpose of this paper is to point out difficulties in making decisions that impact public health. The intent of such decisions is to improve public health, but as illustrated in the paper, there can be unintended adverse consequences. Such unplanned issues require continued attention and efforts for responsible officials in the protection of environmental public health. This article presents examples of such events, when in the past, it was necessary to assess and regulate a number of potentially hazardous chemicals commonly used as insecticides, gasoline additives, and wood preservatives. PMID:25092130

Braving difficult choices alone: children's and adolescents' medical decision making.

PubMed

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.

Predicting the impact of land management decisions on overland flow generation: Implications for cesium migration in forested Fukushima watersheds

NASA Astrophysics Data System (ADS)

Siirila-Woodburn, Erica R.; Steefel, Carl I.; Williams, Kenneth H.; Birkholzer, Jens T.

2018-03-01

The effects of land use and land cover (LULC) change on environmental systems across the land surface's "critical zone" are highly uncertain, often making prediction and risk management decision difficult. In a series of numerical experiments with an integrated hydrologic model, overland flow generation is quantified for both present day and forest thinning scenarios. A typhoon storm event in a watershed near the Fukushima Dai-ichi Nuclear Power Plant is used as an example application in which the interplay between LULC change and overland flow generation is important given that sediment-bound radionuclides may cause secondary contamination via surface water transport. Results illustrate the nonlinearity of the integrated system spanning from the deep groundwater to the atmosphere, and provide quantitative tools when determining the tradeoffs of different risk-mitigation strategies.

Effects of deep brain stimulation of the subthalamic nucleus on perceptual decision making.

PubMed

Zaehle, Tino; Wagenbreth, Caroline; Voges, Jürgen; Heinze, Hans-Jochen; Galazky, Imke

2017-02-20

When faced with difficult decisions, people prefer to stay with the default. This status quo bias often leads to suboptimal choice behavior. Neurophysiological evidence suggests a pivot role of the Subthalamic Nucleus (STN) for overcoming such status quo bias in difficult decisions, but causal evidence is lacking. The present study investigated whether subthalamic deep brain stimulation (DBS) in patients with Parkinson's disease (PD) influences the status quo bias. Eighteen PD patients treated with STN-DBS performed a difficult perceptual decision task incorporating intrinsic status quo option. Patients were tested with (ON) and without (OFF) active STN stimulation. Our results show that DBS of the STN affected perceptual decision making in PD patients depending on the difficulty of decision. STN-DBS improved difficult perceptual decisions due to a selective increase in accuracy (hit rate) that was independent of response bias (no effect on false alarm rate). Furthermore, STN-DBS impacted status quo bias as a function of baseline impulsivity. In impulsive patients, STN-DBS increased the default bias, whereas in less impulsive PD patients, DBS of the STN reduced the status quo bias. In line with our hypothesis, STN-DBS selectively affected the tendency to stick with the default option on difficult decisions, and promoted increased decision accuracy. Moreover, we demonstrate the impact of baseline cognitive abilities on DBS-related performance changes in PD patients. Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.

Gender identity in disorders of sex development: review article.

PubMed

Yang, Jennifer H; Baskin, Laurence S; DiSandro, Michael

2010-01-01

Many concerns have been raised regarding the treatment and long-term outcome of infants born with complex genital anomalies. Debate among clinicians, psychologists, ethicists, and patient advocate groups regarding the optimal management of these individuals is ongoing. Although determining the most appropriate gender is a difficult task, this review will help clarify some of the issues at hand. A literature review which addresses the challenges of advising families about gender identity in infants and children with disorders of sex development. The evidence for endocrine effects on neurobiological development with regard to sexual behavior is compelling, although the existing outcome studies are largely anecdotal and somewhat contradictory. Gender assignment in infants born with a disorder of sex development remains only one of the many difficult decisions faced by both the treatment team and the family. Improved long-term follow-up of these patients will provide much needed feedback on previous and contemporary management. 2010 Elsevier Inc. All rights reserved.

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

PubMed

Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

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

Doll, D.C.; Ringenberg, Q.S.; Yarbro, J.W.

Although cancer during pregnancy is infrequent, its management is difficult for patients, their families, and their physicians. When termination of the pregnancy is unacceptable, decisions regarding the use of irradiation and chemotherapy are complicated by the well-known high risks of abortion and fetal malformation. This risk is concentrated in the first trimester and varies with the choice of chemotherapeutic agents or combinations of agents. There is only minimal evidence of increased risk of malformation or abortion in the second or third trimester. Recent progress in cancer therapy has made cure a reasonable goal, and for some malignant neoplasms, cure ismore » still possible even when initial therapy is modified or delayed. When cure is a reasonable goal, curative therapy should not be compromised by modification or delay. When treatment for cure or significant palliation is not possible, however, the goal should shift to protection of the fetus from damage by the injudicious use of teratogenic cancer therapy. This report will review the available data that may assist in these difficult decisions. 114 references.« less

Cognitive Bias in Systems Verification

NASA Technical Reports Server (NTRS)

Larson, Steve

2012-01-01

Working definition of cognitive bias: Patterns by which information is sought and interpreted that can lead to systematic errors in decisions. Cognitive bias is used in diverse fields: Economics, Politics, Intelligence, Marketing, to name a few. Attempts to ground cognitive science in physical characteristics of the cognitive apparatus exceed our knowledge. Studies based on correlations; strict cause and effect is difficult to pinpoint. Effects cited in the paper and discussed here have been replicated many times over, and appear sound. Many biases have been described, but it is still unclear whether they are all distinct. There may only be a handful of fundamental biases, which manifest in various ways. Bias can effect system verification in many ways . Overconfidence -> Questionable decisions to deploy. Availability -> Inability to conceive critical tests. Representativeness -> Overinterpretation of results. Positive Test Strategies -> Confirmation bias. Debiasing at individual level very difficult. The potential effect of bias on the verification process can be managed, but not eliminated. Worth considering at key points in the process.

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery.

PubMed

Meyer, Annika; Gross, Neil; Teng, Marita

2018-01-01

Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedure-specific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding. This is true for many head and neck oncologic surgeries. Furthermore, although elective procedures may be delayed for optimization of antithrombotic medication, emergent procedures cannot. Head and neck surgery often represents the most challenging of all these circumstances, given the potential risk of airway compromise from bleeding after head and neck surgery. © 2017 Wiley Periodicals, Inc.

Climate change and European forests: what do we know, what are the uncertainties, and what are the implications for forest management?

PubMed

Lindner, Marcus; Fitzgerald, Joanne B; Zimmermann, Niklaus E; Reyer, Christopher; Delzon, Sylvain; van der Maaten, Ernst; Schelhaas, Mart-Jan; Lasch, Petra; Eggers, Jeannette; van der Maaten-Theunissen, Marieke; Suckow, Felicitas; Psomas, Achilleas; Poulter, Benjamin; Hanewinkel, Marc

2014-12-15

The knowledge about potential climate change impacts on forests is continuously expanding and some changes in growth, drought induced mortality and species distribution have been observed. However despite a significant body of research, a knowledge and communication gap exists between scientists and non-scientists as to how climate change impact scenarios can be interpreted and what they imply for European forests. It is still challenging to advise forest decision makers on how best to plan for climate change as many uncertainties and unknowns remain and it is difficult to communicate these to practitioners and other decision makers while retaining emphasis on the importance of planning for adaptation. In this paper, recent developments in climate change observations and projections, observed and projected impacts on European forests and the associated uncertainties are reviewed and synthesised with a view to understanding the implications for forest management. Current impact assessments with simulation models contain several simplifications, which explain the discrepancy between results of many simulation studies and the rapidly increasing body of evidence about already observed changes in forest productivity and species distribution. In simulation models uncertainties tend to cascade onto one another; from estimating what future societies will be like and general circulation models (GCMs) at the global level, down to forest models and forest management at the local level. Individual climate change impact studies should not be uncritically used for decision-making without reflection on possible shortcomings in system understanding, model accuracy and other assumptions made. It is important for decision makers in forest management to realise that they have to take long-lasting management decisions while uncertainty about climate change impacts are still large. We discuss how to communicate about uncertainty - which is imperative for decision making - without diluting the overall message. Considering the range of possible trends and uncertainties in adaptive forest management requires expert knowledge and enhanced efforts for providing science-based decision support. Copyright © 2014 Elsevier Ltd. All rights reserved.

Welfare, Quality of Life, and Euthanasia of Aged Horses.

PubMed

McGowan, Catherine M; Ireland, Joanne L

2016-08-01

Duration of ownership strengthens the human-horse bond, affecting decision-making about the horse's welfare, quality of life (QoL), and euthanasia. Most owners consider their geriatric horses to have good or excellent QoL; however, increasing age is negatively associated with QoL. Management factors are important. The most common reasons for euthanasia include musculoskeletal disorders or lameness, colic, and nonspecific chronic diseases. The decision to euthanize is difficult, so the advice of the veterinarian and QoL are important. This article focuses on the human-horse bond, assessment of QoL, reasons for euthanasia, and owner experiences of mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Choosing to Win: How Sof Can Better Select Partners for Capacity Building

DTIC Science & Technology

2014-06-01

countries will yield the best results when SOF are employed to build capacity. This thesis uses two RAND reports—What Works Best When Building...environment, planners will be forced to make difficult decisions about which countries will yield the best results when SOF are employed to build...deliberate planning, global posture, global force management, and nuclear weapons planning.20 The GEF also directs the combatant commanders to

A Decision Support System for effective use of probability forecasts

NASA Astrophysics Data System (ADS)

De Kleermaeker, Simone; Verkade, Jan

2013-04-01

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

Effective dialogue: enhanced public engagement as a legitimising tool for municipal waste management decision-making.

PubMed

Garnett, Kenisha; Cooper, Tim

2014-12-01

The complexity of municipal waste management decision-making has increased in recent years, accompanied by growing scrutiny from stakeholders, including local communities. This complexity reflects a socio-technical framing of the risks and social impacts associated with selecting technologies and sites for waste treatment and disposal facilities. Consequently there is growing pressure on local authorities for stakeholders (including communities) to be given an early opportunity to shape local waste policy in order to encourage swift planning, development and acceptance of the technologies needed to meet statutory targets to divert waste from landfill. This paper presents findings from a research project that explored the use of analytical-deliberative processes as a legitimising tool for waste management decision-making. Adopting a mixed methods approach, the study revealed that communicating the practical benefits of more inclusive forms of engagement is proving difficult even though planning and policy delays are hindering development and implementation of waste management infrastructure. Adopting analytical-deliberative processes at a more strategic level will require local authorities and practitioners to demonstrate how expert-citizen deliberations may foster progress in resolving controversial issues, through change in individuals, communities and institutions. The findings suggest that a significant shift in culture will be necessary for local authorities to realise the potential of more inclusive decision processes. This calls for political actors and civic society to collaborate in institutionalising public involvement in both strategic and local planning structures. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review.

PubMed

Zydziūnaite, Vilma; Suominen, Tarja; Astedt-Kurki, Päivi; Lepaite, Daiva

2010-01-01

The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership. The search was conducted on Medline and PubMed databases (1998-2008). The systematic review included 21 selected articles. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of "ethical dilemma" are the following: "continuous balancing," "result of resource allocation," "gap between professional obligations and possibilities," "ethically controversial situation," "concern about interactions," "ethical difficulty," "outcome of medical choices," "concern about society access to health care resources," "ethically difficult/challenging situation," "(the consequence of) ethical concern/ethical issue." In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.

Dynamic decision making for dam-break emergency management - Part 2: Application to Tangjiashan landslide dam failure

NASA Astrophysics Data System (ADS)

Peng, M.; Zhang, L. M.

2013-02-01

Tangjiashan landslide dam, which was triggered by the Ms = 8.0 Wenchuan earthquake in 2008 in China, threatened 1.2 million people downstream of the dam. All people in Beichuan Town 3.5 km downstream of the dam and 197 thousand people in Mianyang City 85 km downstream of the dam were evacuated 10 days before the breaching of the dam. Making such an important decision under uncertainty was difficult. This paper applied a dynamic decision-making framework for dam-break emergency management (DYDEM) to help rational decision in the emergency management of the Tangjiashan landslide dam. Three stages are identified with different levels of hydrological, geological and social-economic information along the timeline of the landslide dam failure event. The probability of dam failure is taken as a time series. The dam breaching parameters are predicted with a set of empirical models in stage 1 when no soil property information is known, and a physical model in stages 2 and 3 when knowledge of soil properties has been obtained. The flood routing downstream of the dam in these three stages is analyzed to evaluate the population at risk (PAR). The flood consequences, including evacuation costs, flood damage and monetized loss of life, are evaluated as functions of warning time using a human risk analysis model based on Bayesian networks. Finally, dynamic decision analysis is conducted to find the optimal time to evacuate the population at risk with minimum total loss in each of these three stages.

Effective dialogue: Enhanced public engagement as a legitimising tool for municipal waste management decision-making

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

Garnett, Kenisha, E-mail: k.garnett@cranfield.ac.uk; Cooper, Tim, E-mail: t.h.cooper@ntu.ac.uk

2014-12-15

Highlights: • A review of public engagement in waste management decision-making is undertaken. • Enhanced public engagement is explored as a means to legitimise waste decisions. • Analytical–deliberative processes are explored as a tool for effective dialogue. • Considerations for integrating public values with technical analysis are outlined. • Insights into the design of appropriate public engagement processes are provided. - Abstract: The complexity of municipal waste management decision-making has increased in recent years, accompanied by growing scrutiny from stakeholders, including local communities. This complexity reflects a socio-technical framing of the risks and social impacts associated with selecting technologies andmore » sites for waste treatment and disposal facilities. Consequently there is growing pressure on local authorities for stakeholders (including communities) to be given an early opportunity to shape local waste policy in order to encourage swift planning, development and acceptance of the technologies needed to meet statutory targets to divert waste from landfill. This paper presents findings from a research project that explored the use of analytical–deliberative processes as a legitimising tool for waste management decision-making. Adopting a mixed methods approach, the study revealed that communicating the practical benefits of more inclusive forms of engagement is proving difficult even though planning and policy delays are hindering development and implementation of waste management infrastructure. Adopting analytical–deliberative processes at a more strategic level will require local authorities and practitioners to demonstrate how expert-citizen deliberations may foster progress in resolving controversial issues, through change in individuals, communities and institutions. The findings suggest that a significant shift in culture will be necessary for local authorities to realise the potential of more inclusive decision processes. This calls for political actors and civic society to collaborate in institutionalising public involvement in both strategic and local planning structures.« less

Sequential decision making in computational sustainability via adaptive submodularity

USGS Publications Warehouse

Krause, Andreas; Golovin, Daniel; Converse, Sarah J.

2015-01-01

Many problems in computational sustainability require making a sequence of decisions in complex, uncertain environments. Such problems are generally notoriously difficult. In this article, we review the recently discovered notion of adaptive submodularity, an intuitive diminishing returns condition that generalizes the classical notion of submodular set functions to sequential decision problems. Problems exhibiting the adaptive submodularity property can be efficiently and provably near-optimally solved using simple myopic policies. We illustrate this concept in several case studies of interest in computational sustainability: First, we demonstrate how it can be used to efficiently plan for resolving uncertainty in adaptive management scenarios. Secondly, we show how it applies to dynamic conservation planning for protecting endangered species, a case study carried out in collaboration with the US Geological Survey and the US Fish and Wildlife Service.

Working with interpreters: The challenges of introducing Option Grid patient decision aids.

PubMed

Wood, Fiona; Phillips, Katie; Edwards, Adrian; Elwyn, Glyn

2017-03-01

We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Option Grid decision aids are not being used as intended in interpreted consultations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Braving Difficult Choices Alone: Children's and Adolescents' Medical Decision Making

PubMed Central

Ruggeri, Azzurra; Gummerum, Michaela; Hanoch, Yaniv

2014-01-01

Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process. PMID:25084274

PRA and Conceptual Design

NASA Technical Reports Server (NTRS)

DeMott, Diana; Fuqua, Bryan; Wilson, Paul

2013-01-01

Once a project obtains approval, decision makers have to consider a variety of alternative paths for completing the project and meeting the project objectives. How decisions are made involves a variety of elements including: cost, experience, current technology, ideologies, politics, future needs and desires, capabilities, manpower, timing, available information, and for many ventures management needs to assess the elements of risk versus reward. The use of high level Probabilistic Risk Assessment (PRA) Models during conceptual design phases provides management with additional information during the decision making process regarding the risk potential for proposed operations and design prototypes. The methodology can be used as a tool to: 1) allow trade studies to compare alternatives based on risk, 2) determine which elements (equipment, process or operational parameters) drives the risk, and 3) provide information to mitigate or eliminate risks early in the conceptual design to lower costs. Creating system models using conceptual design proposals and generic key systems based on what is known today can provide an understanding of the magnitudes of proposed systems and operational risks and facilitates trade study comparisons early in the decision making process. Identifying the "best" way to achieve the desired results is difficult, and generally occurs based on limited information. PRA provides a tool for decision makers to explore how some decisions will affect risk before the project is committed to that path, which can ultimately save time and money.

[Error prevention through management of complications in urology: standard operating procedures from commercial aviation as a model].

PubMed

Kranz, J; Sommer, K-J; Steffens, J

2014-05-01

Patient safety and risk/complication management rank among the current megatrends in modern medicine, which has undoubtedly become more complex. In time-critical, error-prone and difficult situations, which often occur repeatedly in everyday clinical practice, guidelines are inappropriate for acting rapidly and intelligently. With the establishment and consistent use of standard operating procedures like in commercial aviation, a possible strategic approach is available. These medical aids to decision-making - quick reference cards - are short, optimized instructions that enable a standardized procedure in case of medical claims.

Adaptive decision processes in perceptual comparisons: effects of changes in the global difficulty context.

PubMed

Baranski, Joseph V; Petrusic, William M

2003-06-01

Adaptive decision processes were investigated in experiments involving an unexpected change in the global ease or difficulty of the task. Under accuracy stress, a shift from an easy to a difficult context induced a marked increase in decision time, but a shift from a difficult to an easy context did not. Under speed stress, a shift to a more difficult context induced lower accuracy and rated confidence, depending on the difficulty of the decisions. A view of caution developed in D. Vickers's (1979) accumulator theory--whereby one seeks to base decisions on more information--is compared with a view based on slow and fast guessing theory (W. M. Petrusic, 1992; W. M. Petrusic & J. V. Baranski, 1989a)--whereby one seeks to base decisions on more diagnostic information. On balance, the findings support the latter view.

Patients' attitudes to their embryos and their destiny: social conditioning?

PubMed

de Lacey, Sheryl

2007-02-01

The clinical management of embryo storage and disposal is dynamic and subject to changes in the cultural context such as public debate and the implementation of public policy. Studies of the decisions made by patient couples for their embryos, and trends in decision-making over time and in relation to issues arising in the cultural context are rare. Studies of the attitudes that patient couples have towards their frozen embryos have largely focused on measuring patients' intentions in relation to publicly contentious outcomes. A small but expanding number of interview studies are illuminating the meaning that couples attribute to frozen embryos and how this influences decisions for their destiny. This chapter maps both quantitative and qualitative studies of patients' attitudes and decisions illuminating similarities and contradictions in study findings, and ultimately highlights the range of attitudes in patients, clinics and the community towards what is evidently a difficult and morally challenging decision to end the storage of frozen embryos.

Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

PubMed

Nordby, Halvor

2015-01-01

Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.

Neuro-Fuzzy Support of Knowledge Management in Social Regulation

NASA Astrophysics Data System (ADS)

Petrovic-Lazarevic, Sonja; Coghill, Ken; Abraham, Ajith

2002-09-01

The aim of the paper is to demonstrate the neuro-fuzzy support of knowledge management in social regulation. Knowledge could be understood for social regulation purposes as explicit and tacit. Explicit knowledge relates to the community culture indicating how things work in the community based on social policies and procedures. Tacit knowledge is ethics and norms of the community. The former could be codified, stored and transferable in order to support decision making, while the latter being based on personal knowledge, experience and judgments is difficult to codify and store. Tacit knowledge expressed through linguistic information can be stored and used to support knowledge management in social regulation through the application of fuzzy and neuro-fuzzy logic.

Medical equipment classification: method and decision-making support based on paraconsistent annotated logic.

PubMed

Oshiyama, Natália F; Bassani, Rosana A; D'Ottaviano, Itala M L; Bassani, José W M

2012-04-01

As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification.

Mapping social-ecological vulnerability to inform local decision making.

PubMed

Thiault, Lauric; Marshall, Paul; Gelcich, Stefan; Collin, Antoine; Chlous, Frédérique; Claudet, Joachim

2018-04-01

An overarching challenge of natural resource management and biodiversity conservation is that relationships between people and nature are difficult to integrate into tools that can effectively guide decision making. Social-ecological vulnerability offers a valuable framework for identifying and understanding important social-ecological linkages, and the implications of dependencies and other feedback loops in the system. Unfortunately, its implementation at local scales has hitherto been limited due at least in part to the lack of operational tools for spatial representation of social-ecological vulnerability. We developed a method to map social-ecological vulnerability based on information on human-nature dependencies and ecosystem services at local scales. We applied our method to the small-scale fishery of Moorea, French Polynesia, by combining spatially explicit indicators of exposure, sensitivity, and adaptive capacity of both the resource (i.e., vulnerability of reef fish assemblages to fishing) and resource users (i.e., vulnerability of fishing households to the loss of fishing opportunity). Our results revealed that both social and ecological vulnerabilities varied considerably through space and highlighted areas where sources of vulnerability were high for both social and ecological subsystems (i.e., social-ecological vulnerability hotspots) and thus of high priority for management intervention. Our approach can be used to inform decisions about where biodiversity conservation strategies are likely to be more effective and how social impacts from policy decisions can be minimized. It provides a new perspective on human-nature linkages that can help guide sustainability management at local scales; delivers insights distinct from those provided by emphasis on a single vulnerability component (e.g., exposure); and demonstrates the feasibility and value of operationalizing the social-ecological vulnerability framework for policy, planning, and participatory management decisions. © 2017 Society for Conservation Biology.

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

Managing bay and estuarine ecosystems for multiple services

USGS Publications Warehouse

Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

2013-01-01

Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

Ecosystem performance monitoring of rangelands by integrating modeling and remote sensing

USGS Publications Warehouse

Wylie, Bruce K.; Boyte, Stephen P.; Major, Donald J.

2012-01-01

Monitoring rangeland ecosystem dynamics, production, and performance is valuable for researchers and land managers. However, ecosystem monitoring studies can be difficult to interpret and apply appropriately if management decisions and disturbances are inseparable from the ecosystem's climate signal. This study separates seasonal weather influences from influences caused by disturbances and management decisions, making interannual time-series analysis more consistent and interpretable. We compared the actual ecosystem performance (AEP) of five rangeland vegetation types in the Owyhee Uplands for 9 yr to their expected ecosystem performance (EEP). Integrated growing season Normalized Difference Vegetation Index data for each of the nine growing seasons served as a proxy for annual AEP. Regression-tree models used long-term site potential, seasonal weather, and land cover data sets to generate annual EEP, an estimate of ecosystem performance incorporating annual weather variations. The difference between AEP and EEP provided a performance measure for each pixel in the study area. Ecosystem performance anomalies occurred when the ecosystem performed significantly better or worse than the model predicted. About 14% of the Owyhee Uplands showed a trend of significant underperformance or overperformance (P<0.10). Land managers can use results from weather-based rangeland ecosystem performance models to help support adaptive management strategies.

Guidelines for Using Movement Science to Inform Biodiversity Policy

NASA Astrophysics Data System (ADS)

Barton, Philip S.; Lentini, Pia E.; Alacs, Erika; Bau, Sana; Buckley, Yvonne M.; Burns, Emma L.; Driscoll, Don A.; Guja, Lydia K.; Kujala, Heini; Lahoz-Monfort, José J.; Mortelliti, Alessio; Nathan, Ran; Rowe, Ross; Smith, Annabel L.

2015-10-01

Substantial advances have been made in our understanding of the movement of species, including processes such as dispersal and migration. This knowledge has the potential to improve decisions about biodiversity policy and management, but it can be difficult for decision makers to readily access and integrate the growing body of movement science. This is, in part, due to a lack of synthesis of information that is sufficiently contextualized for a policy audience. Here, we identify key species movement concepts, including mechanisms, types, and moderators of movement, and review their relevance to (1) national biodiversity policies and strategies, (2) reserve planning and management, (3) threatened species protection and recovery, (4) impact and risk assessments, and (5) the prioritization of restoration actions. Based on the review, and considering recent developments in movement ecology, we provide a new framework that draws links between aspects of movement knowledge that are likely the most relevant to each biodiversity policy category. Our framework also shows that there is substantial opportunity for collaboration between researchers and government decision makers in the use of movement science to promote positive biodiversity outcomes.

Using an ecological ethics framework to make decisions about the relocation of wildlife.

PubMed

McCoy, Earl D; Berry, Kristin

2008-12-01

Relocation is an increasingly prominent conservation tool for a variety of wildlife, but the technique also is controversial, even among conservation practitioners. An organized framework for addressing the moral dilemmas often accompanying conservation actions such as relocation has been lacking. Ecological ethics may provide such a framework and appears to be an important step forward in aiding ecological researchers and biodiversity managers to make difficult moral choices. A specific application of this framework can make the reasoning process more transparent and give more emphasis to the strong sentiments about non-human organisms held by many potential users. Providing an example of the application of the framework may also increase the appeal of the reasoning process to ecological researchers and biodiversity managers. Relocation as a conservation action can be accompanied by a variety of moral dilemmas that reflect the interconnection of values, ethical positions, and conservation decisions. A model that is designed to address moral dilemmas arising from relocation of humans provides/demonstrates/illustrates a possible way to apply the ecological ethics framework and to involve practicing conservationists in the overall decision-making process.

The Huaihe Basin Water Resource and Water Quality Management Platform Implemented with a Spatio-Temporal Data Model

NASA Astrophysics Data System (ADS)

Liu, Y.; Zhang, W.; Yan, C.

2012-07-01

Presently, planning and assessment in maintenance, renewal and decision-making for watershed hydrology, water resource management and water quality assessment are evolving toward complex, spatially explicit regional environmental assessments. These problems have to be addressed with object-oriented spatio-temporal data models that can restore, manage, query and visualize various historic and updated basic information concerning with watershed hydrology, water resource management and water quality as well as compute and evaluate the watershed environmental conditions so as to provide online forecasting to police-makers and relevant authorities for supporting decision-making. The extensive data requirements and the difficult task of building input parameter files, however, has long been an obstacle to use of such complex models timely and effectively by resource managers. Success depends on an integrated approach that brings together scientific, education and training advances made across many individual disciplines and modified to fit the needs of the individuals and groups who must write, implement, evaluate, and adjust their watershed management plans. The centre for Hydro-science Research, Nanjing University, in cooperation with the relevant watershed management authorities, has developed a WebGIS management platform to facilitate this complex process. Improve the management of watersheds over the Huaihe basin through the development, promotion and use of a web-based, user-friendly, geospatial watershed management data and decision support system (WMDDSS) involved many difficulties for the development of this complicated System. In terms of the spatial and temporal characteristics of historic and currently available information on meteorological, hydrological, geographical, environmental and other relevant disciplines, we designed an object-oriented spatiotemporal data model that combines spatial, attribute and temporal information to implement the management system. Using this system, we can update, query and analyze environmental information as well as manage historical data, and a visualization tool was provided to help the user interpret results so as to provide scientific support for decision-making. The utility of the system has been demonstrated its values by being used in watershed management and environmental assessments.

Psychosis during pregnancy: treatment considerations.

PubMed

Pinkofsky, H B

1997-09-01

The onset of psychosis during pregnancy presents several difficult management decisions and a careful risk-benefit analysis is required. Withholding antipsychotic treatment may produce more risks than benefits. Studies on neuroleptic teratogenicity are contradictory. Most of the commonly used neuroleptics exhibit a pregnancy risk of category C. Neuroleptic use during pregnancy may be associated with adverse effects in the pre- and postnatal period. These concerns include compromising uterine blood flow, post-partum neonatal sedation, and extrapyramidal signs expressed in the neonate. Each neuroleptic exhibits a unique pharmacokinetic profile. The antipsychotic properties and side effects considered most significant include sedation, half-life, hypotension, and apparent hydrophilicity. In this case study a decision to select molindone was based on these parameters.

Strengthening links between waterfowl research and management

USGS Publications Warehouse

Roberts, Anthony J.; Eadie, John M.; Howerter, David; Johnson, Fred A.; Nichols, James; Runge, Michael C.; Vrtiska, Mark; Williams, Byron K.

2018-01-01

Waterfowl monitoring, research, regulation, and adaptive planning are leading the way in supporting science-informed wildlife management. However, increasing societal demands on natural resources have created a greater need for adaptable and successful linkages between waterfowl science and management. We presented a special session at the 2016 North American Duck Symposium, Annapolis, Maryland, USA on the successes and challenges of linking research and management in waterfowl conservation, and we summarize those thoughts in this commentary. North American waterfowl management includes a diversity of actions including management of harvest and habitat. Decisions for waterfowl management are structured using decision analysis by incorporating stakeholder values into formal objectives, identifying research relevant to objectives, integrating scientific knowledge, and choosing an optimal strategy with respect to objectives. Recently, the consideration of the value of information has been proposed as a means to evaluate the utility of research designed to meet objectives. Despite these advances, the ability to conduct waterfowl research with direct management application may be increasingly difficult in research institutions for several reasons including reduced funding for applied research and the lower perceived value of applied versus theoretical research by some university academics. In addition, coordination between researchers and managers may be logistically constrained, and communication may be ineffective between the 2 groups. Strengthening these links would help develop stronger and more coordinated approaches for the conservation of waterfowl and the wetlands upon which they depend.

Solving fuzzy shortest path problem by genetic algorithm

NASA Astrophysics Data System (ADS)

Syarif, A.; Muludi, K.; Adrian, R.; Gen, M.

2018-03-01

Shortest Path Problem (SPP) is known as one of well-studied fields in the area Operations Research and Mathematical Optimization. It has been applied for many engineering and management designs. The objective is usually to determine path(s) in the network with minimum total cost or traveling time. In the past, the cost value for each arc was usually assigned or estimated as a deteministic value. For some specific real world applications, however, it is often difficult to determine the cost value properly. One way of handling such uncertainty in decision making is by introducing fuzzy approach. With this situation, it will become difficult to solve the problem optimally. This paper presents the investigations on the application of Genetic Algorithm (GA) to a new SPP model in which the cost values are represented as Triangular Fuzzy Number (TFN). We adopts the concept of ranking fuzzy numbers to determine how good the solutions. Here, by giving his/her degree value, the decision maker can determine the range of objective value. This would be very valuable for decision support system in the real world applications.Simulation experiments were carried out by modifying several test problems with 10-25 nodes. It is noted that the proposed approach is capable attaining a good solution with different degree of optimism for the tested problems.

Utilizing a Health Impact Assessment (HIA) to Connect Natural ...

EPA Pesticide Factsheets

Marrying scientific and health research with natural resource management should be a straightforward process. However, differences in purpose, goals, language, levels of detail and implementation authority between the scientists who conduct research and resource managers who plan and implement projects make it difficult for resource managers to include information not specific to the problem at hand. One method to overcome this barrier is a Health Impact Assessment (HIA) or process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making process. An HIA informs decision makers and stakeholders of the potential health effects of a proposed program, policy, project or plan through a systematic investigation of impacts to health and health determinants and deliberative engagement of community members and other stakeholders throughout the HIA process. USEPA will be conducting an HIA on the Minnesota Department of Natural Resources’ sediment remediation and habitat restoration project at Kingsbury Bay and Grassy Point. This poster outlines the HIA process, illustrates how technical and stakeholder committees inform the process, and presents the determinants of health that will be explored in the HIA. This poster will illustrate how a Health Impact Assessment, a process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making proces

Decontamination and management of human remains following incidents of hazardous chemical release.

PubMed

Hauschild, Veronique D; Watson, Annetta; Bock, Robert

2012-01-01

To provide specific guidance and resources for systematic and orderly decontamination of human remains resulting from a chemical terrorist attack or accidental chemical release. A detailed review and health-based decision criteria protocol is summarized. Protocol basis and logic are derived from analyses of compound-specific toxicological data and chemical/physical characteristics. Guidance is suitable for civilian or military settings where human remains potentially contaminated with hazardous chemicals may be present, such as sites of transportation accidents, terrorist operations, or medical examiner processing points. Guidance is developed from data-characterizing controlled experiments with laboratory animals, fabrics, and materiel. Logic and specific procedures for decontamination and management of remains, protection of mortuary affairs personnel, and decision criteria to determine when remains are sufficiently decontaminated are presented. Established procedures as well as existing materiel and available equipment for decontamination and verification provide reasonable means to mitigate chemical hazards from chemically exposed remains. Unique scenarios such as those involving supralethal concentrations of certain liquid chemical warfare agents may prove difficult to decontaminate but can be resolved in a timely manner by application of the characterized systematic approaches. Decision criteria and protocols to "clear" decontaminated remains for transport and processing are also provided. Once appropriate decontamination and verification have been accomplished, normal procedures for management of remains and release can be followed.

Identifying Key Performance Indicators for Holistic Hospital Management with a Modified DEMATEL Approach.

PubMed

Si, Sheng-Li; You, Xiao-Yue; Liu, Hu-Chen; Huang, Jia

2017-08-19

Performance analysis is an important way for hospitals to achieve higher efficiency and effectiveness in providing services to their customers. The performance of the healthcare system can be measured by many indicators, but it is difficult to improve them simultaneously due to the limited resources. A feasible way is to identify the central and influential indicators to improve healthcare performance in a stepwise manner. In this paper, we propose a hybrid multiple criteria decision making (MCDM) approach to identify key performance indicators (KPIs) for holistic hospital management. First, through integrating evidential reasoning approach and interval 2-tuple linguistic variables, various assessments of performance indicators provided by healthcare experts are modeled. Then, the decision making trial and evaluation laboratory (DEMATEL) technique is adopted to build an interactive network and visualize the causal relationships between the performance indicators. Finally, an empirical case study is provided to demonstrate the proposed approach for improving the efficiency of healthcare management. The results show that "accidents/adverse events", "nosocomial infection", ''incidents/errors", "number of operations/procedures" are significant influential indicators. Also, the indicators of "length of stay", "bed occupancy" and "financial measures" play important roles in performance evaluation of the healthcare organization. The proposed decision making approach could be considered as a reference for healthcare administrators to enhance the performance of their healthcare institutions.

The Application of Mathematical Programming to the Productivity Investment Fund Program: A Capital Rationing Problem.

DTIC Science & Technology

1987-01-01

survey research, Gitman and Forrester (1977) report that managers consider the most difficult and important stages of capital budgeting to be project...confirms this (Finn, 1973; Gitman and Forrester, 1977). In the public sector, hard rationing is probably more common, where compliance with budgeted...decisions (e.g., Klammer, 1972, Banda and Nolan, 1972; Osteryoung, 1973; Gitman and Forrester, 1977; Farragher, 1986). It is not known if the existence of

Expert systems applied to spacecraft fire safety

NASA Technical Reports Server (NTRS)

Smith, Richard L.; Kashiwagi, Takashi

1989-01-01

Expert systems are problem-solving programs that combine a knowledge base and a reasoning mechanism to simulate a human expert. The development of an expert system to manage fire safety in spacecraft, in particular the NASA Space Station Freedom, is difficult but clearly advantageous in the long-term. Some needs in low-gravity flammability characteristics, ventilating-flow effects, fire detection, fire extinguishment, and decision models, all necessary to establish the knowledge base for an expert system, are discussed.

Determining Financial Capability of SSI/SSDI Beneficiaries with Psychiatric Disabilities: A Case Series

PubMed Central

Lazar, Christina M.; Black, Anne C.; McMahon, Thomas J; O’Shea, Kevin; Rosen, Marc I.

2015-01-01

Objective Social Security beneficiaries’ liberty is constrained if they are judged incapable of managing their disability payments and are assigned a fiduciary to manage benefit payments on their behalf. Conversely, beneficiaries’ well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and capability guidelines appear to be applied inconsistently in practice. This case series describes the ambiguities remaining for a small number of individuals even after published criteria for capability— failing to meet basic needs and/or harmful spending on drugs— are applied. Methods Trained, experienced assessors rated the financial capability of 119 individuals in intensive outpatient or inpatient psychiatric facilities who received SSI or SSDI payments. Ten individuals’ cases were determined difficult to judge. Results Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending needed to be considered incapable, the amount of spending on harmful things needed to be considered incapable, how intermittent periods of capability and incapability should be considered, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information. Conclusion The cases raise fundamental questions about what financial incapability is, but also illustrate how detailed consideration of beneficiaries’ living situations and decision making can inform the difficult dichotomous decision about capability. PMID:25727116

Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities.

PubMed

Lazar, Christina M; Black, Anne C; McMahon, Thomas J; O'Shea, Kevin; Rosen, Marc I

2015-03-01

The liberty of individuals who receive Social Security disability payments is constrained if they are judged incapable of managing their payments and are assigned a payee or conservator to manage benefit payments on their behalf. Conversely, beneficiaries' well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and that capability guidelines appear to be applied inconsistently. This article describes ambiguities that remained for individuals even after a comprehensive assessment of financial capability was conducted by independent assessors. Trained, experienced assessors rated the financial capability of 118 individuals in intensive outpatient or inpatient psychiatric facilities who received Social Security Disability Insurance or Supplemental Security Income. Ten individuals' cases were determined to be difficult to judge. Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending that indicates incapability, the amount of spending on harmful things that indicates incapability, how to consider intermittent periods of capability and incapability, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information. The cases raise fundamental questions about how to define and identify financial incapability, but they also illustrate how detailed consideration of beneficiaries' living situations and decision making can inform the difficult dichotomous decision about capability.

Canadian Innovations in Siting Hazardous Waste Management Facilities

PubMed

Kuhn; Ballard

1998-07-01

/ Siting hazardous waste facilities is an extremely complex and difficult endeavor. Public aversion to the construction of these facilities in or near their community often results in concerted opposition, referred to as the NIMBY syndrome. For the most part, siting processes do not fail because of inadequate environmental or technical considerations, but because of the adversarial decision-making strategies employed by the proponents. Innovative siting processes used in the provinces of Alberta and Manitoba offer tangible evidence of the successful application of an innovative siting approach based on the principles of decentralization of decision-making authority and full and meaningful public involvement. The purpose of this paper is to evaluate four Canadian siting processes from the perspective of public participation and access to decision-making authority. Examples of siting processes related to hazardous waste management facilities are provided from the provinces of Alberta, Manitoba, British Columbia, and Ontario. Siting has evolved from approaches dominated by top-down decision making to increasing decentralized and pluralistic approaches. Focusing on social and political concerns of potentially affected communities and on the process of decision making itself are fundamental to achieving siting success. In Alberta initially, and later in Manitoba, this new "open approach" to siting has resulted in the construction of the first two comprehensive hazardous waste treatment facilities in Canada.KEY WORDS: Hazardous waste facilities; Siting methodologies; Public participation

Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour

PubMed Central

2014-01-01

Background Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management. Methods Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes. Results Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making. Conclusion This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour. PMID:24397421

Continuous improvement in the Industrial and Management Systems Engineering programme at Kuwait University

NASA Astrophysics Data System (ADS)

Aldowaisan, Tariq; Allahverdi, Ali

2016-07-01

This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been applied to the results of four assessment tools and other data sources to improve performance. Important improvements include the need to reconsider two student outcomes as they were difficult to implement in courses. In addition, through benchmarking and the engagement of Alumni and Employers, key decisions were made to improve the curriculum and enhance employability.

Talking about end-of-life preferences in marriage: applying the theory of motivated information management.

PubMed

Rafferty, Katherine A; Cramer, Emily; Priddis, DeAnne; Allen, Mike

2015-01-01

The theory of motivated information management (TMIM) provides one framework to examine information-seeking behaviors, especially in conversations involving sensitive or difficult information such as preferences for end-of-life (EOL) care. The spouse plays a significant role in decision making surrounding EOL care. Consequently, individuals need information about spouses' EOL preferences in order to ensure carrying out those desires. Our findings support the value of TMIM as a framework to understand factors that influence couples' EOL care information-seeking behaviors. In support of the theory, we provide factors that influence the initiation or avoidance of EOL conversations between spouses.

Clinical decision making in a high-risk primary care environment: a qualitative study in the UK.

PubMed

Balla, John; Heneghan, Carl; Thompson, Matthew; Balla, Margaret

2012-01-01

Examine clinical reasoning and decision making in an out of hours (OOH) primary care setting to gain insights into how general practitioners (GPs) make clinical decisions and manage risk in this environment. Semi-structured interviews using open-ended questions. A 2-month qualitative interview study conducted in Oxfordshire, UK. 21 GPs working in OOH primary care. The most powerful themes to emerge related to dealing with urgent potentially high-risk cases, keeping patients safe and responding to their needs, while trying to keep patients out of hospital and the concept of 'fire fighting'. There were a number of well-defined characteristics that GPs reported making presentations easy or difficult to deal with. Severely ill patients were straightforward, while the older people, with complex multisystem diseases, were often difficult. GPs stopped collecting clinical information and came to clinical decisions when high-risk disease and severe illness requiring hospital attention has been excluded; they had responded directly to the patient's needs and there was a reliable safety net in place. Learning points that GPs identified as important for trainees in the OOH setting included the importance of developing rapport in spite of time pressures, learning to deal with uncertainty and learning about common presentations with a focus on critical cues to exclude severe illness. The findings support suggestions that improvements in primary care OOH could be achieved by including automated and regular timely feedback system for GPs and individual peer and expert clinician support for GPs with regular meetings to discuss recent cases. In addition, trainee support and mentoring to focus on clinical skills, knowledge and risk management issues specific to OOH is currently required. Investigating the stopping rules used for diagnostic closure may provide new insights into the root causes of clinical error in such a high-risk setting.

Utilizing a Health Impact Assessment (HIA) to Connect Natural ...

EPA Pesticide Factsheets

Marrying scientific and health research with natural resource management should be a straightforward process. However, differences in purpose, goals, language, levels of detail and implementation authority between the scientists who conduct research and resource managers who plan and implement projects make it difficult for resource managers to include information not specific to the problem at hand. One method to overcome this barrier is a Health Impact Assessment (HIA) or process that uses scientific data, health expertise and public input to factor public health considerations into the decision-making process. An HIA informs decision makers and stakeholders of the potential health effects of a proposed program, policy, project or plan through a systematic investigation of impacts to health and health determinants and deliberative engagement of community members and other stakeholders throughout the HIA process. USEPA will be conducting an HIA on the Minnesota Department of Natural Resources’ sediment remediation and habitat restoration project at Kingsbury Bay and Grassy Point. This poster outlines the HIA process, illustrates how technical and stakeholder committees inform the process, and presents the determinants of health that will be explored in the HIA. not applicable

Using complexity science and negotiation theory to resolve boundary-crossing water issues

NASA Astrophysics Data System (ADS)

Islam, Shafiqul; Susskind, Lawrence

2018-07-01

Many water governance and management issues are complex. The complexity of these issues is related to crossing of multiple boundaries: political, social and jurisdictional, as well as physical, ecological and biogeochemical. Resolution of these issues usually requires interactions of many parties with conflicting values and interests operating across multiple boundaries and scales to make decisions. The interdependence and feedback among interacting variables, processes, actors and institutions are hard to model and difficult to forecast. Thus, decision-making related to complex water problems needs be contingent and adaptive. This paper draws on a number of ideas from complexity science and negotiation theory that may make it easier to cope with the complexities and difficulties of managing boundary crossing water disputes. It begins with the Water Diplomacy Framework that was developed and tested over the past several years. Then, it uses three key ideas from complexity science (interdependence and interconnectedness; uncertainty and feedback; emergence and adaptation) and three from negotiation theory (stakeholder identification and engagement; joint fact finding; and value creation through option generation) to show how application of these ideas can help enhance effectiveness of water management.

Ecohydrology and Its Relation to Integrated Groundwater Management

USGS Publications Warehouse

Hunt, Randall J.; Hayashi, Masaki; Batelaan, Okke

2016-01-01

In the twentieth century, groundwater characterization focused primarily on easily measured hydraulic metrics of water storage and flows. Twenty-first century concepts of groundwater availability, however, encompass other factors having societal value, such as ecological well-being. Effective ecohydrological science is a nexus of fundamental understanding derived from two scientific disciplines: (1) ecology, where scale, thresholds, feedbacks and tipping points for societal questions form the basis for the ecologic characterization, and (2) hydrology, where the characteristics, magnitude, and timing of water flows are characterized for a defined system of interest. In addition to ecohydrology itself, integrated groundwater management requires input from resource managers to understand which areas of the vast world of ecohydrology are important for decision making. Expectations of acceptable uncertainty, or even what ecohydrological outputs have utility, are often not well articulated within societal decision making frameworks, or within the science community itself. Similarly, “acceptable levels of impact” are difficult to define. Three examples are given to demonstrate the use of ecohydrological considerations for long-term sustainability of groundwater resources and their related ecosystem function. Such examples illustrate the importance of accommodating ecohydrogeological aspects into integrated groundwater management of the twenty-first century, regardless of society, climate, or setting.

Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas.

PubMed

Kivelevitch, Dario; Frieder, Jillian; Watson, Ian; Paek, So Yeon; Menter, M Alan

2018-04-01

Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. Areas covered: This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. Expert opinion: Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.

Voting systems for environmental decisions.

PubMed

Burgman, Mark A; Regan, Helen M; Maguire, Lynn A; Colyvan, Mark; Justus, James; Martin, Tara G; Rothley, Kris

2014-04-01

Voting systems aggregate preferences efficiently and are often used for deciding conservation priorities. Desirable characteristics of voting systems include transitivity, completeness, and Pareto optimality, among others. Voting systems that are common and potentially useful for environmental decision making include simple majority, approval, and preferential voting. Unfortunately, no voting system can guarantee an outcome, while also satisfying a range of very reasonable performance criteria. Furthermore, voting methods may be manipulated by decision makers and strategic voters if they have knowledge of the voting patterns and alliances of others in the voting populations. The difficult properties of voting systems arise in routine decision making when there are multiple criteria and management alternatives. Because each method has flaws, we do not endorse one method. Instead, we urge organizers to be transparent about the properties of proposed voting systems and to offer participants the opportunity to approve the voting system as part of the ground rules for operation of a group. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of the Society for Conservation Biology.

Coastal storm monitoring in Virginia

USGS Publications Warehouse

Wicklein, Shaun M.; Bennett, Mark

2014-01-01

Coastal communities in Virginia are prone to flooding, particularly during hurricanes, nor’easters, and other coastal low-pressure systems. These weather systems affect public safety, personal and public property, and valuable infrastructure, such as transportation, water and sewer, and electric-supply networks. Local emergency managers, utility operators, and the public are tasked with making difficult decisions regarding evacuations, road closures, and post-storm recovery efforts as a result of coastal flooding. In coastal Virginia these decisions often are made on the basis of anecdotal knowledge from past events or predictions based on data from monitoring sites located far away from the affected area that may not reflect local conditions. Preventing flood hazards, such as hurricane-induced storm surge, from becoming human disasters requires an understanding of the relative risks that flooding poses to specific communities. The risk to life and property can be very high if decisions about evacuations and road closures are made too late or not at all.

Re-thinking barriers to organizational change in public hospitals.

PubMed

Edwards, Nigel; Saltman, Richard B

2017-01-01

Public hospitals are well known to be difficult to reform. This paper provides a comprehensive six-part analytic framework that can help policymakers and managers better shape their organizational and institutional behavior. The paper first describes three separate structural characteristics which, together, inhibit effective problem description and policy design for public hospitals. These three structural constraints are i) the dysfunctional characteristics found in most organizations, ii) the particular dysfunctions of professional health sector organizations, and iii) the additional dysfunctional dimensions of politically managed organizations. While the problems in each of these three dimensions of public hospital organization are well-known, and the first two dimensions clearly affect private as well as publicly run hospitals, insufficient attention has been paid to the combined impact of all three factors in making public hospitals particularly difficult to manage and steer. Further, these three structural dimensions interact in an institutional environment defined by three restrictive context limitations, again two of which also affect private hospitals but all three of which compound the management dilemmas in public hospitals. The first contextual limitation is the inherent complexity of delivering high quality, safe, and affordable modern inpatient care in a hospital setting. The second contextual limitation is a set of specific market failures in public hospitals, which limit the scope of the standard financial incentives and reform measures. The third and last contextual limitation is the unique problem of generalized and localized anxiety , which accompanies the delivery of medical services, and which suffuses decision-making on the part of patients, medical staff, hospital management, and political actors alike. This combination of six institutional characteristics - three structural dimensions and three contextual dimensions - can help explain why public hospitals are different in character from other parts of the public sector, and the scale of the challenge they present to political decision-makers.

Acute severe asthma presenting in late pregnancy.

PubMed

Holland, S M; Thomson, K D

2006-01-01

Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

National Aeronautics and Space Administration fundamental research program. Information utilization and evaluation

NASA Technical Reports Server (NTRS)

Estes, J. E.; Eisgruber, L.

1981-01-01

In the second half of the 1980's NASA can expect to face difficult choices among alternative fundamental and applied research, and development projects that could potentially lead to improvements in the information systems used to manage renewable resources. The working group on information utilization and evaluation believes that effective choices cannot be made without a better understanding of the current and prospective problems and opportunities involved in the application of remote sensing to improve renewable research information systems. A renewable resources information system is defined in a broad context to include a flow of data/information from: acquisition through processing, storage, integration with other data, analysis, graphic presentation, decision making, and assessment of the affects of those decisions.

Adaptation strategies for water supply management in a drought prone Mediterranean river basin: Application of outranking method.

PubMed

Kumar, Vikas; Del Vasto-Terrientes, Luis; Valls, Aida; Schuhmacher, Marta

2016-01-01

The regional water allocation planning is one of those complex decision problems where holistic approach to water supply management considering different criteria would be valuable. However, multi-criteria decision making with diverse indicators measured on different scales and uncertainty levels is difficult to solve. Objective of this paper is to develop scenarios for the future imbalances in water supply and demand for a water stressed Mediterranean area of Northern Spain (Tarragona) and to test the applicability and suitability of an outranking method ELECTRE-III-H for evaluating sectoral water allocation policies. This study is focused on the use of alternative water supply scenarios to fulfil the demand of water from three major sectors: domestic, industrial and agricultural. A detail scenario planning for regional water demand and supply has been discussed. For each future scenario of climate change, the goal is to obtain a ranking of a set of possible actions with regards to different types of indicators (costs, water stress and environmental impact). The analytical method used is based on outranking models for decision aid with hierarchical structures of criteria and ranking alternatives using partial preorders based on pairwise preference relations. We compare several adaptation measures including alternative water sources (reclaimed water and desalination); inter basin water transfer and sectoral demand management coming from industry, agriculture and domestic sectors and tested the sustainability of management actions for different climate change scenarios. Results have shown use of alternative water resources as the most reliable alternative with medium reclaimed water reuse in industry and agriculture and low to medium use of desalination water in domestic and industrial sectors as the best alternative. The proposed method has several advantages such as the management of heterogeneous scales of measurement without requiring any artificial transformation and the management of uncertainty by means of comparisons at a qualitative level in terms of the decision maker preferences. Copyright © 2015 Elsevier B.V. All rights reserved.

Environmental and economic assessment methods for waste management decision-support: possibilities and limitations.

PubMed

Finnveden, Göran; Björklund, Anna; Moberg, Asa; Ekvall, Tomas

2007-06-01

A large number of methods and approaches that can be used for supporting waste management decisions at different levels in society have been developed. In this paper an overview of methods is provided and preliminary guidelines for the choice of methods are presented. The methods introduced include: Environmental Impact Assessment, Strategic Environmental Assessment, Life Cycle Assessment, Cost-Benefit Analysis, Cost-effectiveness Analysis, Life-cycle Costing, Risk Assessment, Material Flow Accounting, Substance Flow Analysis, Energy Analysis, Exergy Analysis, Entropy Analysis, Environmental Management Systems, and Environmental Auditing. The characteristics used are the types of impacts included, the objects under study and whether the method is procedural or analytical. The different methods can be described as systems analysis methods. Waste management systems thinking is receiving increasing attention. This is, for example, evidenced by the suggested thematic strategy on waste by the European Commission where life-cycle analysis and life-cycle thinking get prominent positions. Indeed, life-cycle analyses have been shown to provide policy-relevant and consistent results. However, it is also clear that the studies will always be open to criticism since they are simplifications of reality and include uncertainties. This is something all systems analysis methods have in common. Assumptions can be challenged and it may be difficult to generalize from case studies to policies. This suggests that if decisions are going to be made, they are likely to be made on a less than perfect basis.

Future Water Management in the South Platte River Basin: Impacts of Hydraulic Fracturing, Population, Agriculture, and Climate Change in a Semi-Arid Region.

NASA Astrophysics Data System (ADS)

Walker, E. L.; Hogue, T. S.; Anderson, A. M.; Read, L.

2015-12-01

In semi-arid basins across the world, the gap between water supply and demand is growing due to climate change, population growth, and shifts in agriculture and unconventional energy development. Water conservation efforts among residential and industrial water users, recycling and reuse techniques and innovative regulatory frameworks for water management strive to mitigate this gap, however, the extent of these strategies are often difficult to quantify and not included in modeling water allocations. Decision support systems (DSS) are purposeful for supporting water managers in making informed decisions when competing demands create the need to optimize water allocation between sectors. One region of particular interest is the semi-arid region of the South Platte River basin in northeastern Colorado, where anthropogenic and climatic effects are expected to increase the gap between water supply and demand in the near future. Specifically, water use in the South Platte is impacted by several high-intensity activities, including unconventional energy development, i.e. hydraulic fracturing, and large withdrawals for agriculture; these demands are in addition to a projected population increase of 100% by 2050. The current work describes the development of a DSS for the South Platte River basin, using the Water Evaluation and Planning system software (WEAP) to explore scenarios of how variation in future water use in the energy, agriculture, and municipal sectors will impact water allocation decisions. Detailed data collected on oil and gas water use in the Niobrara shale play will be utilized to predict future sector use. We also employ downscaled climate projections for the region to quantify the potential range of water availability in the basin under each scenario, and observe whether or not, and to what extent, climate may impact management decisions at the basin level.

Species distributions models in wildlife planning: agricultural policy and wildlife management in the great plains

USGS Publications Warehouse

Fontaine, Joseph J.; Jorgensen, Christopher; Stuber, Erica F.; Gruber, Lutz F.; Bishop, Andrew A.; Lusk, Jeffrey J.; Zach, Eric S.; Decker, Karie L.

2017-01-01

We know economic and social policy has implications for ecosystems at large, but the consequences for a given geographic area or specific wildlife population are more difficult to conceptualize and communicate. Species distribution models, which extrapolate species-habitat relationships across ecological scales, are capable of predicting population changes in distribution and abundance in response to management and policy, and thus, are an ideal means for facilitating proactive management within a larger policy framework. To illustrate the capabilities of species distribution modeling in scenario planning for wildlife populations, we projected an existing distribution model for ring-necked pheasants (Phasianus colchicus) onto a series of alternative future landscape scenarios for Nebraska, USA. Based on our scenarios, we qualitatively and quantitatively estimated the effects of agricultural policy decisions on pheasant populations across Nebraska, in specific management regions, and at wildlife management areas. 

The laboratory test utilization management toolbox

PubMed Central

Baird, Geoffrey

2014-01-01

Efficiently managing laboratory test utilization requires both ensuring adequate utilization of needed tests in some patients and discouraging superfluous tests in other patients. After the difficult clinical decision is made to define the patients that do and do not need a test, a wealth of interventions are available to the clinician and laboratorian to help guide appropriate utilization. These interventions are collectively referred to here as the utilization management toolbox. Experience has shown that some tools in the toolbox are weak and other are strong, and that tools are most effective when many are used simultaneously. While the outcomes of utilization management studies are not always as concrete as may be desired, what data is available in the literature indicate that strong utilization management interventions are safe and effective measures to improve patient health and reduce waste in an era of increasing financial pressure. PMID:24969916

Predict ephemeral and perennial range quantity and quality during normal grazing season. [Arizona, California, Oregon, and Alaska

NASA Technical Reports Server (NTRS)

Bentley, R. G., Jr. (Principal Investigator)

1974-01-01

The author has identified the following significant results. Collection and update of resource inventory data has historically been a difficult, time consuming task. Accurate resource data is necessary as a basis for wise management decisions made by a resource management agency such as the Bureau of Land Management. Black and white and color infrared composites of ERTS satellite imagery at 1:1,000,000 and enlarged scales can be used as data gathering tools. No investment in expensive sophisticated equipment is necessary. A photointerpreter can map boundaries of soils, plant communities, levels of forage production, areas revegetated by man, and areas burned by wildlife directly from satellite imagery. The ERTS system of producing and distributing imagery must be improved greatly before satellite imagery can be useful to the resource manager.

Using an ecological ethics framework to make decisions about the relocation of wildlife

USGS Publications Warehouse

McCoy, E.D.; Berry, K.

2008-01-01

Relocation is an increasingly prominent conservation tool for a variety of wildlife, but the technique also is controversial, even among conservation practitioners. An organized framework for addressing the moral dilemmas often accompanying conservation actions such as relocation has been lacking. Ecological ethics may provide such a framework and appears to be an important step forward in aiding ecological researchers and biodiversity managers to make difficult moral choices. A specific application of this framework can make the reasoning process more transparent and give more emphasis to the strong sentiments about non-human organisms held by many potential users. Providing an example of the application of the framework may also increase the appeal of the reasoning process to ecological researchers and biodiversity managers. Relocation as a conservation action can be accompanied by a variety of moral dilemmas that reflect the interconnection of values, ethical positions, and conservation decisions. A model that is designed to address moral dilemmas arising from relocation of humans provides/demonstrates/illustrates a possible way to apply the ecological ethics framework and to involve practicing conservationists in the overall decision-making process. ?? 2008 Springer Science+Business Media B.V.

RESPONSIVENESS, LANGUAGE, AND ALIGNMENT: REFLECTIONS ON SOME CHALLENGES FOR HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Dillon, Andrew

2015-01-01

Health systems around the world cope with the challenge of difficult economic times, and the value of health technology assessment (HTA) is increasing. Making the right choices, with limited resources, in the face of increasingly complex technologies requires decisions informed by data and analyses that help us to manage the risks involved. Those who undertake and use HTA can play a greater role in helping decision makers meet these challenges; they need to think how to define innovation and respond to it, how to communicate their analyses, and, critically, how to align their work with the ambitions of their health systems. HTA can become a key health system enabler without compromising its objectivity or independence. It can say that it is too early to determine the value of a new technology when the data simply will not support a safe decision. However, it can also be bold and recommend the managed introduction of new technologies, even when the when the data is immature, provided that the health system understands the risks and there is a plausible case for believing that further research will support the value proposition. The goal for HTA is to be able confidently to do both.

Bioethical aspects of end-of-life care.

PubMed

Zamperetti, N; Bellomo, R; Ronco, C

2008-01-01

Managing end-of-life care can be difficult because of the particular nature of intensive care support, which can separate the biological and the biographical aspects of life. Artificial organ support can temporarily delay death but, at the same time, may fail to restore a quality of life that the patient judges acceptable. For this reason, two concepts must be considered: that the mission of the healthcare system should be to care for patients according to their interests and wishes and that quality of care is related above all to the careful commitment of healthcare workers to the patient's best interests. Keeping these concepts in mind, the rule of the five Cs (competence, collegiality, communication, continuity of care and compassion) might be helpful in the management of end-of-life care. Unfortunately, neither the rule of the five Cs nor the careful use of moral principles in order to promote the patients' dignity can assure a universally acceptable decision. A reasonable level of 'moral certainty', however, might be achieved using a deliberative approach, which provides for the inclusion of all the different subjects involved in the decision-making process (patient, family, doctors, nurses and other carers), in order to reach the best possible decision in a specific situation.

Robust Decision Making to Support Water Quality Climate Adaptation: a Case Study in the Chesapeake Bay Watershed

NASA Astrophysics Data System (ADS)

Fischbach, J. R.; Lempert, R. J.; Molina-Perez, E.

2017-12-01

The U.S. Environmental Protection Agency (USEPA), together with state and local partners, develops watershed implementation plans designed to meet water quality standards. Climate uncertainty, along with uncertainty about future land use changes or the performance of water quality best management practices (BMPs), may make it difficult for these implementation plans to meet water quality goals. In this effort, we explored how decision making under deep uncertainty (DMDU) methods such as Robust Decision Making (RDM) could help USEPA and its partners develop implementation plans that are more robust to future uncertainty. The study focuses on one part of the Chesapeake Bay watershed, the Patuxent River, which is 2,479 sq km in area, highly urbanized, and has a rapidly growing population. We simulated the contribution of stormwater contaminants from the Patuxent to the overall Total Maximum Daily Load (TMDL) for the Chesapeake Bay under multiple scenarios reflecting climate and other uncertainties. Contaminants considered included nitrogen, phosphorus, and sediment loads. The assessment included a large set of scenario simulations using the USEPA Chesapeake Bay Program's Phase V watershed model. Uncertainties represented in the analysis included 18 downscaled climate projections (based on 6 general circulation models and 3 emissions pathways), 12 land use scenarios with different population projections and development patterns, and alternative assumptions about BMP performance standards and efficiencies associated with different suites of stormwater BMPs. Finally, we developed cost estimates for each of the performance standards and compared cost to TMDL performance as a key tradeoff for future water quality management decisions. In this talk, we describe how this research can help inform climate-related decision support at USEPA's Chesapeake Bay Program, and more generally how RDM and other DMDU methods can support improved water quality management under climate uncertainty.

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

Identifying climate risk perceptions, information needs, and barriers to information exchange among public land managers.

PubMed

Peters, Casey B; Schwartz, Mark W; Lubell, Mark N

2018-03-01

Meeting ecosystem management challenges posed by climate change requires building effective communication channels among researchers, planners and practitioners to focus research on management issues requiring new knowledge. We surveyed resource managers within two regions of the western United States regions to better understand perceived risks and vulnerabilities associated with climate change and barriers to obtaining and using relevant climate science information in making ecosystem management decisions. We sought to understand what types of climate science information resource managers find most valuable, and the formats in which they prefer to receive climate science information. We found broad concern among natural resource managers in federal agencies that climate change will make it more difficult for them to achieve their management goals. Primary barriers to incorporating climate science into planning are distributed among challenges identifying, receiving, and interpreting appropriate science and a lack of direction provided by agency leadership needed to meaningfully use this emerging science in resource planning. Copyright © 2017 Elsevier B.V. All rights reserved.

Hospital doctors behave differently, and only by respecting the fundamentals of professional organizations will managers be able to create common goals with professionals.

PubMed

Van Dijck, H

2014-08-01

Hospital doctors behave differently from other hospital workers. The general and specific characteristics of the doctors' behavior are described. As professionals, doctors want to make autonomous decisions and more specifically, they negotiate differently. The best description of their negotiation style is one that features multi-actor, multi-issue characteristics. They behave as actors in a network in never-ending rounds of negotiations with variable issues up for discussion: one time you lose, the next you win. A doctor's career starts with a long residency period in which he or she absorbs professional habits. His or her knowledge and way of organizing are implicit. It is hard for him or her to explicitly describe what he or she is doing. This makes it difficult for managers to discuss quality issues with doctors. Dealing with disruptive behavior is not easy either. The difficult tasks of the chief medical officer, who acts as a go-between, are highlighted. Only when managers respect the fundamentals of the professional organization will they be able to create common goals with the professionals. Common goals bring about better care in hospitals.

Design of an Aircrew Scheduling Decision Aid for the 6916th Electronic Security Squadron.

DTIC Science & Technology

1987-06-01

Security Classification) Design of an Aircrew Scheduling Decision Aid for the 6916th Electronic Security Squadron 12. PERSONAL AUTHOR(S) Thomas J. Kopf...Because of the great number of possible scheduling alternatives, it is difficult to find an optimal solution to-the scheduling problem. Additionally...changes to the original schedule make it even more difficult to find an optimal solution. The emergence of capable microcompu- ters, decision support

Understanding by Older Patients of Dialysis and Conservative Management for Chronic Kidney Failure

PubMed Central

Tonkin-Crine, Sarah; Okamoto, Ikumi; Leydon, Geraldine M.; Murtagh, Fliss E.M.; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

2015-01-01

Background Older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients’ reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units. Study Design Qualitative study with semistructured interviews. Settings & Participants Patients 75 years or older recruited from 9 renal units. Units were chosen to reflect variation in the scale of delivery of conservative management. Methodology Semistructured interviews audiorecorded and transcribed verbatim. Analytical Approach Data were analyzed using thematic analysis. Results 42 interviews were completed, 4 to 6 per renal unit. Patients were sampled from those receiving dialysis, those preparing for dialysis, and those choosing conservative management. 14 patients in each group were interviewed. Patients who had chosen different treatments held varying beliefs about what dialysis could offer. The information that patients reported receiving from clinical staff differed between units. Patients from units with a more established conservative management pathway were more aware of conservative management, less often believed that dialysis would guarantee longevity, and more often had discussed the future with staff. Some patients receiving conservative management reported that they would have dialysis if they became unwell in the future, indicating the conditional nature of their decision. Limitations Recruitment of older adults with frailty and comorbid conditions was difficult and therefore transferability of findings to this population is limited. Conclusions Older adults with chronic kidney disease stage 5 who have chosen different treatment options have contrasting beliefs about the likely outcomes of dialysis for those who are influenced by information provided by renal units. Supporting renal staff in discussing conservative management as a valid alternative to dialysis for a subset of patients will aid informed decision making. There is a need for better evidence about conservative management to support shared decision making for older people with chronic kidney failure. PMID:25304984

Identifying Key Performance Indicators for Holistic Hospital Management with a Modified DEMATEL Approach

PubMed Central

Si, Sheng-Li; You, Xiao-Yue; Huang, Jia

2017-01-01

Performance analysis is an important way for hospitals to achieve higher efficiency and effectiveness in providing services to their customers. The performance of the healthcare system can be measured by many indicators, but it is difficult to improve them simultaneously due to the limited resources. A feasible way is to identify the central and influential indicators to improve healthcare performance in a stepwise manner. In this paper, we propose a hybrid multiple criteria decision making (MCDM) approach to identify key performance indicators (KPIs) for holistic hospital management. First, through integrating evidential reasoning approach and interval 2-tuple linguistic variables, various assessments of performance indicators provided by healthcare experts are modeled. Then, the decision making trial and evaluation laboratory (DEMATEL) technique is adopted to build an interactive network and visualize the causal relationships between the performance indicators. Finally, an empirical case study is provided to demonstrate the proposed approach for improving the efficiency of healthcare management. The results show that “accidents/adverse events”, “nosocomial infection”, ‘‘incidents/errors”, “number of operations/procedures” are significant influential indicators. Also, the indicators of “length of stay”, “bed occupancy” and “financial measures” play important roles in performance evaluation of the healthcare organization. The proposed decision making approach could be considered as a reference for healthcare administrators to enhance the performance of their healthcare institutions. PMID:28825613

An Agent-Based Model of Private Woodland Owner Management Behavior Using Social Interactions, Information Flow, and Peer-To-Peer Networks

PubMed Central

Huff, Emily Silver; Leahy, Jessica E.; Hiebeler, David; Weiskittel, Aaron R.; Noblet, Caroline L.

2015-01-01

Privately owned woodlands are an important source of timber and ecosystem services in North America and worldwide. Impacts of management on these ecosystems and timber supply from these woodlands are difficult to estimate because complex behavioral theory informs the owner’s management decisions. The decision-making environment consists of exogenous market factors, internal cognitive processes, and social interactions with fellow landowners, foresters, and other rural community members. This study seeks to understand how social interactions, information flow, and peer-to-peer networks influence timber harvesting behavior using an agent-based model. This theoretical model includes forested polygons in various states of ‘harvest readiness’ and three types of agents: forest landowners, foresters, and peer leaders (individuals trained in conservation who use peer-to-peer networking). Agent rules, interactions, and characteristics were parameterized with values from existing literature and an empirical survey of forest landowner attitudes, intentions, and demographics. The model demonstrates that as trust in foresters and peer leaders increases, the percentage of the forest that is harvested sustainably increases. Furthermore, peer leaders can serve to increase landowner trust in foresters. Model output and equations will inform forest policy and extension/outreach efforts. The model also serves as an important testing ground for new theories of landowner decision making and behavior. PMID:26562429

STS-114: Engine Cut-Off Sensors Are a No-Go: Teaching Notes for NASA Case Study

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2013-01-01

This case study format is intended to simulate the experience of facing the same difficult challenges and making the same critical decisions as managers, engineers, and scientists in the Space Shuttle Program. It has been designed for use in the classroom setting to help students develop skills related to decision-making. Students will read about the engine cut-off sensor anomaly which created challenges during the STS-114 mission and have the opportunity to make decisions as lead NASA engineers and Mission Management Team members. Included within this document are three case study presentation options - class discussion, group activity, and open-ended research. Please read the full case prior to in-class presentation to allow ample time for students' analysis and reflection, as well as to prepare additional questions. activities or exercises, material selection, etc. Depending upon the setting of your presentation and the number of participants, please choose at least one presentation format beforehand and plan accordingly. You may expect the following learning objectives by using the proposed formats. Learning Objectives: To enable students to experience the responsibilities of NASA management, engineers, and analysis; to discover possible procedures for investigating system anomalies; to become familiar with the liquid hydrogen low level engine cut-off sensor, including its function, connecting components, and location within the Space Shuttle; and to encourage critical analysis and stimulating discussion of Space Shuttle mission challenges.

Connecting Hazard Analysts and Risk Managers to Sensor Information.

PubMed

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-06-11

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes.

Monitoring and Identifying in Real time Critical Patients Events.

PubMed

Chavez Mora, Emma

2014-01-01

Nowadays pervasive health care monitoring environments, as well as business activity monitoring environments, gather information from a variety of data sources. However it includes new challenges because of the use of body and wireless sensors, nontraditional operational and transactional sources. This makes the health data more difficult to monitor. Decision making in this environment is typically complex and unstructured as clinical work is essentially interpretative, multitasking, collaborative, distributed and reactive. Thus, the health care arena requires real time data management in areas such as patient monitoring, detection of adverse events and adaptive responses to operational failures. This research presents a new architecture that enables real time patient data management through the use of intelligent data sources.

Connecting Hazard Analysts and Risk Managers to Sensor Information

PubMed Central

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-01-01

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes. PMID:27879915

A Design Heritage-Based Forecasting Methodology for Risk Informed Management of Advanced Systems

NASA Technical Reports Server (NTRS)

Maggio, Gaspare; Fragola, Joseph R.

1999-01-01

The development of next generation systems often carries with it the promise of improved performance, greater reliability, and reduced operational costs. These expectations arise from the use of novel designs, new materials, advanced integration and production technologies intended for functionality replacing the previous generation. However, the novelty of these nascent technologies is accompanied by lack of operational experience and, in many cases, no actual testing as well. Therefore some of the enthusiasm surrounding most new technologies may be due to inflated aspirations from lack of knowledge rather than actual future expectations. This paper proposes a design heritage approach for improved reliability forecasting of advanced system components. The basis of the design heritage approach is to relate advanced system components to similar designs currently in operation. The demonstrated performance of these components could then be used to forecast the expected performance and reliability of comparable advanced technology components. In this approach the greater the divergence of the advanced component designs from the current systems the higher the uncertainty that accompanies the associated failure estimates. Designers of advanced systems are faced with many difficult decisions. One of the most common and more difficult types of these decisions are those related to the choice between design alternatives. In the past decision-makers have found these decisions to be extremely difficult to make because they often involve the trade-off between a known performing fielded design and a promising paper design. When it comes to expected reliability performance the paper design always looks better because it is on paper and it addresses all the know failure modes of the fielded design. On the other hand there is a long, and sometimes very difficult road, between the promise of a paper design and its fulfillment; with the possibility that sometimes the reliability promise is not fulfilled at all. Decision makers in advanced technology areas have always known to discount the performance claims of a design to a degree in proportion to its stage of development, and at times have preferred the more mature design over the one of lesser maturity even with the latter promising substantially better performance once fielded. As with the broader measures of performance this has also been true for projected reliability performance. Paper estimates of potential advances in design reliability are to a degree uncertain in proportion to the maturity of the features being proposed to secure those advances. This is especially true when performance-enhancing features in other areas are also planned to be part of the development program.

Water Management Decisions within a Changing Hydrologic Environment

NASA Astrophysics Data System (ADS)

Wegner, D. L.

2013-12-01

Across the United States and around the world we are facing unprecedented demands on our surface and ground water. Increasing population demands coupled with maintaining water quality, supporting species and ecosystem services, distribution of supply, hydrologic variability associated with changing climatic conditions - all require us to look more rigorously at the intersection of policy, management and science. The water supply and hydroelectric constituencies has embraced the concept of Adaptive Management in balancing the needs of resources, people, economies and providing ecosystem support. In its infancy Adaptive Management was employed as a way to move forward on dam operation and reservoir management decisions while recognizing the unknowns of how up or downstream physical and biological elements of freshwater systems would respond. River science at the time was not mature or expansive enough to address the interrelated and complex impacts of the nuances of changing operations of dams. Adaptive Management, the concept, made good sense and has provided a framework to inform management and policy decisions while keeping the door open for integrating new knowledge into a management matrix - the essence of adaptation. The application of Adaptive Management principles has continued to expand as water management demands increase. The application and reality of the use of Adaptive Management has had variable success. In the United States we have over 25 federal agencies that have water in their mission statements. Combine this with 50 states with their own water management requirements, Native American Tribes, and countless watershed and local water supply constraints and you get a sense of the challenge associated with collaborating and addressing water management issues. Without having a set of national water objectives and goals (a National Water Policy) it is up to the collaboration and integration of the multiple water silos with appropriate science. It is within this context that river restoration and management case studies will be explored to evaluate opportunities, challenges, the process of integrating science-policy-management, and some perspectives on the possible options for building a water future. A water future that embraces the essence of Adaptive Management without using the concept as a convenient mechanism for avoiding having to make difficult decisions on water management. The review will include assessing the application of various tools including hydrologic and ecosystem models, experimental floods, channel-cleansing flows, manipulation of habitats, and seasonal allocation of water to provide flooding of estuary habitats and river mouths for water volume and water quality purposes.

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis.

PubMed

Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; Macdonald, Mary Ellen; Marchand, Robert

2014-01-01

Conversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service. This qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place. The organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients' complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic. Decision-making conversations and the initiation thereof were framed by the organization of care and the referral process prior to initial encounters. While symptom management was taken for granted as part of health care professionals' expected role, engaging in decisions regarding preparation for death implicitly remained under patients' control. This work makes important clinical contributions by exposing the rhetorical function of family physicians' discourse when introducing palliative care decisions.

Integrating Collaboration, Adaptive Management, and Scenario-Planning to Address Rapid Change: Experiences at Las Cienegas National Conservation Area

NASA Astrophysics Data System (ADS)

Caves, J. K.; Bodner, G.; Simms, K.; Fisher, L.; Robertson, T.

2012-12-01

There is growing recognition that public lands cannot be managed as islands; rather, land management must address the ecological, social, and temporal complexity that often spans jurisdictions and traditional planning horizons. Collaborative decision-making and adaptive management (CAM) have been promoted as methods to reconcile competing societal demands and respond to complex ecosystem dynamics. We present the experiences of land managers and stakeholders in using CAM at Las Cienegas National Conservation Area (LCNCA), a highly valued site under the jurisdiction of the Bureau of Land Management (BLM). The CAM process at Las Cienegas is marked by strong stakeholder engagement, with four core elements: 1) shared watershed goals with measurable resource objectives; 2) mechanisms to incorporate new information into decision-making; 3) efforts to make information increasingly relevant and reliable; and 4) shared learning to improve both the process and management actions. The combination of stakeholder engagement and adaptive management has led to agreement on contentious issues, more innovative solutions, and more effective land management. Yet the region is now experiencing rapid changes outside managers' control—including climate change, human population growth, and reduced federal budgets—with large but unpredictable impacts on natural resources. While CAM experience provides a strong foundation for making the difficult and contentious management decisions that such changes are likely to require, neither collaboration nor adaptive management provides a sufficient structure for addressing uncontrollable and unpredictable change. As a result, LCNCA is exploring two specific modifications to CAM that may better address emerging challenges, including: 1) Creating nested resource objectives to distinguish between those objectives which may be crucial from those which may hinder a flexible response to climate change, and 2) Incorporating scenario planning into CAM to explore how climate change may interact with other drivers and alter options for the future, to identify robust management, and to prioritize ecological monitoring efforts. The experiences at LCNCA demonstrate how collaboration and adaptive management can be used to improve social and environmental outcomes and, with a few modifications, may help address the complexity and change that threatens to overwhelm even the best efforts to sustain public lands.

Studying the Past for the Future: Managing Modern Biodiversity from Historic and Prehistoric Data

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

Foster, Professor Thomas; Olsen, Lisa M; Dale, Virginia H

Management of biodiversity and anthropogenic effects on the environment are some of the most difficult challenges facing humans today. In this paper, we describe how archaeological, historical, and ecological data can be combined to identify metrics of ecological change. Archaeological surveys, historic witness tree data, analysis of ancient pollen, and recent satellite imagery are combined to create indicators of change that are useable by modem environmental managers at Fort Benning Military Reservation in Georgia and Alabama in the United States. Archaeological data were collected at 30 meter intervals, historic vegetation data were collected from early nineteenth century survey maps, andmore » ancient pollen and charcoal were collected from soil cores in lakes. We show how data sets collected with disparate goals from anthropology and ecology can be applied to make policy decisions about environmental management.« less

A Path to Actionable Climate Science: Perspectives from the Field

NASA Astrophysics Data System (ADS)

DeCrappeo, Nicole M.; Bisbal, Gustavo A.; Meadow, Alison M.

2018-02-01

The U.S. Department of the Interior Climate Science Centers (CSCs) work with natural and cultural resource managers and scientists to gather information and build tools needed to help fish, wildlife, and ecosystems adapt to the impacts of climate change. The CSCs prioritize the delivery of actionable science products (e.g., synthesized scientific information, maps, decision support tools, etc.) that are focused on key management priorities and co-produced by teams of scientists and managers. In the specific case of the Northwest CSC, we have been successful at promoting and supporting the co-production of actionable climate science at the individual project level, but it has been more difficult to replicate this success at the regional program level. Here we identify the most significant challenges in satisfying this mandate and propose the creation of a Science Advisory Panel to provide improved interface between resource managers and scientists engaged with the Northwest CSC.

Hybridization and endangered species protection in the molecular era.

PubMed

Wayne, Robert K; Shaffer, H Bradley

2016-06-01

After decades of discussion, there is little consensus on the extent to which hybrids between endangered and nonendangered species should be protected by US law. As increasingly larger, genome-scale data sets are developed, we can identify individuals and populations with even trace levels of genetic admixture, making the 'hybrid problem' all the more difficult. We developed a decision-tree framework for evaluating hybrid protection, including both the processes that produced hybrids (human-mediated or natural) and the ecological impact of hybrids on natural ecosystems. We then evaluated our decision tree for four case studies drawn from our own work and briefly discuss several other cases from the literature. Throughout, we highlight the management outcomes that our approach provides and the nuances of hybridization as a conservation problem. © 2016 John Wiley & Sons Ltd.

When to stop managing or surveying cryptic threatened species

PubMed Central

Chadès, Iadine; McDonald-Madden, Eve; McCarthy, Michael A.; Wintle, Brendan; Linkie, Matthew; Possingham, Hugh P.

2008-01-01

Threatened species become increasingly difficult to detect as their populations decline. Managers of such cryptic threatened species face several dilemmas: if they are not sure the species is present, should they continue to manage for that species or invest the limited resources in surveying? We find optimal solutions to this problem using a Partially Observable Markov Decision Process and rules of thumb derived from an analytical approximation. We discover that managing a protected area for a cryptic threatened species can be optimal even if we are not sure the species is present. The more threatened and valuable the species is, relative to the costs of management, the more likely we are to manage this species without determining its continued persistence by using surveys. If a species remains unseen, our belief in the persistence of the species declines to a point where the optimal strategy is to shift resources from saving the species to surveying for it. Finally, when surveys lead to a sufficiently low belief that the species is extant, we surrender resources to other conservation actions. We illustrate our findings with a case study using parameters based on the critically endangered Sumatran tiger (Panthera tigris sumatrae), and we generate rules of thumb on how to allocate conservation effort for any cryptic species. Using Partially Observable Markov Decision Processes in conservation science, we determine the conditions under which it is better to abandon management for that species because our belief that it continues to exist is too low. PMID:18779594

When to stop managing or surveying cryptic threatened species.

PubMed

Chadès, Iadine; McDonald-Madden, Eve; McCarthy, Michael A; Wintle, Brendan; Linkie, Matthew; Possingham, Hugh P

2008-09-16

Threatened species become increasingly difficult to detect as their populations decline. Managers of such cryptic threatened species face several dilemmas: if they are not sure the species is present, should they continue to manage for that species or invest the limited resources in surveying? We find optimal solutions to this problem using a Partially Observable Markov Decision Process and rules of thumb derived from an analytical approximation. We discover that managing a protected area for a cryptic threatened species can be optimal even if we are not sure the species is present. The more threatened and valuable the species is, relative to the costs of management, the more likely we are to manage this species without determining its continued persistence by using surveys. If a species remains unseen, our belief in the persistence of the species declines to a point where the optimal strategy is to shift resources from saving the species to surveying for it. Finally, when surveys lead to a sufficiently low belief that the species is extant, we surrender resources to other conservation actions. We illustrate our findings with a case study using parameters based on the critically endangered Sumatran tiger (Panthera tigris sumatrae), and we generate rules of thumb on how to allocate conservation effort for any cryptic species. Using Partially Observable Markov Decision Processes in conservation science, we determine the conditions under which it is better to abandon management for that species because our belief that it continues to exist is too low.

Gastric neuroendocrine tumours.

PubMed

Crosby, David A; Donohoe, Claire L; Fitzgerald, Louise; Muldoon, Cian; Hayes, Brian; O'Toole, Dermot; Reynolds, John V

2012-01-01

Gastric neuroendocrine tumours (NETs) are increasingly recognised, and management decisions may be difficult due to an incomplete understanding of aetiology, natural history and optimum therapy. This article presents a current understanding based on recent advances in epidemiology, classification, molecular profiling, and treatment. Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance. Gastric NETs may be divided into three clinical prognostic groups: type I is associated with autoimmune atrophic gastritis and hypergastrinaemia, type II is associated with Zollinger-Ellison syndrome, and type III lesions are gastrin-independent, have the greatest metastatic potential and poorest prognosis. There has been an increased frequency of gastric NETs reported. Management approaches have evolved in parallel with advances in endoscopic staging and surgery, as well as improved understanding of the biology and natural history of NETs. Gastric NETs present a spectrum of activity from indolent tumours to metastatic malignancy. Treatment decisions for patients must be individualised and are best managed by a multidisciplinary team approach. The current evidence base is limited to small series and efforts to treat patients within clinical networks of expertise are warranted. Copyright © 2012 S. Karger AG, Basel.

Analysis of nonlinear relationships in dual epidemics, and its application to the management of grapevine downy and powdery mildews.

PubMed

Savary, Serge; Delbac, Lionel; Rochas, Amélie; Taisant, Guillaume; Willocquet, Laetitia

2009-08-01

Dual epidemics are defined as epidemics developing on two or several plant organs in the course of a cropping season. Agricultural pathosystems where such epidemics develop are often very important, because the harvestable part is one of the organs affected. These epidemics also are often difficult to manage, because the linkage between epidemiological components occurring on different organs is poorly understood, and because prediction of the risk toward the harvestable organs is difficult. In the case of downy mildew (DM) and powdery mildew (PM) of grapevine, nonlinear modeling and logistic regression indicated nonlinearity in the foliage-cluster relationships. Nonlinear modeling enabled the parameterization of a transmission coefficient that numerically links the two components, leaves and clusters, in DM and PM epidemics. Logistic regression analysis yielded a series of probabilistic models that enabled predicting preset levels of cluster infection risks based on DM and PM severities on the foliage at successive crop stages. The usefulness of this framework for tactical decision-making for disease control is discussed.

Management of metal-on-metal hip implant patients: Who, when and how to revise?

PubMed

Berber, Reshid; Skinner, John A; Hart, Alister J

2016-05-18

The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed.

Management of metal-on-metal hip implant patients: Who, when and how to revise?

PubMed Central

Berber, Reshid; Skinner, John A; Hart, Alister J

2016-01-01

The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II).

PubMed

Carrascosa, J M; Galán, M; de Lucas, R; Pérez-Ferriols, A; Ribera, M; Yanguas, I

2016-11-01

There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Pig farmers' perceptions, attitudes, influences and management of information in the decision-making process for disease control.

PubMed

Alarcon, Pablo; Wieland, Barbara; Mateus, Ana L P; Dewberry, Chris

2014-10-01

The objectives of this study were (1) to explore the factors involved in the decision-making process used by pig farmers for disease control and (2) to investigate pig farmers' attitudes and perceptions about different information sources relating to disease control. In 2011 a qualitative study involving 20 face-to-face interviews with English pig farmers was conducted. The questionnaire was composed of three parts. The first part required farmers to identify two diseases they had experienced and which were difficult to recognize and/or control. They were asked to report how the disease problem was recognized, how the need for control was decided, and what affected the choice of control approach. For the latter, a structure related to the Theory of Planned Behaviour was used. Their verbal responses were classified as associated with: (1) attitude and beliefs, (2) subjective norms, or (3) perceived behavioural control (PBC). In the second part, five key sources of information for disease control (Defra, BPEX, research from academia, internet and veterinarians) and the factors related to barriers to knowledge were investigated. Interviews were recorded and transcribed. A qualitative analysis of the text of the interview transcripts was carried out using templates. Drivers for disease control were 'pig mortality', 'feeling of entering in an economically critical situation', 'animal welfare' and 'feeling of despair'. Veterinarians were perceived by several participating farmers as the most trusted information source on disease control. However, in particular non-sustainable situations, other producers, and especially experiences from abroad, seemed to considerably influence the farmers' decision-making. 'Lack of knowledge', 'farm structure and management barriers' and 'economic constrains' were identified in relation to PBC. Several negative themes, such as 'lack of communication', 'not knowing where to look', and 'information bias' were associated with research from academia. This study identified a range of factors influencing the decision-making process for disease control by pig farmers. In addition, it highlighted the lack of awareness and difficult access of producers to current scientific research outputs. The factors identified should be considered when developing communication strategies to disseminate research findings and advice for disease control. Copyright © 2013 Elsevier B.V. All rights reserved.

Understanding Patenting Decisions: A Classroom Exercise

ERIC Educational Resources Information Center

Bernard, John C.; Yiannaka, Amalia

2010-01-01

Although many students have some knowledge of patents, it can be difficult for them to understand the components of an innovator's decision-making process. Key issues, such as whether to patent or to use trade secrecy, how broad a scope to claim, and what to do in the event of patent infringement, can be difficult to grasp from a standard lecture.…

Quantifying the Value of Downscaled Climate Model Information for Adaptation Decisions: When is Downscaling a Smart Decision?

NASA Astrophysics Data System (ADS)

Terando, A. J.; Wootten, A.; Eaton, M. J.; Runge, M. C.; Littell, J. S.; Bryan, A. M.; Carter, S. L.

2015-12-01

Two types of decisions face society with respect to anthropogenic climate change: (1) whether to enact a global greenhouse gas abatement policy, and (2) how to adapt to the local consequences of current and future climatic changes. The practice of downscaling global climate models (GCMs) is often used to address (2) because GCMs do not resolve key features that will mediate global climate change at the local scale. In response, the development of downscaling techniques and models has accelerated to aid decision makers seeking adaptation guidance. However, quantifiable estimates of the value of information are difficult to obtain, particularly in decision contexts characterized by deep uncertainty and low system-controllability. Here we demonstrate a method to quantify the additional value that decision makers could expect if research investments are directed towards developing new downscaled climate projections. As a proof of concept we focus on a real-world management problem: whether to undertake assisted migration for an endangered tropical avian species. We also take advantage of recently published multivariate methods that account for three vexing issues in climate impacts modeling: maximizing climate model quality information, accounting for model dependence in ensembles of opportunity, and deriving probabilistic projections. We expand on these global methods by including regional (Caribbean Basin) and local (Puerto Rico) domains. In the local domain, we test whether a high resolution (2km) dynamically downscaled GCM reduces the multivariate error estimate compared to the original coarse-scale GCM. Initial tests show little difference between the downscaled and original GCM multivariate error. When propagated through to a species population model, the Value of Information analysis indicates that the expected utility that would accrue to the manager (and species) if this downscaling were completed may not justify the cost compared to alternative actions.

Software Tools For Building Decision-support Models For Flood Emergency Situations

NASA Astrophysics Data System (ADS)

Garrote, L.; Molina, M.; Ruiz, J. M.; Mosquera, J. C.

The SAIDA decision-support system was developed by the Spanish Ministry of the Environment to provide assistance to decision-makers during flood situations. SAIDA has been tentatively implemented in two test basins: Jucar and Guadalhorce, and the Ministry is currently planning to have it implemented in all major Spanish basins in a few years' time. During the development cycle of SAIDA, the need for providing as- sistance to end-users in model definition and calibration was clearly identified. System developers usually emphasise abstraction and generality with the goal of providing a versatile software environment. End users, on the other hand, require concretion and specificity to adapt the general model to their local basins. As decision-support models become more complex, the gap between model developers and users gets wider: Who takes care of model definition, calibration and validation?. Initially, model developers perform these tasks, but the scope is usually limited to a few small test basins. Before the model enters operational stage, end users must get involved in model construction and calibration, in order to gain confidence in the model recommendations. However, getting the users involved in these activities is a difficult task. The goal of this re- search is to develop representation techniques for simulation and management models in order to define, develop and validate a mechanism, supported by a software envi- ronment, oriented to provide assistance to the end-user in building decision models for the prediction and management of river floods in real time. The system is based on three main building blocks: A library of simulators of the physical system, an editor to assist the user in building simulation models, and a machine learning method to calibrate decision models based on the simulation models provided by the user.

Risk Acceptance Personality Paradigm: How We View What We Don't Know We Don't Know

NASA Technical Reports Server (NTRS)

Massie, Michael J.; Morris, A. Terry

2011-01-01

The purpose of integrated hazard analyses, probabilistic risk assessments, failure modes and effects analyses, fault trees and many other similar tools is to give managers of a program some idea of the risks associated with their program. All risk tools establish a set of undesired events and then try to evaluate the risk to the program by assessing the severity of the undesired event and the likelihood of that event occurring. Some tools provide qualitative results, some provide quantitative results and some do both. However, in the end the program manager and his/her team must decide which risks are acceptable and which are not. Even with a wide array of analysis tools available, risk acceptance is often a controversial and difficult decision making process. And yet, today's space exploration programs are moving toward more risk based design approaches. Thus, risk identification and good risk assessment is becoming even more vital to the engineering development process. This paper explores how known and unknown information influences risk-based decisions by looking at how the various parts of our personalities are affected by what they know and what they don't know. This paper then offers some criteria for consideration when making risk-based decisions.

Using Models to Inform Policy: Insights from Modeling the Complexities of Global Polio Eradication

NASA Astrophysics Data System (ADS)

Thompson, Kimberly M.

Drawing on over 20 years of experience modeling risks in complex systems, this talk will challenge SBP participants to develop models that provide timely and useful answers to critical policy questions when decision makers need them. The talk will include reflections on the opportunities and challenges associated with developing integrated models for complex problems and communicating their results effectively. Dr. Thompson will focus the talk largely on collaborative modeling related to global polio eradication and the application of system dynamics tools. After successful global eradication of wild polioviruses, live polioviruses will still present risks that could potentially lead to paralytic polio cases. This talk will present the insights of efforts to use integrated dynamic, probabilistic risk, decision, and economic models to address critical policy questions related to managing global polio risks. Using a dynamic disease transmission model combined with probabilistic model inputs that characterize uncertainty for a stratified world to account for variability, we find that global health leaders will face some difficult choices, but that they can take actions that will manage the risks effectively. The talk will emphasize the need for true collaboration between modelers and subject matter experts, and the importance of working with decision makers as partners to ensure the development of useful models that actually get used.

Ontology-Based Gap Analysis for Technology Selection: A Knowledge Management Framework for the Support of Equipment Purchasing Processes

NASA Astrophysics Data System (ADS)

Macris, Aristomenis M.; Georgakellos, Dimitrios A.

Technology selection decisions such as equipment purchasing and supplier selection are decisions of strategic importance to companies. The nature of these decisions usually is complex, unstructured and thus, difficult to be captured in a way that will be efficiently reusable. Knowledge reusability is of paramount importance since it enables users participate actively in process design/redesign activities stimulated by the changing technology selection environment. This paper addresses the technology selection problem through an ontology-based approach that captures and makes reusable the equipment purchasing process and assists in identifying (a) the specifications requested by the users' organization, (b) those offered by various candidate vendors' organizations and (c) in performing specifications gap analysis as a prerequisite for effective and efficient technology selection. This approach has practical appeal, operational simplicity, and the potential for both immediate and long-term strategic impact. An example from the iron and steel industry is also presented to illustrate the approach.

Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

PubMed

Kronbak, Lone Grønbæk; Vestergaard, Niels

2013-12-15

In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. Copyright © 2013 Elsevier Ltd. All rights reserved.

Parenting the parents of pediatric patients.

PubMed

Soxman, Jane

2006-11-01

Managing the behavior of pediatric patients has been the focus of many studies; however, paying attention to the parents and their individual circumstances may be just as important to achieve our treatment goals. Parents today expect to be involved in treatment decisions and often have distinct expectations regarding their children's experiences. Parental attitudes and emotions can adversely affect the tone of the appointment and negatively influence the child's perception of the event. Managing the behavior of a challenging child is difficult, but combining that with the challenging behavior of a parent can be exhausting. This article will provide anticipatory guidance on how to enhance communication skills to avoid confusion and offer direction to parents before, during, and after the treatment of their children.

Addressing Climate Change in Long-Term Water Planning Using Robust Decisionmaking

NASA Astrophysics Data System (ADS)

Groves, D. G.; Lempert, R.

2008-12-01

Addressing climate change in long-term natural resource planning is difficult because future management conditions are deeply uncertain and the range of possible adaptation options are so extensive. These conditions pose challenges to standard optimization decision-support techniques. This talk will describe a methodology called Robust Decisionmaking (RDM) that can complement more traditional analytic approaches by utilizing screening-level water management models to evaluate large numbers of strategies against a wide range of plausible future scenarios. The presentation will describe a recent application of the methodology to evaluate climate adaptation strategies for the Inland Empire Utilities Agency in Southern California. This project found that RDM can provide a useful way for addressing climate change uncertainty and identify robust adaptation strategies.

New Map Symbol System for Disaster Management

NASA Astrophysics Data System (ADS)

Marinova, Silvia T.

2018-05-01

In the last 10 years Bulgaria was frequently affected by natural and man-made disasters that caused considerable losses. According to the Bulgarian Disaster Management Act (2006) disaster management should be planned at local, regional and national level. Disaster protection is based on plans that include maps such as hazard maps, maps for protection, maps for evacuation planning, etc. Decision-making and cooperation between two or more neighboring municipalities or regions in crisis situation are still rendered difficult because the maps included in the plans differ in scale, colors, map symbols and cartographic design. To improve decision-making process in case of emergency and to reduce the number of human loss and property damages disaster management plans at local and regional level should be supported by detailed thematic maps created in accordance with uniform contents, map symbol system and design. The paper proposes a new symbol system for disaster management that includes a four level hierarchical classification of objects and phenomena according to their type and origin. All objects and phenomena of this classification are divided into five categories: disasters; infrastructure; protection services and infrastructure for protection; affected people and affected infrastructure; operational sites and activities. The symbols of these categories are shown with different background colors and shapes so that they are identifiable. All the symbols have simple but associative design. The new symbol system is used in the design of a series of maps for disaster management at local and regional level.

Using Bayesian Population Viability Analysis to Define Relevant Conservation Objectives.

PubMed

Green, Adam W; Bailey, Larissa L

2015-01-01

Adaptive management provides a useful framework for managing natural resources in the face of uncertainty. An important component of adaptive management is identifying clear, measurable conservation objectives that reflect the desired outcomes of stakeholders. A common objective is to have a sustainable population, or metapopulation, but it can be difficult to quantify a threshold above which such a population is likely to persist. We performed a Bayesian metapopulation viability analysis (BMPVA) using a dynamic occupancy model to quantify the characteristics of two wood frog (Lithobates sylvatica) metapopulations resulting in sustainable populations, and we demonstrate how the results could be used to define meaningful objectives that serve as the basis of adaptive management. We explored scenarios involving metapopulations with different numbers of patches (pools) using estimates of breeding occurrence and successful metamorphosis from two study areas to estimate the probability of quasi-extinction and calculate the proportion of vernal pools producing metamorphs. Our results suggest that ≥50 pools are required to ensure long-term persistence with approximately 16% of pools producing metamorphs in stable metapopulations. We demonstrate one way to incorporate the BMPVA results into a utility function that balances the trade-offs between ecological and financial objectives, which can be used in an adaptive management framework to make optimal, transparent decisions. Our approach provides a framework for using a standard method (i.e., PVA) and available information to inform a formal decision process to determine optimal and timely management policies.

Providing Climate Policy Makers With a Strong Scientific Base (Invited)

NASA Astrophysics Data System (ADS)

Struzik, E.

2009-12-01

Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

Soliciting scientific information and beliefs in predictive modeling and adaptive management

NASA Astrophysics Data System (ADS)

Glynn, P. D.; Voinov, A. A.; Shapiro, C. D.

2015-12-01

Post-normal science requires public engagement and adaptive corrections in addressing issues with high complexity and uncertainty. An adaptive management framework is presented for the improved management of natural resources and environments through a public participation process. The framework solicits the gathering and transformation and/or modeling of scientific information but also explicitly solicits the expression of participant beliefs. Beliefs and information are compared, explicitly discussed for alignments or misalignments, and ultimately melded back together as a "knowledge" basis for making decisions. An effort is made to recognize the human or participant biases that may affect the information base and the potential decisions. In a separate step, an attempt is made to recognize and predict the potential "winners" and "losers" (perceived or real) of any decision or action. These "winners" and "losers" include present human communities with different spatial, demographic or socio-economic characteristics as well as more dispersed or more diffusely characterized regional or global communities. "Winners" and "losers" may also include future human communities as well as communities of other biotic species. As in any adaptive management framework, assessment of predictions, iterative follow-through and adaptation of policies or actions is essential, and commonly very difficult or impossible to achieve. Recognizing beforehand the limits of adaptive management is essential. More generally, knowledge of the behavioral and economic sciences and of ethics and sociology will be key to a successful implementation of this adaptive management framework. Knowledge of biogeophysical processes will also be essential, but by definition of the issues being addressed, will always be incomplete and highly uncertain. The human dimensions of the issues addressed and the participatory processes used carry their own complexities and uncertainties. Some ideas and principles are provided that may help guide and implement the proposed adaptive management framework and its public and stakeholder engagement processes. Examples and characteristics of issues that could be beneficially addressed through the proposed framework will also be presented.

The use of data-mining techniques for developing effective decisionsupport systems: A case study of simulating the effects ofclimate change on coastal salinity intrusion

USGS Publications Warehouse

Conrads, Paul; Edwin Roehl, Jr.

2017-01-01

Natural-resource managers and stakeholders face difficult challenges when managing interactions between natural and societal systems. Potential changes in climate could alter interactions between environmental and societal systems and adversely affect the availability of water resources in many coastal communities. The availability of freshwater in coastal streams can be threatened by saltwater intrusion. Even though the collective interests and computer skills of the community of managers, scientists and other stakeholders are quite varied, there is an overarching need for equal access by all to the scientific knowledge needed to make the best possible decisions. This paper describes a decision support system, PRISM-2, developed to evaluate salinity intrusion due to potential climate change along the South Carolina coast in southeastern USA. The decision support system is disseminated as a spreadsheet application and integrates the output of global circulation models, watershed models and salinity intrusion models with real-time databases for simulation, graphical user interfaces, and streaming displays of results. The results from PRISM-2 showed that a 31-cm and 62-cm increase in sea level reduced the daily availability of freshwater supply to a coastal municipal intake by 4% and 12% of the time, respectively. Future climate change projections by a global circulation model showed a seasonal change in salinity intrusion events from the summer to the fall for the majority of events.

Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System.

PubMed

Kuhn, Lindsay; Reeves, Kelly; Taylor, Yhenneko; Tapp, Hazel; McWilliams, Andrew; Gunter, Andrew; Cleveland, Jeffrey; Dulin, Michael

2015-01-01

Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls. Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant. This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice. © Copyright 2015 by the American Board of Family Medicine.

The passive-aggressive organization.

PubMed

Kaplan, Robert S; Norton, David P

2005-10-01

Passive-aggressive organizations are friendly places to work: People are congenial, conflict is rare, and consensus is easy to reach. But, at the end of the day, even the best proposals fail to gain traction, and a company can go nowhere so imperturbably that it's easy to pretend everything is fine. Such companies are not necessarily saddled with mulishly passive-aggressive employees. Rather, they are filled with mostly well-intentioned people who are the victirms of flawed processes and policies. Commonly, a growing company's halfhearted or poorly thought-out attempts to decentralize give rise to multiple layers of managers, whose authority for making decisions becomes increasingly unclear. Some managers, as a result, hang back, while others won't own up to the calls they've made, inviting colleagues to second-guess or overturn the decisions. In such organizations, information does not circulate freely, and that makes it difficult for workers to understand the impact of their actions on company performance and for managers to correctly appraise employees' value to the organization. A failure to accurately match incentives to performance stifles initiative, and people do just enough to get by. Breaking free from this pattern is hard; a long history of seeing corporate initiatives ignored and then fade away tends to make people cynical. Often it's best to bring in an outsider to signal that this time things will be different. He or she will need to address every obstacle all at once: clarify decision rights; see to it that decisions stick; and reward people for sharing information and adding value, not for successfully negotiating corporate politics. If those steps are not taken, it's only a matter of time before the diseased elements of a passive-aggressive organization overwhelm the remaining healthy ones and drive the company into financial distress.

Individual differences in temperament and behavioral management practices for nonhuman primates

PubMed Central

Coleman, Kristine

2011-01-01

Effective behavioral management plans are tailored to unique behavioral patterns of each individual species. However, even within a species behavioral needs of individuals can vary. Factors such as age, sex, and temperament can affect behavioral needs of individuals. While some of these factors, such as age and sex, are taken into account, other factors, such as an individual’s temperament, are rarely specifically provided for in behavioral management plans. However, temperament may affect how animals respond to socialization, positive reinforcement training and other forms of enrichment. This review will examine how individual differences in temperament might affect, or be affected by, behavioral management practices for captive primates. Measuring temperament may help us predict outcome of social introductions. It can also predict which animals may be difficult to train using traditional methods. Further, knowledge of temperament may be able to help identify individuals at risk for development of behavioral problems. Taken together, understanding individual differences in temperament of captive primates can help guide behavioral management decisions. PMID:22518067

Designing smart analytical data services for a personal health framework.

PubMed

Koumakis, Lefteris; Kondylakis, Haridimos; Chatzimina, Maria; Iatraki, Galatia; Argyropaidas, Panagiotis; Kazantzaki, Eleni; Tsiknakis, Manolis; Kiefer, Stephan; Marias, Kostas

2016-01-01

Information in the healthcare domain and in particular personal health record information is heterogeneous by nature. Clinical, lifestyle, environmental data and personal preferences are stored and managed within such platforms. As a result, significant information from such diverse data is difficult to be delivered, especially to non-IT users like patients, physicians or managers. Another issue related to the management and analysis is the volume, which increases more and more making the need for efficient data visualization and analysis methods mandatory. The objective of this work is to present the architectural design for seamless integration and intelligent analysis of distributed and heterogeneous clinical information in the PHR context, as a result of a requirements elicitation process in iManageCancer project. This systemic approach aims to assist health-care professionals to orient themselves in the disperse information space and enhance their decision-making capabilities, to encourage patients to have an active role by managing their health information and interacting with health-care professionals.

The Restoration Rapid Assessment Tool: An Access/Visual Basic application

USGS Publications Warehouse

Hiebert, Ron; Larson, D.L.; Thomas, K.; Tancreto, N.; Haines, D.; Richey, A.; Dow, T.; Drees, L.

2009-01-01

Managers of parks and natural areas are increasingly faced with difficult decisions concerning restoration of disturbed lands. Financial and workforce resources often limit these restoration efforts, and rarely can a manager afford to address all concerns within the region of interest. With limited resources, managers and scientists have to decide which areas will be targeted for restoration and the restoration treatments to use in these areas. A broad range of approaches are used to make such decisions, from well-researched expert opinions (Cipollini et al. 2005) to gut feeling, with variable degrees of input from site visits, data collection, and data analysis used to support the decision. A standardized approach including an analytical assessment of site characteristics based on the best information available, with a written or electronic record of all the steps taken along the way, would make comparisons among a group of sites easier and lend credibility through use of common, documented criteria at all sites. In response to these concerns, we have developed the Restoration Rapid Assessment Tool (RRAT). RRAT is based on field observations of key indicators of site degradation, stressors influencing the site, value of the site with respect to larger management objectives, likelihood of achieving the management goals, and logistical constraints to restoration. The purpose of RRAT is not to make restoration decisions or prescribe methods, but rather to ensure that a basic set of pertinent issues are considered for each site and to facilitate comparisons among sites. Several concepts have been central to the development of RRAT. First, the management goal (also known as desired future condition) of any site under evaluation should be defined before the field evaluation begins. Second, the evaluation should be based upon readily observable indicators so as to avoid cumbersome field methods. Third, the ease with which site stressors can be ameliorated must be factored into the evaluation. Fourth, intrinsic site value must be assessed independently of current condition. Finally, logistical considerations must also be addressed. Our initial focus has been on riparian areas because they are among the most heavily impacted habitat types, and RRAT indicators reflect this focus.

A Diagnostics Tool to detect ensemble forecast system anomaly and guide operational decisions

NASA Astrophysics Data System (ADS)

Park, G. H.; Srivastava, A.; Shrestha, E.; Thiemann, M.; Day, G. N.; Draijer, S.

2017-12-01

The hydrologic community is moving toward using ensemble forecasts to take uncertainty into account during the decision-making process. The New York City Department of Environmental Protection (DEP) implements several types of ensemble forecasts in their decision-making process: ensemble products for a statistical model (Hirsch and enhanced Hirsch); the National Weather Service (NWS) Advanced Hydrologic Prediction Service (AHPS) forecasts based on the classical Ensemble Streamflow Prediction (ESP) technique; and the new NWS Hydrologic Ensemble Forecasting Service (HEFS) forecasts. To remove structural error and apply the forecasts to additional forecast points, the DEP post processes both the AHPS and the HEFS forecasts. These ensemble forecasts provide mass quantities of complex data, and drawing conclusions from these forecasts is time-consuming and difficult. The complexity of these forecasts also makes it difficult to identify system failures resulting from poor data, missing forecasts, and server breakdowns. To address these issues, we developed a diagnostic tool that summarizes ensemble forecasts and provides additional information such as historical forecast statistics, forecast skill, and model forcing statistics. This additional information highlights the key information that enables operators to evaluate the forecast in real-time, dynamically interact with the data, and review additional statistics, if needed, to make better decisions. We used Bokeh, a Python interactive visualization library, and a multi-database management system to create this interactive tool. This tool compiles and stores data into HTML pages that allows operators to readily analyze the data with built-in user interaction features. This paper will present a brief description of the ensemble forecasts, forecast verification results, and the intended applications for the diagnostic tool.

Time Sharing Between Robotics and Process Control: Validating a Model of Attention Switching.

PubMed

Wickens, Christopher Dow; Gutzwiller, Robert S; Vieane, Alex; Clegg, Benjamin A; Sebok, Angelia; Janes, Jess

2016-03-01

The aim of this study was to validate the strategic task overload management (STOM) model that predicts task switching when concurrence is impossible. The STOM model predicts that in overload, tasks will be switched to, to the extent that they are attractive on task attributes of high priority, interest, and salience and low difficulty. But more-difficult tasks are less likely to be switched away from once they are being performed. In Experiment 1, participants performed four tasks of the Multi-Attribute Task Battery and provided task-switching data to inform the role of difficulty and priority. In Experiment 2, participants concurrently performed an environmental control task and a robotic arm simulation. Workload was varied by automation of arm movement and both the phases of environmental control and existence of decision support for fault management. Attention to the two tasks was measured using a head tracker. Experiment 1 revealed the lack of influence of task priority and confirmed the differing roles of task difficulty. In Experiment 2, the percentage attention allocation across the eight conditions was predicted by the STOM model when participants rated the four attributes. Model predictions were compared against empirical data and accounted for over 95% of variance in task allocation. More-difficult tasks were performed longer than easier tasks. Task priority does not influence allocation. The multiattribute decision model provided a good fit to the data. The STOM model is useful for predicting cognitive tunneling given that human-in-the-loop simulation is time-consuming and expensive. © 2016, Human Factors and Ergonomics Society.

A Hybrid-Cloud Science Data System Enabling Advanced Rapid Imaging & Analysis for Monitoring Hazards

NASA Astrophysics Data System (ADS)

Hua, H.; Owen, S. E.; Yun, S.; Lundgren, P.; Moore, A. W.; Fielding, E. J.; Radulescu, C.; Sacco, G.; Stough, T. M.; Mattmann, C. A.; Cervelli, P. F.; Poland, M. P.; Cruz, J.

2012-12-01

Volcanic eruptions, landslides, and levee failures are some examples of hazards that can be more accurately forecasted with sufficient monitoring of precursory ground deformation, such as the high-resolution measurements from GPS and InSAR. In addition, coherence and reflectivity change maps can be used to detect surface change due to lava flows, mudslides, tornadoes, floods, and other natural and man-made disasters. However, it is difficult for many volcano observatories and other monitoring agencies to process GPS and InSAR products in an automated scenario needed for continual monitoring of events. Additionally, numerous interoperability barriers exist in multi-sensor observation data access, preparation, and fusion to create actionable products. Combining high spatial resolution InSAR products with high temporal resolution GPS products--and automating this data preparation & processing across global-scale areas of interests--present an untapped science and monitoring opportunity. The global coverage offered by satellite-based SAR observations, and the rapidly expanding GPS networks, can provide orders of magnitude more data on these hazardous events if we have a data system that can efficiently and effectively analyze the voluminous raw data, and provide users the tools to access data from their regions of interest. Currently, combined GPS & InSAR time series are primarily generated for specific research applications, and are not implemented to run on large-scale continuous data sets and delivered to decision-making communities. We are developing an advanced service-oriented architecture for hazard monitoring leveraging NASA-funded algorithms and data management to enable both science and decision-making communities to monitor areas of interests via seamless data preparation, processing, and distribution. Our objectives: * Enable high-volume and low-latency automatic generation of NASA Solid Earth science data products (InSAR and GPS) to support hazards monitoring. * Facilitate NASA-USGS collaborations to share NASA InSAR and GPS data products, which are difficult to process in high-volume and low-latency, for decision-support. * Enable interoperable discovery, access, and sharing of NASA observations and derived actionable products, and between the observation and decision-making communities. * Enable their improved understanding through visualization, mining, and cross-agency sharing. Existing InSAR & GPS processing packages and other software are integrated for generating geodetic decision support monitoring products. We employ semantic and cloud-based data management and processing techniques for handling large data volumes, reducing end product latency, codifying data system information with semantics, and deploying interoperable services for actionable products to decision-making communities.

Prognosis after treatment with multiple dental implants under general anesthesia and sedation in a cerebral palsy patient with mental retardation: A case report.

PubMed

Hong, Young-Joon; Dan, Jung-Bae; Kim, Myung-Jin; Kim, Hyun Jeong; Seo, Kwang-Suk

2017-06-01

Cerebral palsy is a non-progressive disorder resulting from central nervous system damage caused by multiple factors. Almost all cerebral palsy patients have a movement disorder that makes dental treatment difficult. Oral hygiene management is difficult and the risks for periodontitis, dental caries and loss of multiple teeth are high. Placement of dental implants for multiple missing teeth in cerebral palsy patients needs multiple rounds of general anesthesia, and the prognosis is poor despite the expense. Therefore, making the decision to perform multiple dental implant treatments on cerebral palsy patients is difficult. A 33-year-old female patient with cerebral palsy and mental retardation was scheduled for multiple implant treatments. She underwent computed tomography (CT) under sedation and the operation of nine dental implants under general anesthesia. Implant-supported fixed prosthesis treatment was completed. During follow-up, she had the anterior incisors extracted and underwent the surgery of 3 additional dental implants, completing the prosthetic treatment. Although oral parafunctions existed due to cerebral palsy, no implant failure was observed 9 years after the first implant surgery.

Eye Tracking and Pupillometry are Indicators of Dissociable Latent Decision Processes

PubMed Central

Cavanagh, James F.; Wiecki, Thomas V.; Kochar, Angad; Frank, Michael J.

2014-01-01

Can you predict what someone is going to do just by watching them? This is certainly difficult: it would require a clear mapping between observable indicators and unobservable cognitive states. In this report we demonstrate how this is possible by monitoring eye gaze and pupil dilation, which predict dissociable biases during decision making. We quantified decision making using the Drift Diffusion Model (DDM), which provides an algorithmic account of how evidence accumulation and response caution contribute to decisions through separate latent parameters of drift rate and decision threshold, respectively. We used a hierarchical Bayesian estimation approach to assess the single trial influence of observable physiological signals on these latent DDM parameters. Increased eye gaze dwell time specifically predicted an increased drift rate toward the fixated option, irrespective of the value of the option. In contrast, greater pupil dilation specifically predicted an increase in decision threshold during difficult decisions. These findings suggest that eye tracking and pupillometry reflect the operations of dissociated latent decision processes. PMID:24548281

Multi-criteria analysis for the determination of the best WEEE management scenario in Cyprus.

PubMed

Rousis, K; Moustakas, K; Malamis, S; Papadopoulos, A; Loizidou, M

2008-01-01

Waste from electrical and electronic equipment (WEEE) constitutes one of the most complicated solid waste streams in terms of its composition, and, as a result, it is difficult to be effectively managed. In view of the environmental problems derived from WEEE management, many countries have established national legislation to improve the reuse, recycling and other forms of recovery of this waste stream so as to apply suitable management schemes. In this work, alternative systems are examined for the WEEE management in Cyprus. These systems are evaluated by developing and applying the Multi-Criteria Decision Making (MCDM) method PROMETHEE. In particular, through this MCDM method, 12 alternative management systems were compared and ranked according to their performance and efficiency. The obtained results show that the management schemes/systems based on partial disassembly are the most suitable for implementation in Cyprus. More specifically, the optimum scenario/system that can be implemented in Cyprus is that of partial disassembly and forwarding of recyclable materials to the native existing market and disposal of the residues at landfill sites.

Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.

PubMed

Berger, Bettina; Schwarz, Christiane; Heusser, Peter

2015-05-07

Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). A literature search was carried out in a variety of lay and medical databases. written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.

Behavioural and physiological effects of finely balanced decision-making in chickens.

PubMed

Davies, Anna C; Nicol, Christine J; Persson, Mia E; Radford, Andrew N

2014-01-01

In humans, more difficult decisions result in behavioural and physiological changes suggestive of increased arousal, but little is known about the effect of decision difficulty in other species. A difficult decision can have a number of characteristics; we aimed to monitor how finely balanced decisions, compared to unbalanced ones, affected the behaviour and physiology of chickens. An unbalanced decision was one in which the two options were of unequal net value (1 (Q1) vs. 6 (Q6) pieces of sweetcorn with no cost associated with either option); a finely balanced decision was one in which the options were of equal net value (i.e. hens were "indifferent" to both options). To identify hens' indifference, a titration procedure was used in which a cost (electromagnetic weight on an access door) was applied to the Q6 option, to find the individual point at which hens chose this option approximately equally to Q1 via a non-weighted door. We then compared behavioural and physiological indicators of arousal (head movements, latency to choose, heart-rate variability and surface body temperature) when chickens made decisions that were unbalanced or finely balanced. Significant physiological (heart-rate variability) and behavioural (latency to pen) differences were found between the finely balanced and balanced conditions, but these were likely to be artefacts of the greater time and effort required to push through the weighted doors. No other behavioural and physiological measures were significantly different between the decision categories. We suggest that more information is needed on when best to monitor likely changes in arousal during decision-making and that future studies should consider decisions defined as difficult in other ways.

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

PubMed

Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2017-09-12

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. 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. 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. 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. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Why do parents enrol in a childhood obesity management program?: a qualitative study with parents of overweight and obese children.

PubMed

Davidson, Kamila; Vidgen, Helen

2017-02-02

Despite the high prevalence of childhood overweight and obesity enrolment to weight management programs remains difficult, time consuming, costly and has limited effectiveness. The aim of this paper was to explore parents' perspectives on factors that influence their decision to enrol in a program to address their child's weight. Semi-structured qualitative telephone interviews were undertaken with 21 parents of primary school aged children above the healthy weight range who had enrolled in a healthy lifestyle program. Questions were developed and analysed using the Theory of Planned Behaviour. They addressed parental reasons for enrolment, expectations of the program and apprehensions regarding enrolling. Prior to deciding to enrol, parents tended to be aware of the child's weight status, had attempted to address it themselves and had sought help from a number of people including health professionals. Parental decision to enrol was influenced by their evaluation of their previous attempts and their child's emotional state. Awareness of their child's weight status is an important first step in parents taking action at this health issue however it is unlikely to be sufficient on its own. Parental decision to join a childhood obesity management program can be complex and is likely to be made after numerous and unsuccessful attempts to address the child's weight. Strategies to encourage parents to enrol in programs should include activities beyond awareness of weight status. Health professionals should use contact time with parents to raise awareness of the child's weight status and to provide encouragement to address overweight and obesity. Parents must be supported in their attempts to address their child's overweight and obesity whether they choose to manage it themselves or within a program.

The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward.

PubMed

Thillaivanam, Saravanapriya; Amin, Arwa M; Gopalakrishnan, Sheila; Ibrahim, Baharudin

2016-10-01

Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia. This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation. Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to McIsaac rule criteria was 45% before implementation of the McIsaac rule, but improved to 67.9% (P = 0.0005) after implementation. The McIsaac rule is an effective tool for the management of sore throat in children in Malaysia.

Antinauseants in Pregnancy: Teratogens or Not?

PubMed Central

Biringer, Anne

1984-01-01

Nausea and/or vomiting affect 50% of all pregnant women. For most women, this is a self-limited problem which responds well to conservative management. However, there are some situations where the risk to the mother and fetus posed by the illness are greater than the possible risks of teratogenicity of antinauseant drugs. Antihistamines have had the widest testing, and to date, there has been no evidence linking doxylamine, dimenhydrinate or promethazine to congenital malformations. Since no available drugs have official approval for use in nausea and vomiting of pregnancy the physician is left alone to make this difficult decision. PMID:21279128

Planning for post disaster recovery: Lesson learnt from flood events in Kelantan Malaysia

NASA Astrophysics Data System (ADS)

Rani, Wan Nurul Mardiah Wan Mohd; Nifa, Faizatul Akmar Abdul; Ismail, Mohd Noorizhar; Khalid, Khairin Norhashidah

2017-10-01

As the frequency of disaster occurrence increases, the world cities today are getting more difficult in terms of the management of the event. One of the most discussed issues today is the management of the post-disaster recovery that involves several stages such as the planning, management of multiple stakeholders, restoration, reconstruction and delivery. It is important to note that input from related stakeholders is necessary to make the right decision during this most critical period. In the process of building back after a disaster, it is important to ensure the newly constructed infrastructures are built to be more resilient and able to withstand a certain level of disaster recurrence. Elements of disaster risk reduction should be incorporated in the planning, redesign, construction and the operation of the built environment. In Malaysia, the disaster management has been the responsibility of the Disaster Management and Relief Committee that consists of agencies at the central, state and local levels. This is to ensure that all aspects are being considered and to be more effective in managing the situation.

Gas gangrene in the diabetic foot: lessons learned from a salvaged limb.

PubMed

Aerden, D; Lipsky, B A; Denecker, N; Nieboer, K; Keymeulen, B

2014-01-01

A 55 year old man was seen in the emergency department with an infected right foot and sepsis. Examination of the right foot revealed subcutaneous crepitus from the metatarsal head up to the tarsus; interstitial and intramedullary gas was confirmed on x-rays and computed tomographic scans. During 44 days of hospitalization, the patient was treated with multiple courses of antibiotic therapy, various wound care modalities (including negative wound pressure therapy) and several surgical interventions (debridements, amputations, revascularizations and reconstructive plastic surgery). Although limb salvage was ultimately accomplished, in retrospect many management decisions were suboptimal. A critical reassessment of our approach to this patient allowed us to identify several areas for improvement and this audit provided us an opportunity to learn from managing this difficult case.

[Identification and management of intra-operative suspicious tissues in 20 transsphenoidal surgery cases].

PubMed

Liu, Jun-Feng; Ke, Chang-Shu; Chen, Xi; Xu, Yu; Zhang, Hua-Qiu; Chen, Juan; Gan, Chao; Li, Chao-Xi; Lei, Ting

2013-05-01

To determine appropriate protocols for the identification and management of intra operative suspicious tissues during transsphenoidal surgery. Clinical data and pathological reports of 20 patients with intra-operative suspicious tissues during transsphenoidal surgeries were analyzed retrospectively. The methods for discriminating between adenoma and normal pituitary tissues were reviewed. The postoperative pathological reports revealed that adenoma and normal pituitary tissues coexisted in 9 samples, while 5 samples were identified as normal pituitary tissues, 2 as adenoma tissues, and 4 as other tissues. Adenomas were distinguished from normal pituitary tissues on the basis of intra-operative appearance, texture, blood supply and possible existence of boundary. If decisions are difficult to made during surgeries from the appearance of the suspicious tissues, pathological examinations are advised as a guidance for the next steps.

RECOVER - An Automated Burned Area Emergency Response Decision Support System for Post-fire Rehabilitation Management of Savanna Ecosystems in the Western US

NASA Astrophysics Data System (ADS)

Weber, K.; Schnase, J. L.; Carroll, M.; Brown, M. E.; Gill, R.; Haskett, G.; Gardner, T.

2013-12-01

In partnership with the Department of Interior's Bureau of Land Management (BLM) and the Idaho Department of Lands (IDL), we are building and evaluating the RECOVER decision support system. RECOVER - which stands for Rehabilitation Capability Convergence for Ecosystem Recovery - is an automatically deployable, context-aware decision support system for savanna wildfires that brings together in a single application the information necessary for post-fire rehabilitation decision-making and long-term ecosystem monitoring. RECOVER uses state-of-the-art cloud-based data management technologies to improve performance, reduce cost, and provide site-specific flexibility for each fire. The RECOVER Server uses Integrated Rule-Oriented Data System (iRODS) data grid technology deployed in the Amazon Elastic Compute Cloud (EC2). The RECOVER Client is an Adobe Flex web map application that is able to provide a suite of convenient GIS analytical capabilities. In a typical use scenario, the RECOVER Server is provided a wildfire name and geospatial extent. The Server then automatically gathers Earth observational data and other relevant products from various geographically distributed data sources. The Server creates a database in the cloud where all relevant information about the wildfire is stored. This information is made available to the RECOVER Client and ultimately to fire managers through their choice of web browser. The Server refreshes the data throughout the burn and subsequent recovery period (3-5 years) with each refresh requiring two minutes to complete. Since remediation plans must be completed within 14 days of a fire's containment, RECOVER has the potential to significantly improve the decision-making process. RECOVER adds an important new dimension to post-fire decision-making by focusing on ecosystem rehabilitation in semiarid savannas. A novel aspect of RECOVER's approach involves the use of soil moisture estimates, which are an important but difficult-to-obtain element of post-fire rehabilitation planning. We will use downscaled soil moisture data from three primary observational sources to begin evaluation of soil moisture products and build the technology needed for RECOVER to use future SMAP products. As a result, RECOVER, BLM, and the fire applications community will be ready customers for data flowing out of new NASA missions, such as NPP, LDCM, and SMAP.

Operative management of chronic pancreatitis: A review.

PubMed

Tillou, John D; Tatum, Jacob A; Jolissaint, Joshua S; Strand, Daniel S; Wang, Andrew Y; Zaydfudim, Victor; Adams, Reid B; Brayman, Kenneth L

2017-08-01

Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach. There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, etc.), resection (pancreticoduodenectomy, etc.) and combined drainage/resection procedures (Frey procedure, etc.). Additionally, many centers currently perform total pancreatectomy with islet autotransplantation, in addition to minimally invasive options that are intended to tailor therapy to individual patients. Operative management of chronic pancreatitis often improves quality of life, and is associated with low rates of morbidity and mortality. The decision as to which procedure is optimal for each patient should be based on a combination of pathologic changes, prior interventions, and individual surgeon and center experience. Copyright © 2017 Elsevier Inc. All rights reserved.

The Management of Classical Hodgkin's Lymphoma: Past, Present, and Future.

PubMed

Richardson, S E; McNamara, C

2011-01-01

The management of classical Hodgkin's lymphoma (CHL) is a success story of modern multi-agent haemato-oncology. Prior to the middle of the twentieth century CHL was fatal in the majority of cases. Introduction of single agent radiotherapy (RT) demonstrated for the first time that these patients could be cured. Developments in chemotherapy including the mechlorethamine, vincristine, procarbazine and prednisolone (MOPP) and Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) regimens have resulted in cure rates of over 80%. Even in relapse, CHL patients can be salvaged with high dose chemotherapy and autologous haematopoietic stem cell transplantation (ASCT). Challenges remain, however, in finding new strategies to manage the small number of patients who continue to relapse or progress. In addition, the young age of many Hodgkin's patients forces difficult decisions in balancing the benefit of early disease control against the survival disadvantage of late toxicity. In this article we aim to summarise past trials, define the current standard of care and appraise future developments in the management of CHL.

Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services.

PubMed

Ravoux, Peggy; Baker, Peter; Brown, Hilary

2012-05-01

A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members' perspectives of managing clients with challenging behaviours in residential services. Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members' immediate responses to clients' difficult behaviours and their decision-making processes. The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved. Staff members' responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future. © 2011 Blackwell Publishing Ltd.

Analysis of post-mining excavations as places for municipal waste

NASA Astrophysics Data System (ADS)

Górniak-Zimroz, Justyna

2018-01-01

Waste management planning is an interdisciplinary task covering a wide range of issues including costs, legal requirements, spatial planning, environmental protection, geography, demographics, and techniques used in collecting, transporting, processing and disposing of waste. Designing and analyzing this issue is difficult and requires the use of advanced analysis methods and tools available in GIS geographic information systems containing readily available graphical and descriptive databases, data analysis tools providing expert decision support while selecting the best-designed alternative, and simulation models that allow the user to simulate many variants of waste management together with graphical visualization of the results of performed analyzes. As part of the research study, there have been works undertaken concerning the use of multi-criteria data analysis in waste management in areas located in southwestern Poland. These works have proposed the inclusion in waste management of post-mining excavations as places for the final or temporary collection of waste assessed in terms of their suitability with the tools available in GIS systems.

Traceability and Risk Analysis Strategies for Addressing Counterfeit Electronics in Supply Chains for Complex Systems.

PubMed

DiMase, Daniel; Collier, Zachary A; Carlson, Jinae; Gray, Robin B; Linkov, Igor

2016-10-01

Within the microelectronics industry, there is a growing concern regarding the introduction of counterfeit electronic parts into the supply chain. Even though this problem is widespread, there have been limited attempts to implement risk-based approaches for testing and supply chain management. Supply chain risk management tends to focus on the highly visible disruptions of the supply chain instead of the covert entrance of counterfeits; thus counterfeit risk is difficult to mitigate. This article provides an overview of the complexities of the electronics supply chain, and highlights some gaps in risk assessment practices. In particular, this article calls for enhanced traceability capabilities to track and trace parts at risk through various stages of the supply chain. Placing the focus on risk-informed decision making through the following strategies is needed, including prioritization of high-risk parts, moving beyond certificates of conformance, incentivizing best supply chain management practices, adoption of industry standards, and design and management for supply chain resilience. © 2016 Society for Risk Analysis.

Challenges in getting workforce research in nursing used for decision-making in policy and practice: a Canadian perspective.

PubMed

O'Brien-Pallas, Linda; Hayes, Laureen

2008-12-01

This paper draws upon empirical research and other published sources to discuss nursing workforce issues, the challenges of using health human resource research in policy decisions and the importance of evidence-based policies and practices for nursing care and outcomes. Increasing evidence points to the critical relationship between registered nurse care and improved patient outcomes. The negative impact that insufficient nurse staffing has on patient, nursing and system outcomes has influenced health human resource researchers to further examine nurses' work environments to determine factors that are amenable to policy change. Survey of literature was conducted. Electronic databases were searched using keywords. Sustained health human resource planning efforts by policy makers are difficult given changing governments and political agendas. The health human resource conceptual framework provides researchers and planners with a guide to decision-making that considers current circumstances as well as those factors that need to be accounted for in predicting future requirements. However, effective use of research depends on communication of findings between researchers and policymakers. Health care managers and other decision-makers in health care organisations often lack an understanding of the research process and do not always have easy access to current evidence. Also, managerial decisions are often constrained by organisational requirements such as resource availability and policies and procedures. Unless nursing workplace issues are addressed, the physiological and psychological stress in the work environments of nurses will continue. Effective health human resource policy and planning (at the macro level) and management strategies (at the micro level) would stabilise the nursing workforce and reduce job stress. Furthermore, the efficiency and cost-effectiveness of the health system could be enhanced through improved health outcomes of care providers and health care clients.

Implementing participatory decision making in forest planning.

PubMed

Ananda, Jayanath

2007-04-01

Forest policy decisions are often a source of debate, conflict, and tension in many countries. The debate over forest land-use decisions often hinges on disagreements about societal values related to forest resource use. Disagreements on social value positions are fought out repeatedly at local, regional, national, and international levels at an enormous social cost. Forest policy problems have some inherent characteristics that make them more difficult to deal with. On the one hand, forest policy decisions involve uncertainty, long time scales, and complex natural systems and processes. On the other hand, such decisions encompass social, political, and cultural systems that are evolving in response to forces such as globalization. Until recently, forest policy was heavily influenced by the scientific community and various economic models of optimal resource use. However, growing environmental awareness and acceptance of participatory democracy models in policy formulation have forced the public authorities to introduce new participatory mechanisms to manage forest resources. Most often, the efforts to include the public in policy formulation can be described using the lower rungs of Arnstein's public participation typology. This paper presents an approach that incorporates stakeholder preferences into forest land-use policy using the Analytic Hierarchy Process (AHP). An illustrative case of regional forest-policy formulation in Australia is used to demonstrate the approach. It is contended that applying the AHP in the policy process could considerably enhance the transparency of participatory process and public acceptance of policy decisions.

Impacts of Human Recreation on Brown Bears (Ursus arctos): A Review and New Management Tool.

PubMed

Fortin, Jennifer K; Rode, Karyn D; Hilderbrand, Grant V; Wilder, James; Farley, Sean; Jorgensen, Carole; Marcot, Bruce G

2016-01-01

Increased popularity of recreational activities in natural areas has led to the need to better understand their impacts on wildlife. The majority of research conducted to date has focused on behavioral effects from individual recreations, thus there is a limited understanding of the potential for population-level or cumulative effects. Brown bears (Ursus arctos) are the focus of a growing wildlife viewing industry and are found in habitats frequented by recreationists. Managers face difficult decisions in balancing recreational opportunities with habitat protection for wildlife. Here, we integrate results from empirical studies with expert knowledge to better understand the potential population-level effects of recreational activities on brown bears. We conducted a literature review and Delphi survey of brown bear experts to better understand the frequencies and types of recreations occurring in bear habitats and their potential effects, and to identify management solutions and research needs. We then developed a Bayesian network model that allows managers to estimate the potential effects of recreational management decisions in bear habitats. A higher proportion of individual brown bears in coastal habitats were exposed to recreation, including photography and bear-viewing than bears in interior habitats where camping and hiking were more common. Our results suggest that the primary mechanism by which recreation may impact brown bears is through temporal and spatial displacement with associated increases in energetic costs and declines in nutritional intake. Killings in defense of life and property were found to be minimally associated with recreation in Alaska, but are important considerations in population management. Regulating recreation to occur predictably in space and time and limiting recreation in habitats with concentrated food resources reduces impacts on food intake and may thereby, reduce impacts on reproduction and survival. Our results suggest that decisions managers make about regulating recreational activities in time and space have important consequences for bear populations. The Bayesian network model developed here provides a new tool for managers to balance demands of multiple recreational activities while supporting healthy bear populations.

The impacts of human recreation on brown bears (Ursus arctos): A review and new management tool

USGS Publications Warehouse

Fortin-noreus, Jennifer; Rode, Karyn D.; Hilderbrand, Grant V.; Wilder, James; Farley, Sean; Jorgensen, Carole; Marcot, Bruce G.

2016-01-01

Increased popularity of recreational activities in natural areas has led to the need to better understand their impacts on wildlife. The majority of research conducted to date has focused on behavioral effects from individual recreations, thus there is a limited understanding of the potential for population-level or cumulative effects. Brown bears (Ursus arctos) are the focus of a growing wildlife viewing industry and are found in habitats frequented by recreationists. Managers face difficult decisions in balancing recreational opportunities with habitat protection for wildlife. Here, we integrate results from empirical studies with expert knowledge to better understand the potential population-level effects of recreational activities on brown bears. We conducted a literature review and Delphi survey of brown bear experts to better understand the frequencies and types of recreations occurring in bear habitats and their potential effects, and to identify management solutions and research needs. We then developed a Bayesian network model that allows managers to estimate the potential effects of recreational management decisions in bear habitats. A higher proportion of individual brown bears in coastal habitats were exposed to recreation, including photography and bear-viewing than bears in interior habitats where camping and hiking were more common. Our results suggest that the primary mechanism by which recreation may impact brown bears is through temporal and spatial displacement with associated increases in energetic costs and declines in nutritional intake. Killings in defense of life and property were found to be minimally associated with recreation in Alaska, but are important considerations in population management. Regulating recreation to occur predictably in space and time and limiting recreation in habitats with concentrated food resources reduces impacts on food intake and may thereby, reduce impacts on reproduction and survival. Our results suggest that decisions managers make about regulating recreational activities in time and space have important consequences for bear populations. The Bayesian network model developed here provides a new tool for managers to balance demands of multiple recreational activities while supporting healthy bear populations.

Impacts of Human Recreation on Brown Bears (Ursus arctos): A Review and New Management Tool

PubMed Central

Fortin, Jennifer K.; Rode, Karyn D.; Hilderbrand, Grant V.; Wilder, James; Farley, Sean; Jorgensen, Carole; Marcot, Bruce G.

2016-01-01

Increased popularity of recreational activities in natural areas has led to the need to better understand their impacts on wildlife. The majority of research conducted to date has focused on behavioral effects from individual recreations, thus there is a limited understanding of the potential for population-level or cumulative effects. Brown bears (Ursus arctos) are the focus of a growing wildlife viewing industry and are found in habitats frequented by recreationists. Managers face difficult decisions in balancing recreational opportunities with habitat protection for wildlife. Here, we integrate results from empirical studies with expert knowledge to better understand the potential population-level effects of recreational activities on brown bears. We conducted a literature review and Delphi survey of brown bear experts to better understand the frequencies and types of recreations occurring in bear habitats and their potential effects, and to identify management solutions and research needs. We then developed a Bayesian network model that allows managers to estimate the potential effects of recreational management decisions in bear habitats. A higher proportion of individual brown bears in coastal habitats were exposed to recreation, including photography and bear-viewing than bears in interior habitats where camping and hiking were more common. Our results suggest that the primary mechanism by which recreation may impact brown bears is through temporal and spatial displacement with associated increases in energetic costs and declines in nutritional intake. Killings in defense of life and property were found to be minimally associated with recreation in Alaska, but are important considerations in population management. Regulating recreation to occur predictably in space and time and limiting recreation in habitats with concentrated food resources reduces impacts on food intake and may thereby, reduce impacts on reproduction and survival. Our results suggest that decisions managers make about regulating recreational activities in time and space have important consequences for bear populations. The Bayesian network model developed here provides a new tool for managers to balance demands of multiple recreational activities while supporting healthy bear populations. PMID:26731652

More than just consumers: Integrating local observations into drought monitoring to better support decision making

NASA Astrophysics Data System (ADS)

Ferguson, D. B.; Masayesva, A.; Meadow, A. M.; Crimmins, M.

2016-12-01

Drought monitoring and drought planning are complex endeavors. Measures of precipitation or streamflow provide little context for understanding how social and environmental systems impacted by drought are responding. In arid and semi-arid regions of the world, this challenge is particularly acute since social-ecological systems are already well-adapted to dry conditions. Understanding what drought means in these regions is an important first step in developing a decision-relevant monitoring system. Traditional drought indices may be of some use, but local observations may ultimately be more relevant for informing difficult decisions in response to unusually dry conditions. This presentation will focus on insights gained from a collaborative project between the University of Arizona and the Hopi Tribe-a Native American community in the U.S. Southwest-to develop a drought information system that is responsive to local needs. The primary goal of the project was to develop a system that: is based on how drought is experienced by Hopi citizens and resource managers, can incorporate local observations of drought impacts as well as conventional indicators, and brings together local expertise with conventional science-based observations. This kind of drought monitoring system can harnesses as much available information as possible to inform resource managers, political leaders, and citizens about drought conditions, but such a system can also engage these local drought stakeholders in observing, thinking about, and helping guide planning for drought.

Forecasting wildlife response to rapid warming in the Alaskan Arctic

USGS Publications Warehouse

Van Hemert, Caroline R.; Flint, Paul L.; Udevitz, Mark S.; Koch, Joshua C.; Atwood, Todd C.; Oakley, Karen L.; Pearce, John M.

2015-01-01

Arctic wildlife species face a dynamic and increasingly novel environment because of climate warming and the associated increase in human activity. Both marine and terrestrial environments are undergoing rapid environmental shifts, including loss of sea ice, permafrost degradation, and altered biogeochemical fluxes. Forecasting wildlife responses to climate change can facilitate proactive decisions that balance stewardship with resource development. In this article, we discuss the primary and secondary responses to physical climate-related drivers in the Arctic, associated wildlife responses, and additional sources of complexity in forecasting wildlife population outcomes. Although the effects of warming on wildlife populations are becoming increasingly well documented in the scientific literature, clear mechanistic links are often difficult to establish. An integrated science approach and robust modeling tools are necessary to make predictions and determine resiliency to change. We provide a conceptual framework and introduce examples relevant for developing wildlife forecasts useful to management decisions.

Laryngotracheal separation in neonatal brainstem dysfunction.

PubMed

Patron, G Cariou; Teissier, N; Malard, O; Van Den Abbeele, T

2010-03-01

Neonatal brainstem dysfunction (NBD) associates four symptoms of variable presence and intensity: suction-swallowing dysfunction, abnormal laryngeal sensitivity and motility, gastroesophageal reflux, and cardiac vagal overactivity. We report three cases of severe NBD with chronic aspiration which required surgical management. Successive failures and clinical deterioration led us to perform laryngotracheal separation. The surgical procedure consisted in suturing the distal segment of the trachea to the cervical skin after complete closure of the larynx. After surgery, these children did not present any pulmonary infection and were allowed oral nutrition. However, oral communication was no longer possible. Although it is a theoretically reversible procedure, the decision is ethically difficult in children free of mental deficiency, because of the vocal loss and the unpredictable NBD outcome. Laryngotracheal separation may be recommended after multidisciplinary decision for severe chronic aspiration in the particular case of children presenting with NBD. Copyright © 2010. Published by Elsevier Masson SAS.

A Paradox of Power: Voices of Warning and Reason in the Geosciences

NASA Astrophysics Data System (ADS)

Thompson, Douglas

As a culture, we are faced with a series of increasingly complex environmental problems. As geoscientists, we are often asked to assume the role of technical experts to provide guidance or solutions to these difficult dilemmas. Unfortunately, the political, social, economic, and judicial aspects of environmental management often require geoscientists to advocate choices or provide definitive answers that are in conflict with our training as never-ending hypothesis testers and unbiased observers of nature.A Paradox of Power: Voices of Warning and Reason in the Geosciences addresses this topic by providing a collection of works that highlights various discrepancies between standard scientific procedures and the public decision-making process. The book presents a range of views and examples that provides geoscientists with a background on the issues surrounding the use of their expertise and analyses in typical law and policy decisions.

Eye tracking and pupillometry are indicators of dissociable latent decision processes.

PubMed

Cavanagh, James F; Wiecki, Thomas V; Kochar, Angad; Frank, Michael J

2014-08-01

Can you predict what people are going to do just by watching them? This is certainly difficult: it would require a clear mapping between observable indicators and unobservable cognitive states. In this report, we demonstrate how this is possible by monitoring eye gaze and pupil dilation, which predict dissociable biases during decision making. We quantified decision making using the drift diffusion model (DDM), which provides an algorithmic account of how evidence accumulation and response caution contribute to decisions through separate latent parameters of drift rate and decision threshold, respectively. We used a hierarchical Bayesian estimation approach to assess the single trial influence of observable physiological signals on these latent DDM parameters. Increased eye gaze dwell time specifically predicted an increased drift rate toward the fixated option, irrespective of the value of the option. In contrast, greater pupil dilation specifically predicted an increase in decision threshold during difficult decisions. These findings suggest that eye tracking and pupillometry reflect the operations of dissociated latent decision processes. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Clinical decision making in the recognition of dying: a qualitative interview study.

PubMed

Taylor, Paul; Dowding, Dawn; Johnson, Miriam

2017-01-25

Recognising dying is an essential clinical skill for general and palliative care professionals alike. Despite the high importance, both identification and good clinical care of the dying patient remains extremely difficult and often controversial in clinical practice. This study aimed to answer the question: "What factors influence medical and nursing staff when recognising dying in end-stage cancer and heart failure patients?" This study used a descriptive approach to decision-making theory. Participants were purposively sampled for profession (doctor or nurse), specialty (cardiology or oncology) and grade (senior vs junior). Recruitment continued until data saturation was reached. Semi-structured interviews were conducted with NHS medical and nursing staff in an NHS Trust which contained cancer and cardiology tertiary referral centres. An interview schedule was designed, based on decision-making literature. Interviews were audio-recorded and transcribed and analysed using thematic framework. Data were managed with Atlas.ti. Saturation was achieved with 19 participants (7 seniors; 8 intermediate level staff; 4 juniors). There were 11 oncologists (6 doctors, 5 nurses) and 8 cardiologists (3 doctors, 5 nurses). Six themes were generated: information used; decision processes; modifying factors; implementation; reflecting on decisions and related decisions. The decision process described was time-dependent, ongoing and iterative, and relies heavily on intuition. This study supports the need to recognise the strengths and weaknesses of expertise and intuition as part of the decision process, and of placing the recognition of dying in a time-dependent context. Clinicians should also be prepared to accept and convey the uncertainty surrounding these decisions, both in practice and in communication with patients and carers.

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

End-of-life issues: difficult decisions and dealing with grief.

PubMed

Loomis, Beth

2009-06-01

People face many challenging psychosocial and spiritual issues as they approach the end of their lives, and caregivers need advice on how to help them. Choosing among treatment options, handling grief, addressing unfinished business, and coping with loss of self-sufficiency are difficult for the dying person, and caregivers must deal with surrogate decision making, raw emotions in the patient and in family members, and the caregivers' own grief. Listening and coping skills are discussed.

Optimal Decision-making Model of Integrated Water Resources Management - A Case of Hsinchu Water Resources Management

NASA Astrophysics Data System (ADS)

Wang, S. Y.; Ho, C. C.; Chang, L. C.

2017-12-01

The public use water in Hsinchu are mainly supplied from Baoshan Reservoir, Second Baoshan Reservoir, Yongheshan Reservoir and Longen Weir. However, the increasing water demand, caused by development of the Hsinchu Science and Industrial Park, results in supply stable water getting more difficult. For stabilize water supply in Hsinchu, the study applies long-term and short-term plans to fulfill the water shortage. Developing an efficient methodology to define a cost-effective action portfolio is an important task. Hence, the study develops a novel decision model, the Stochastic Programming with Recourse Decision Model (SPRDM), to estimate a cost-effective action portfolio. The first-stage of SPRDM determine the long-term action portfolio and the portfolio accompany recourse information (the probability for water shortage event). The second-stage of SPRDM optimize the cost-effective action portfolio in response to the recourse information. In order to consider the uncertainty of reservoir sediment and demand growth, the study set 9 scenarios comprise optimistic, most likely, and pessimistic reservoir sediment and demand growth. The results show the optimal action portfolio consist of FengTain Lake and Panlon Weir, Hsinchu Desalination Plant, Domestic and Industrial Water long-term plans, and Emergency Backup Well, Irrigation Water Transference, Preliminary Water Rationing, Advanced Water Rationing and Water Transport from Other Districts short-term plans. The minimum expected cost of optimal action portfolio is NT$1.1002 billion. The results can be used as a reference for decision making because the results have considered the uncertainty of varied hydrology, reservoir sediment, and water demand growth.

How to manage future groundwater resource of China under climate change and urbanization: An optimal stage investment design from modern portfolio theory.

PubMed

Hua, Shanshan; Liang, Jie; Zeng, Guangming; Xu, Min; Zhang, Chang; Yuan, Yujie; Li, Xiaodong; Li, Ping; Liu, Jiayu; Huang, Lu

2015-11-15

Groundwater management in China has been facing challenges from both climate change and urbanization and is considered as a national priority nowadays. However, unprecedented uncertainty exists in future scenarios making it difficult to formulate management planning paradigms. In this paper, we apply modern portfolio theory (MPT) to formulate an optimal stage investment of groundwater contamination remediation in China. This approach generates optimal weights of investment to each stage of the groundwater management and helps maximize expected return while minimizing overall risk in the future. We find that the efficient frontier of investment displays an upward-sloping shape in risk-return space. The expected value of groundwater vulnerability index increases from 0.6118 to 0.6230 following with the risk of uncertainty increased from 0.0118 to 0.0297. If management investment is constrained not to exceed certain total cost until 2050 year, the efficient frontier could help decision makers make the most appropriate choice on the trade-off between risk and return. Copyright © 2015 Elsevier Ltd. All rights reserved.

Visualising Uncertainty for Decision Support

DTIC Science & Technology

2016-12-01

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

Development of efficiency module of organization of Arctic sea cargo transportation with application of neural network technologies

NASA Astrophysics Data System (ADS)

Sobolevskaya, E. Yu; Glushkov, S. V.; Levchenko, N. G.; Orlov, A. P.

2018-05-01

The analysis of software intended for organizing and managing the processes of sea cargo transportation has been carried out. The shortcomings of information resources are presented, for the organization of work in the Arctic and Subarctic regions of the Far East: the lack of decision support systems, the lack of factor analysis to calculate the time and cost of delivery. The architecture of the module for calculating the effectiveness of the organization of sea cargo transportation has been developed. The simulation process has been considered, which is based on the neural network. The main classification factors with their weighting coefficients have been identified. The architecture of the neural network has been developed to calculate the efficiency of the organization of sea cargo transportation in Arctic conditions. The architecture of the intellectual system of organization of sea cargo transportation has been developed, taking into account the difficult navigation conditions in the Arctic. Its implementation will allow one to provide the management of the shipping company with predictive analytics; to support decision-making; to calculate the most efficient delivery route; to provide on demand online transportation forecast, to minimize the shipping cost, delays in transit, and risks to cargo safety.

Bottlenecks in Geospatial Data-Driven Decision-Making for Natural Disaster Management: A Case Study of Forest Fire Prevention and Control in Guatemala's Maya Biosphere Reserve

NASA Astrophysics Data System (ADS)

Berenter, J. S.; Mueller, J. M.; Morrison, I.

2016-12-01

Annual forest fires are a source of great economic and environmental cost in the Maya Biosphere Reserve (MBR), a region of high ecological and historical value in Guatemala's department of Petén. Scarce institutional resources, limited local response capacity, and difficult terrain place a premium on the use of Earth observation data for forest fire management in the MBR, but also present significant institutional barriers to optimizing the value of this data. Drawing upon key informant interviews and a contingent valuation survey of national and local actors conducted during a three-year performance evaluation of the USAID/NASA Regional Visualization and Monitoring System (SERVIR), this paper traces the flow of SERVIR data from acquisition to decision in order to assess the institutional and contextual factors affecting the value of Earth observation data for forest fire management in the MBR. Findings indicate that the use of satellite data for forest fire management in the MBR is widespread and multi-dimensional: historical assessments of land use and land cover, fire scarring, and climate data help central-level fire management agencies identify and regulate fire-sensitive areas; regular monitoring and dissemination of climate data enables coordination between agricultural burning activities and fire early warning systems; and daily satellite detection of thermal anomalies in land surface temperature permits first responders to monitor and react to "hotspot" activity. Findings also suggest, however, that while the decentralized operations of Petén's fire management systems foster the use of Earth observation data, systemic bottlenecks, including budgetary constraints, inadequate data infrastructure and interpretation capacity, and obstacles to regulatory enforcement, impede the flow of information and use of technology and thus impact the value of that data, particularly in remote and under-resourced areas of the MBR. A geographic expansion and fortification of support systems for use of Earth observation data is thus required to maximize the value of data-driven forest fire management in the MBR. Findings further validate a need for continued cooperation between scientific and governance institutions to disseminate and integrate geospatial data into environmental decision-making.

Clinical decision making: how surgeons do it.

PubMed

Crebbin, Wendy; Beasley, Spencer W; Watters, David A K

2013-06-01

Clinical decision making is a core competency of surgical practice. It involves two distinct types of mental process best considered as the ends of a continuum, ranging from intuitive and subconscious to analytical and conscious. In practice, individual decisions are usually reached by a combination of each, according to the complexity of the situation and the experience/expertise of the surgeon. An expert moves effortlessly along this continuum, according to need, able to apply learned rules or algorithms to specific presentations, choosing these as a result of either pattern recognition or analytical thinking. The expert recognizes and responds quickly to any mismatch between what is observed and what was expected, coping with gaps in information and making decisions even where critical data may be uncertain or unknown. Even for experts, the cognitive processes involved are difficult to articulate as they tend to be very complex. However, if surgeons are to assist trainees in developing their decision-making skills, the processes need to be identified and defined, and the competency needs to be measurable. This paper examines the processes of clinical decision making in three contexts: making a decision about how to manage a patient; preparing for an operative procedure; and reviewing progress during an operative procedure. The models represented here are an exploration of the complexity of the processes, designed to assist surgeons understand how expert clinical decision making occurs and to highlight the challenge of teaching these skills to surgical trainees. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

Improving Access to and Understanding of Regulations through Taxonomies

ERIC Educational Resources Information Center

Cheng, Chin Pang; Lau. Gloria T.; Law, Kincho H.; Pan, Jiayi; Jones, Albert

2009-01-01

Industrial taxonomies have the potential to automate information retrieval, facilitate interoperability and, most importantly, improve decision making - decisions that must comply with existing government regulations and codes of practice. However, it is difficult to find those regulations and codes most relevant to a particular decision, even…

Fertility Preservation in Pediatric and Adolescent Oncology Patients: The Decision-Making Process of Parents.

PubMed

Li, Nancy; Jayasinghe, Yasmin; Kemertzis, Matthew A; Moore, Paddy; Peate, Michelle

2017-06-01

Decisions surrounding fertility preservation (FP) in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data. This review examines the decision-making process of oncology patients and their parents (if patients are in the pediatric or adolescent population) to better understand experiences of decisional conflict and regret. Two electronic databases, Embase and Pubmed, were searched using the terms (Decision-making OR Conflict (Psychology) OR Decision regret) AND (Freezing OR Oocyte OR Ovarian tissue OR Semen preservation OR Fertility preservation OR Cryopreservation) AND (Neoplasms OR Cancer OR Chemotherapy OR Drug therapy OR Radiotherapy). Medical Subject Heading terms were utilized where possible. Included articles discussed FP decision-making from the patient's perspective. Thirty-five articles discussing FP decision-making were included (24 in the adult population, 11 in the pediatric and adolescent population). Key themes from these articles included the following: factors considered in FP decision-making, decision-making in established procedures and experimental procedures, decisional conflict and regret, the perceived importance of information, adolescent involvement in decision-making, and ethical considerations in the pediatric population. Unique ethical issues arise in the pediatric and adolescent population. Considering that the decision to pursue FP is known to be difficult in the adult population, decisional conflict and regret may be greater for parents who are making the decision for their child.

Interaction of Technology Adoption Constraints and Multi-level Policy Coherence at the Energy-Food Nexus

NASA Astrophysics Data System (ADS)

Gerst, M.; Cox, M. E.; Laser, M.; Locke, K. A.; Kapuscinski, A. R.

2017-12-01

Policy- and decision-making at the food-energy-water (FEW) nexus entails additional complexities due to the multi-objective nature of FEW socio-technical systems: policies and decisions meant to improve one facet of the nexus might be less beneficial, or even detrimental, to achieving goals for other facets. In addition, implementing policies and decisions may be more difficult due to increasing coordination required among stakeholders across each nexus facet. We highlight these issues in an economic, material/energy flow, and institutional assessment of dairy farms that produce power from anaerobic digestion of cow manure. This socio-technical system is an example of an integrated food-energy system (IFES), which co-produces food and energy. In the case of dairy farms, water is also a significant consideration because cow manure, if improperly managed, can negatively impact water bodies. Our assessment asks the questions (i) of whether or not adopting an IFES improves farm resilience under potential economic and environment futures and (ii) how decisions, policies, and information can best be tailored to the FEW nexus. Our study consists of semi-structured interviews of 60 farms split between the US states of New York and Vermont, both of which have enacted policies to encourage digester adoption. Each interview asks farmers about their material and energy flows, costs, and decision-making process for adopting (or not) an anaerobic digester. In addition, farmers are asked questions about challenges and barriers they might have faced and future drivers of change. Preliminary results highlight important interactions between policy and decision-making. Foremost, an analysis of policy cohesion shows that environmental objectives cross sectors and governance levels, as state-level greenhouse gas mitigation policies interact with federal-level nutrient management policies. This form of potential policy incoherence may introduce additional problems that hinder digester adoption and operation because technology options might be constrained and information needs may be too great for farmer's to consider adopting a digester.

Distinguishing values from science in decision making: Setting harvest quotas for mountain lions in Montana

USGS Publications Warehouse

Mitchell, Michael S.; Cooley, Hilary; Gude, Justin A.; Kolbe, Jay; Nowak, J. Joshua; Proffitt, Kelly M.; Sells, Sarah N.; Thompson, Mike

2018-01-01

The relative roles of science and human values can be difficult to distinguish when informal processes are used to make complex and contentious decisions in wildlife management. Structured Decision Making (SDM) offers a formal process for making such decisions, where scientific results and concepts can be disentangled from the values of differing stakeholders. We used SDM to formally integrate science and human values for a citizen working group of ungulate hunting advocates, lion hunting advocates, and outfitters convened to address the contentious allocation of harvest quotas for mountain lions (Puma concolor) in west‐central Montana, USA, during 2014. A science team consisting of mountain lion biologists and population ecologists convened to support the working group. The science team used integrated population models that incorporated 4 estimates of mountain lion density to estimate population trajectories for 5 alternative harvest quotas developed by the working group. Results of the modeling predicted that effects of each harvest quota were consistent across the 4 density estimates; harvest quotas affected predicted population trajectories for 5 years after implementation but differences were not strong. Based on these results, the focus of the working group changed to differences in values among stakeholders that were the true impediment to allocating harvest quotas. By distinguishing roles of science and human values in this process, the working group was able to collaboratively recommend a compromise solution. This solution differed little from the status quo that had been the focus of debate, but the SDM process produced understanding and buy‐in among stakeholders involved, reducing disagreements, misunderstanding, and unproductive arguments founded on informal application of scientific data and concepts. Whereas investments involved in conducting SDM may be unnecessary for many decisions in wildlife management, the investment may be beneficial for complex, contentious, and multiobjective decisions that integrate science and human values.

A Vision for Incorporating Environmental Effects into Nitrogen Management Decision Support Tools for U.S. Maize Production

PubMed Central

Banger, Kamaljit; Yuan, Mingwei; Wang, Junming; Nafziger, Emerson D.; Pittelkow, Cameron M.

2017-01-01

Meeting crop nitrogen (N) demand while minimizing N losses to the environment has proven difficult despite significant field research and modeling efforts. To improve N management, several real-time N management tools have been developed with a primary focus on enhancing crop production. However, no coordinated effort exists to simultaneously address sustainability concerns related to N losses at field- and regional-scales. In this perspective, we highlight the opportunity for incorporating environmental effects into N management decision support tools for United States maize production systems by integrating publicly available crop models with grower-entered management information and gridded soil and climate data in a geospatial framework specifically designed to quantify environmental and crop production tradeoffs. To facilitate advances in this area, we assess the capability of existing crop models to provide in-season N recommendations while estimating N leaching and nitrous oxide emissions, discuss several considerations for initial framework development, and highlight important challenges related to improving the accuracy of crop model predictions. Such a framework would benefit the development of regional sustainable intensification strategies by enabling the identification of N loss hotspots which could be used to implement spatially explicit mitigation efforts in relation to current environmental quality goals and real-time weather conditions. Nevertheless, we argue that this long-term vision can only be realized by leveraging a variety of existing research efforts to overcome challenges related to improving model structure, accessing field data to enhance model performance, and addressing the numerous social difficulties in delivery and adoption of such tool by stakeholders. PMID:28804490

Decision making regarding prophylactic mastectomy: stability of preferences and the impact of anticipated feelings of regret.

PubMed

van Dijk, Sandra; van Roosmalen, Mariëlle S; Otten, Wilma; Stalmeier, Peep F M

2008-05-10

Women who test positive for a BRCA1/2 mutation face difficult choices to manage their breast cancer risk; one of these choices is whether to opt for prophylactic mastectomy. Few data are available about this decision-making process. The current study provides data regarding the stability of risk-management preferences over time and the factors that are associated with these preferences. We analyzed data from 338 women who opted for breast cancer antigen (BRCA) testing. First, we prospectively assessed preferences of 80 BRCA mutation carriers at five different points in time ranging from 1 week after blood sampling up to 9 months after BRCA-test disclosure. Second, we applied univariate and multivariate regression analyses to examine which medical, sociodemographic, and psychological factors are related to a preference for prophylactic mastectomy. Ninety percent of the women already indicated a preference regarding risk management at baseline. Moreover, most women had stable preferences over time. Furthermore, anticipated feelings of regret in case of a hypothetical breast cancer diagnosis in the near future were strongly related to risk-management preference (odds ratio = 8.93; P < .0001). Women seem to decide at a relatively early stage about their risk-management preferences. Many of them may be sensitive to the possibility of regret in case of a bad outcome. We discuss whether possible regret in the future is a rational reason for opting for prophylactic mastectomy, or whether it signifies an emotional coping process or strategy in which the future costs are no longer fully considered.

A Vision for Incorporating Environmental Effects into Nitrogen Management Decision Support Tools for U.S. Maize Production.

PubMed

Banger, Kamaljit; Yuan, Mingwei; Wang, Junming; Nafziger, Emerson D; Pittelkow, Cameron M

2017-01-01

Meeting crop nitrogen (N) demand while minimizing N losses to the environment has proven difficult despite significant field research and modeling efforts. To improve N management, several real-time N management tools have been developed with a primary focus on enhancing crop production. However, no coordinated effort exists to simultaneously address sustainability concerns related to N losses at field- and regional-scales. In this perspective, we highlight the opportunity for incorporating environmental effects into N management decision support tools for United States maize production systems by integrating publicly available crop models with grower-entered management information and gridded soil and climate data in a geospatial framework specifically designed to quantify environmental and crop production tradeoffs. To facilitate advances in this area, we assess the capability of existing crop models to provide in-season N recommendations while estimating N leaching and nitrous oxide emissions, discuss several considerations for initial framework development, and highlight important challenges related to improving the accuracy of crop model predictions. Such a framework would benefit the development of regional sustainable intensification strategies by enabling the identification of N loss hotspots which could be used to implement spatially explicit mitigation efforts in relation to current environmental quality goals and real-time weather conditions. Nevertheless, we argue that this long-term vision can only be realized by leveraging a variety of existing research efforts to overcome challenges related to improving model structure, accessing field data to enhance model performance, and addressing the numerous social difficulties in delivery and adoption of such tool by stakeholders.

Groundwater Change in Storage Estimation by Using Monitoring Wells Data

NASA Astrophysics Data System (ADS)

Flores, C. I.

2016-12-01

In present times, remarkable attention is being given to models and data in hydrology, regarding their role in meeting water management requirements to enable well-informed decisions. Water management under the Sustainable Groundwater Management Act (SGMA) is currently challenging, due to it requires that groundwater sustainability agencies (GSAs) formulate groundwater sustainability plans (GSPs) to comply with new regulations and perform a responsible management to secure California's groundwater resources, particularly when droughts and climate change conditions are present. In this scenario, water budgets and change in groundwater storage estimations are key components for decision makers, but their computation is often difficult, lengthy and uncertain. Therefore, this work presents an innovative approach to integrate hydrologic modeling and available groundwater data into a single simplified tool, a proxy function, that estimate in real time the change in storage based on monitoring wells data. A hydrologic model was developed and calibrated for water years 1970 to 2015, the Yolo County IWFM, which was applied to generate the proxy as a study case, by regressing simulated change in storage versus change in head for the cities of Davis and Woodland area, and obtain a linear function dependent on heads variations over time. Later, the proxy was applied to actual groundwater data in this region to predict the change in storage. Results from this work provide proxy functions to approximate change in storage based on monitoring data for daily, monthly and yearly frameworks, being as well easily transferable to any spreadsheet or database to perform simply yet crucial computations in real time for sustainable groundwater management.

A Framework for Business Process Change Requirements Analysis

NASA Astrophysics Data System (ADS)

Grover, Varun; Otim, Samuel

The ability to quickly and continually adapt business processes to accommodate evolving requirements and opportunities is critical for success in competitive environments. Without appropriate linkage between redesign decisions and strategic inputs, identifying processes that need to be modified will be difficult. In this paper, we draw attention to the analysis of business process change requirements in support of process change initiatives. Business process redesign is a multifaceted phenomenon involving processes, organizational structure, management systems, human resource architecture, and many other aspects of organizational life. To be successful, the business process initiative should focus not only on identifying the processes to be redesigned, but also pay attention to various enablers of change. Above all, a framework is just a blueprint; management must lead change. We hope our modest contribution will draw attention to the broader framing of requirements for business process change.

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis.

PubMed

Mitton, Craig; Dionne, Francois; Donaldson, Cam

2014-04-01

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.

Managing the Difficult Child.

ERIC Educational Resources Information Center

Murphy, Linda; Della Corte, Suzanne

1990-01-01

This newsletter issue focuses on ways parents can manage the difficult child with special needs. Characteristics of the difficult child are listed including poor listening skills, irritableness, impulsivity, and tendency to have tantrums. Typical reactions to the difficult child by parents, siblings, other relatives, neighbors, the school, and…

Decision-making in the management of adult classical Hodgkin's lymphoma: determining the optimal treatment.

PubMed

Mounier, Nicolas; Nicolas, Mounier; Gisselbrecht, Christian; Christian, Gisselbrecht

2015-04-01

This review discusses promising new approaches in classical Hodgkin's lymphoma that have been recently evaluated. There is a focus on the fluorodeoxyglucose PET scanning that is now considered crucial for staging and treatment evaluation, including interim evaluation after two cycles. An up-front treatment strategy is discussed, with the place of radiation therapy and the difficult choice of chemotherapy intensity emphasized. Indications for frail patients are also reviewed, particularly elderly or HIV-positive patients. Emerging data on the antibody drug conjugate brentuximab vedotin and its future potential in the transplantation framework for relapsed/refractory Hodgkin's lymphoma is also discussed.

Magnetic resonance spectroscopy-guided transperineal prostate biopsy and brachytherapy for recurrent prostate cancer.

PubMed

Barnes, Agnieszka Szot; Haker, Steven J; Mulkern, Robert V; So, Minna; D'Amico, Anthony V; Tempany, Clare M

2005-12-01

Brachytherapy targeted to the peripheral zone with magnetic resonance imaging (MRI) guidance is a prostate cancer treatment option with potentially fewer complications than other treatments. Follow-up MRI when failure is suspected is, however, difficult because of radiation-induced changes. Furthermore, MR spectroscopy (MRS) is compromised by susceptibility artifacts from radioactive seeds in the peripheral zone. We report a case in which combined MRI/MRS was useful for the detection of prostate cancer in the transitional zone in patients previously treated with MR-guided brachytherapy. We propose that MRI/MRS can help detect recurrent prostate cancer, guide prostate biopsy, and help manage salvage treatment decisions.

[Guidelines for the radiotherapy of gliomas].

PubMed

Feuvret, L; Antoni, D; Biau, J; Truc, G; Noël, G; Mazeron, J-J

2016-09-01

Gliomas are the most frequent primary brain tumours. Treating these tumours is difficult because of the proximity of organs at risk, infiltrating nature, and radioresistance. Clinical prognostic factors such as age, Karnofsky performance status, tumour location, and treatments such as surgery, radiation therapy, and chemotherapy have long been recognized in the management of patients with gliomas. Molecular biomarkers are increasingly evolving as additional factors that facilitate diagnosis and therapeutic decision-making. These practice guidelines aim at helping in choosing the best treatment, in particular radiation therapy. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Perspectives on the land use history of North America: A context for understanding our changing environment

USGS Publications Warehouse

Sisk, Thomas D.

1998-01-01

Ecological change is constant and profound, yet it often occurs at temporal and spatial scales that are difficult to measure and interpret. This publication demonstrates how diverse data bases, archived in different formats and at numerous locations, can be brought together to provide an integrated perspective on the relationship between land use and landcover change. The authors provide the historical context for interpreting recent landcover change in several regions of North America and articulate the value of a comprehensive continental land-use history for guiding environmental policy and management decisions during the coming century and beyond.

Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research study.

PubMed

Rejeh, N; Ahmadi, F; Mohammadi, E; Anoosheh, M; Kazemnejad, A

2008-12-01

Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain. This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method. Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse-patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management.

Medicare Hospice Benefits

MedlinePlus

... Choosing to start hospice care is a difficult decision. The information in this booklet and support from a doctor ... may need hospice care in all health care decisions. The information in this booklet describes the Medicare Program at ...

FEMA's Earthquake Incident Journal: A Web-Based Data Integration and Decision Support Tool for Emergency Management

NASA Astrophysics Data System (ADS)

Jones, M.; Pitts, R.

2017-12-01

For emergency managers, government officials, and others who must respond to rapidly changing natural disasters, timely access to detailed information related to affected terrain, population and infrastructure is critical for planning, response and recovery operations. Accessing, analyzing and disseminating such disparate information in near real-time are critical decision support components. However, finding a way to handle a variety of informative yet complex datasets poses a challenge when preparing for and responding to disasters. Here, we discuss the implementation of a web-based data integration and decision support tool for earthquakes developed by the Federal Emergency Management Agency (FEMA) as a solution to some of these challenges. While earthquakes are among the most well- monitored and measured of natural hazards, the spatially broad impacts of shaking, ground deformation, landslides, liquefaction, and even tsunamis, are extremely difficult to quantify without accelerated access to data, modeling, and analytics. This web-based application, deemed the "Earthquake Incident Journal", provides real-time access to authoritative and event-specific data from external (e.g. US Geological Survey, NASA, state and local governments, etc.) and internal (FEMA) data sources. The journal includes a GIS-based model for exposure analytics, allowing FEMA to assess the severity of an event, estimate impacts to structures and population in near real-time, and then apply planning factors to exposure estimates to answer questions such as: What geographic areas are impacted? Will federal support be needed? What resources are needed to support survivors? And which infrastructure elements or essential facilities are threatened? This presentation reviews the development of the Earthquake Incident Journal, detailing the data integration solutions, the methodology behind the GIS-based automated exposure model, and the planning factors as well as other analytical advances that provide near real-time decision support to the federal government.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study.

PubMed

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study

PubMed Central

Fromberger, Peter; Meyer, Sabrina; Jordan, Kirsten; Müller, Jürgen L.

2018-01-01

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations. PMID:29559934

Making difficult decisions: Immigrants' experiences of employment preparation and participation.

PubMed

Huot, Suzanne; Chen, Xiaojie; King, Christiana; Painter-Zykmund, Ellen; Watt, Kaitlin

2016-06-13

Immigrants engage in complex integration processes that are mediated through daily occupations. A central element of socio-economic integration relates to labor market preparation and participation, including job searching, learning cultural values in the workplace, pursuing credential recognition and engaging in volunteering roles and paid employment. To examine how immigrants experienced occupations relating to preparing for, seeking, and gainingemployment. A secondary analysis using whole text analysis and line-by-line coding of twenty verbatim transcripts from interviews held with ten recently arrived immigrants to London, Ontario, Canada. Sessions consisted of a narrative interview, creation of an occupational map and a semi-structured follow-up interview. The participants' employment related occupations were characterized by the overarching theme of 'making difficult decisions'. This main theme was connected to four related sub-themes: 1) mechanisms of exclusion, 2) learning the host country's culture, 3) the influence of one's outlook on the decisions made, and 4) accessing support. This study identifies factors influencing immigrants' experiences of labor market preparation and participation. 'Making difficult decisions' was faced by all participants throughout the process of becoming part of the Canadian workforce and, ultimately, society at large.

Spatial Bayesian belief networks as a planning decision tool for mapping ecosystem services trade-offs on forested landscapes.

PubMed

Gonzalez-Redin, Julen; Luque, Sandra; Poggio, Laura; Smith, Ron; Gimona, Alessandro

2016-01-01

An integrated methodology, based on linking Bayesian belief networks (BBN) with GIS, is proposed for combining available evidence to help forest managers evaluate implications and trade-offs between forest production and conservation measures to preserve biodiversity in forested habitats. A Bayesian belief network is a probabilistic graphical model that represents variables and their dependencies through specifying probabilistic relationships. In spatially explicit decision problems where it is difficult to choose appropriate combinations of interventions, the proposed integration of a BBN with GIS helped to facilitate shared understanding of the human-landscape relationships, while fostering collective management that can be incorporated into landscape planning processes. Trades-offs become more and more relevant in these landscape contexts where the participation of many and varied stakeholder groups is indispensable. With these challenges in mind, our integrated approach incorporates GIS-based data with expert knowledge to consider two different land use interests - biodiversity value for conservation and timber production potential - with the focus on a complex mountain landscape in the French Alps. The spatial models produced provided different alternatives of suitable sites that can be used by policy makers in order to support conservation priorities while addressing management options. The approach provided provide a common reasoning language among different experts from different backgrounds while helped to identify spatially explicit conflictive areas. Copyright © 2015 Elsevier Inc. All rights reserved.

Breakdowns in coordinated decision making at and above the incident management team level: an analysis of three large scale Australian wildfires.

PubMed

Bearman, Chris; Grunwald, Jared A; Brooks, Benjamin P; Owen, Christine

2015-03-01

Emergency situations are by their nature difficult to manage and success in such situations is often highly dependent on effective team coordination. Breakdowns in team coordination can lead to significant disruption to an operational response. Breakdowns in coordination were explored in three large-scale bushfires in Australia: the Kilmore East fire, the Wangary fire, and the Canberra Firestorm. Data from these fires were analysed using a top-down and bottom-up qualitative analysis technique. Forty-four breakdowns in coordinated decision making were identified, which yielded 83 disconnects grouped into three main categories: operational, informational and evaluative. Disconnects were specific instances where differences in understanding existed between team members. The reasons why disconnects occurred were largely consistent across the three sets of data. In some cases multiple disconnects occurred in a temporal manner, which suggested some evidence of disconnects creating states that were conducive to the occurrence of further disconnects. In terms of resolution, evaluative disconnects were nearly always resolved however operational and informational disconnects were rarely resolved effectively. The exploratory data analysis and discussion presented here represents the first systematic research to provide information about the reasons why breakdowns occur in emergency management and presents an account of how team processes can act to disrupt coordination and the operational response. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Recruitment and Hiring Strategies of Private Practitioners and Implications for Practice Management Training of Veterinary Students.

PubMed

Kogan, Lori R; Hellyer, Peter W; Stewart, Sherry M; Dowers, Kristy L

2015-01-01

Hiring new employees is one of the most important and difficult decisions all veterinary practice managers and owners face. In an effort to improve hiring decisions, many employers are choosing to screen potential employees more thoroughly through the use of interviews, background checks, personality assessments, and online research including social and professional networking websites. The current study reports results from an anonymous online survey created to evaluate practicing veterinarians' attitudes and practices related to the use of recruitment and hiring tools. Results suggest that, compared to those in other professions, veterinarians underutilize these evaluative tools. The profession could benefit from more opportunities for both practitioners and veterinary students to learn how to utilize a broader range of hiring and recruitment techniques. One area of particular and growing concern is the use of Internet social media for evaluation of potential employees. Despite the fairly low number of participants who indicated they currently research applicants online, a significant number plan to implement this practice in the future. Many students are unaware of how their online postings can affect their future job possibilities and career. It is therefore important to designate time within continuing education programs and professional veterinary curricula to educate these populations about hiring and recruitment tool options and about how to manage their personal Internet interactions (especially social media) to enhance and maintain their professional image (e-professionalism).

Human-water interactions in Colorado: Evaluating the impacts of population growth, energy development and dynamic industries on water resource management

NASA Astrophysics Data System (ADS)

Hogue, Terri; Walker, Ella; Read, Laura

2016-04-01

The gap between water supply and demand is growing in the western U.S. due to climate change, rapid population growth, intensive agricultural production, wide-spread energy development and changing industrial use. Water conservation efforts among residential and industrial water users, recycling and reuse techniques, and innovative regulatory frameworks strive to mitigate this gap, however, the extent of these management strategies are often difficult to quantify and are typically not included in prediction of future water allocations. Water use on the eastern slope in Colorado (Denver-Metro region) is impacted by high-intensity activities, including unconventional energy development, large withdrawals for agriculture, and increasing demand for recreational industries. These demands are in addition to a projected population increase of 100% by 2050 in the South Platte River basin, which encompasses the Denver-Metro region. The current presentation focuses on the quantification of regional sector water use utilzing a range of observations and technologies (including remote sensing) and integration into a regional decision support system. We explore scenarios of future water use in the energy, agriculture, and municipal/industrial sectors, and discuss the potential water allocation tradeoffs to various stakeholders. We also employ climate projections to quantify the potential range of water availability under various scenarios and observe the extent to which future climate may influence regional management decisions.

Forests and competing land uses in Kenya

NASA Astrophysics Data System (ADS)

Allaway, James; Cox, Pamela M. J.

1989-03-01

Indigenous forests in Kenya, as in other developing countries, are under heavy pressure from competing agricultural land uses and from unsustainable cutting. The problem in Kenya is compounded by high population growth rates and an agriculturally based economy, which, even with efforts to control birth rates and industrialize, will persist into the next century. Both ecological and economic consequences of these pressures need to be considered in land-use decision making for land and forest management to be effective. This paper presents one way to combine ecological and economic considerations. The status of principal forest areas in Kenya is summarized and competing land uses compared on the basis of ecological functions and economic analysis. Replacement uses do not match the ecological functions of forest, although established stands of tree crops (forest plantations, fuel wood, tea) can have roughly comparable effects on soil and water resources. Indigenous forests have high, although difficult to estimate, economic benefits from tourism and protection of downstream agricultural productivity. Economic returns from competing land uses range widely, with tea having the highest and fuel wood plantations having returns comparable to some annual crops and dairying. Consideration of ecological and economic factors together suggests some trade-offs for improving land allocation decisions and several management opportunities for increasing benefits or reducing costs from particular land uses. The evaluation also suggests a general strategy for forest land management in Kenya.

Panaceas and diversification of environmental policy

PubMed Central

Brock, William A.; Carpenter, Stephen R.

2007-01-01

We consider panacea formation in the framework of adaptive learning and decision for social–ecological systems (SESs). Institutions for managing such systems must address multiple timescales of ecological change, as well as features of the social community in which the ecosystem policy problem is embedded. Response of the SES to each candidate institution must be modeled and treated as a stochastic process with unknown parameters to be estimated. A fundamental challenge is to design institutions that are not vulnerable to capture by subsets of the community that self-organize to direct the institution against the overall social interest. In a world of episodic structural change, such as SESs, adaptive learning can lock in to a single institution, model, or parameter estimate. Policy diversification, leading to escape from panacea traps, can come from monitoring indicators of episodic change on slow timescales, minimax regret decision making, active experimentation to accelerate model identification, mechanisms for broadening the set of models or institutions under consideration, and processes for discovery of new institutions and technologies for ecosystem management. It is difficult to take all of these factors into account, but the discipline that comes with the attempt to model the coupled social–ecological dynamics forces policy makers to confront all conceivable responses. This process helps induce the modesty needed to avoid panacea traps while supporting systematic effort to improve resource management in the public interest. PMID:17881581

7 CFR 3052.405 - Management decision.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 15 2012-01-01 2012-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

7 CFR 3052.405 - Management decision.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 15 2014-01-01 2014-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

7 CFR 3052.405 - Management decision.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

7 CFR 3052.405 - Management decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

Overcoming status quo bias in the human brain.

PubMed

Fleming, Stephen M; Thomas, Charlotte L; Dolan, Raymond J

2010-03-30

Humans often accept the status quo when faced with conflicting choice alternatives. However, it is unknown how neural pathways connecting cognition with action modulate this status quo acceptance. Here we developed a visual detection task in which subjects tended to favor the default when making difficult, but not easy, decisions. This bias was suboptimal in that more errors were made when the default was accepted. A selective increase in subthalamic nucleus (STN) activity was found when the status quo was rejected in the face of heightened decision difficulty. Analysis of effective connectivity showed that inferior frontal cortex, a region more active for difficult decisions, exerted an enhanced modulatory influence on the STN during switches away from the status quo. These data suggest that the neural circuits required to initiate controlled, nondefault actions are similar to those previously shown to mediate outright response suppression. We conclude that specific prefrontal-basal ganglia dynamics are involved in rejecting the default, a mechanism that may be important in a range of difficult choice scenarios.

Fibre-optic awake intubation for caesarean section in a parturient with predicted difficult airway.

PubMed

Trevisan, P

2002-10-01

Anaesthetic management of a parturient with predicted difficult airway presenting for caesarean section (CS) is not a straightforward decision: general anaesthesia should be avoided because intubation can be impossible and a "cannot intubate, cannot ventilate" scenario might ensue, on the other hand regional techniques can be unsuccessful or, though rarely, have complications that require emergency intubation. The case is presented of a primigravida admitted to hospital at 37 weeks' gestation with hypertension, intrauterine growth retardation and oligohydramnios. After a few days' observation, it was decided to proceed with an elective CS. The preoperative airway examination revealed a poor mouth opening with an interdental distance of 20 mm and a Mallampati class IV. The patient was classified as a case of difficult intubation and the following anaesthetic options were considered: epidural anaesthesia, spinal anaesthesia and awake fibreoptic intubation followed by general anaesthesia. The pros and the cons of these techniques were explained to the patient and it was suggested that awake fibreoptic intubation was the safest option. The patient gave her consent, so an uneventful nasal awake fibreoptic intubation was carried out under local anaesthesia. This case report offers the opportunity to underline the risk to perform a central blockade in a parturient with predicted difficult intubation, arguing that the safest course of action is an awake fibrescopic intubation, besides some controversial points to safely perform awake fibreoptic intubation in obstetric patients are discussed.

Parents and end-of-life decision-making for their child: roles and responsibilities.

PubMed

Sullivan, Jane; Gillam, Lynn; Monagle, Paul

2015-09-01

Whether parents want to be and should be the decision-maker for their child in end-of-life matters are contested clinical and ethical questions. Previous research outcomes are equivocal. A qualitative interview method was used to examine the views and experiences of 25 bereaved parents in end-of-life decision-making for their child. Data were analysed thematically. Three types of decision-making roles were identified: self-determined, guided (both involving active decision-making) and acquiescent (passive).The majority of parents had been active in the decision-making process for their child. They perceived themselves as the ultimate end-of-life decision-maker. This was perceived as part of their parental responsibility. A minority of parents did not consider that they had been an active, ultimate decision-maker. Generally, parents in the self-determined and guided groups reported no negative consequences from their decision-making involvement. Importantly, parents in the acquiescent group described their experience as difficult at the time and subsequently, although not all difficulties related directly to decision-making. Parents considered that in principle parents should be the end-of-life decision-maker for their child, but understood personal characteristics and preference could prevent some parents from taking this role. This study unequivocally supports parents' desire to fulfil the end-of-life decision-making role. It provides a nuanced understanding of parents' roles and contributes evidence for the ethical position that parents should be the end-of-life decision-makers for their child, unless not in the child's best interests. On the whole, parents want this role and can manage its consequences. Indeed, not being the end-of-life decision-maker could be detrimental to parents' well-being. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

PubMed

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

2013-01-01

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

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study.

PubMed

Lie, Silje S; Karlsen, Bjørg; Niemiec, Christopher P; Graue, Marit; Oftedal, Bjørg

2018-01-01

Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. The qualitative content analysis yielded 2 main themes. We labeled the first theme as "Written reflection affects awareness and commitment in diabetes self-management", which reflects 2 subthemes, namely, "Writing creates space and time for autonomous reflection" and "Writing influences individuals' focus in diabetes self-management". We labeled the second theme as "Written reflection is perceived as inapplicable in diabetes self-management", which reflects 2 subthemes, namely, "Responding in writing is difficult" and "The timing of the writing is inappropriate". Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a "blended" approach, especially for those who consider written reflection to be difficult or unfamiliar.

A better way to deliver bad news.

PubMed

Manzoni, Jean-François

2002-09-01

In an ideal world, a subordinate would accept critical feedback from a manager with an open mind. He or she would ask a few clarifying questions, promise to work on certain performance areas, and show signs of improvement over time. But things don't always turn out that way. Such conversations can be unpleasant. Emotions can run high; tempers can flare. Fearing that the employee will become angry and defensive, the boss all too often inadvertently sabotages the meeting by preparing for it in a way that stifles honest discussion. This unintentional--indeed, unconscious--stress-induced habit makes it difficult to deliver corrective feedback effectively. Insead professor Jean-François Manzoni says that by changing the mind-set with which they develop and deliver negative feedback, managers can increase their odds of having productive conversations without damaging relationships. Manzoni describes two behavioral phenomena that color the feedback process--the fundamental attribution error and the false consensus effect--and uses real-world examples to demonstrate how bosses' critiques can go astray. Managers tend to frame difficult situations and decisions in a way that is narrow (alternatives aren't considered) and binary (there are only two possible outcomes--win or lose). And during the feedback discussion, managers' framing of the issues often remains frozen, regardless of the direction the conversation takes. Manzoni advises managers not to just settle on the first acceptable explanation for a behavior or situation they've witnessed. Bosses also need to consider an employee's circumstances rather than just attributing weak performance to a person's disposition. In short, delivering more effective feedback requires an open-minded approach, one that will convince employees that the process is fair and that the boss is ready for an honest conversation.

An investigation of the factors effecting high-risk individuals’ decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC)

PubMed Central

Hallowell, Nina; Badger, Shirlene; Richardson, Sue; Caldas, Carlos; Hardwick, Richard H.; Fitzgerald, Rebecca C.; Lawton, Julia

2018-01-01

Because Hereditary Diffuse Gastric Cancer (HDGC) has an early onset and poor prognosis, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual’s life stage. These findings have implications for advising this patient group. PMID:27256430

Negotiation and Decision Making with Collaborative Software: How MarineMap 'Changed the Game' in California's Marine Life Protected Act Initiative.

PubMed

Cravens, Amanda E

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study-which draws on data from approximately 60 semi-structured interviews and an online survey--examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

Implementing Participatory Decision Making in Forest Planning

NASA Astrophysics Data System (ADS)

Ananda, Jayanath

2007-04-01

Forest policy decisions are often a source of debate, conflict, and tension in many countries. The debate over forest land-use decisions often hinges on disagreements about societal values related to forest resource use. Disagreements on social value positions are fought out repeatedly at local, regional, national, and international levels at an enormous social cost. Forest policy problems have some inherent characteristics that make them more difficult to deal with. On the one hand, forest policy decisions involve uncertainty, long time scales, and complex natural systems and processes. On the other hand, such decisions encompass social, political, and cultural systems that are evolving in response to forces such as globalization. Until recently, forest policy was heavily influenced by the scientific community and various economic models of optimal resource use. However, growing environmental awareness and acceptance of participatory democracy models in policy formulation have forced the public authorities to introduce new participatory mechanisms to manage forest resources. Most often, the efforts to include the public in policy formulation can be described using the lower rungs of Arnstein’s public participation typology. This paper presents an approach that incorporates stakeholder preferences into forest land-use policy using the Analytic Hierarchy Process (AHP). An illustrative case of regional forest-policy formulation in Australia is used to demonstrate the approach. It is contended that applying the AHP in the policy process could considerably enhance the transparency of participatory process and public acceptance of policy decisions.

Negotiation and Decision Making with Collaborative Software: How MarineMap `Changed the Game' in California's Marine Life Protected Act Initiative

NASA Astrophysics Data System (ADS)

Cravens, Amanda E.

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study—which draws on data from approximately 60 semi-structured interviews and an online survey—examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

Integrating observations and models to help understanding how flooding impacts upon catchments as a basis for decision making.

NASA Astrophysics Data System (ADS)

Owen, Gareth; Quinn, Paul; O'Donnell, Greg

2014-05-01

This paper explains how flood management projects might be better informed in the future by using more observations and a novel impact modelling tool in a simple transparent framework. The understanding of how local scale impacts propagate downstream to impact on the downstream hydrograph is difficult to determine using traditional rainfall runoff and hydraulic routing methods. The traditional approach to modelling essentially comprises selecting a fixed model structure and then calibrating to an observational hydrograph, which make those model predictions highly uncertain. Here, a novel approach is used in which the structure of the runoff generation is not specified a priori and incorporates expert knowledge. Rather than using externally for calibration, the observed outlet hydrographs are used directly within the model. Essentially the approach involves the disaggregation of the outlet hydrograph by making assumptions about the spatial distribution of runoff generated. The channel network is parameterised through a comparison of the timing of observed hydrographs at a number of nested locations within the catchment. The user is then encouraged to use their expert knowledge to define how runoff is generated locally and what the likely impact of any local mitigation is. Therefore the user can specify any hydrological model or flow estimation method that captures their expertise. Equally, the user is encouraged to install as many instruments as they can afford to cover the catchment network. A Decision Support Matrix (DSM) is used to encapsulate knowledge of the runoff dynamics gained from simulation in a simple visual way and hence to convey the likely impacts that arise from a given flood management scenario. This tool has been designed primarily to inform and educate landowners, catchment managers and decision makers. The DSM outlines scenarios that are likely to increase or decrease runoff rates and allows the user to contemplate the implications and uncertainty of their decisions. The tool can also be used to map the likely changes in flood peak due to land use management options. An example case study will be shown for a 35km2 catchment in Northern England which is prone to flooding. The method encourages end users to instrument and quantify their own catchment network and to make informed, evidence based decisions appropriate to their own flooding problems.

Water Plan 2030: A Dynamic Education Model for Teaching Water Management Issues

NASA Astrophysics Data System (ADS)

Rupprecht, C.; Washburne, J.; Lansey, K.; Williams, A.

2006-12-01

Dynamic educational tools to assist teachers and students in recognizing the impacts of water management decisions in a realistic context are not readily available. Water policy issues are often complex and difficult for students trying to make meaningful connections between system components. To fill this need, we have developed a systems modeling-based educational decision support system (DSS) with supplementary materials. This model, called Water Plan 2030, represents a general semi-arid watershed; it allows users to examine water management alternatives by changing input values for various water uses and basin conditions and immediately receive graphical outputs to compare decisions. The main goal of our DSS model is to foster students' abilities to make knowledgeable decisions with regard to water resources issues. There are two reasons we have developed this model for traditional classroom settings. First, the DSS model provides teachers with a mechanism for educating students about inter-related hydrologic concepts, complex systems and facilitates discussion of water resources issues. Second, Water Plan 2030 encourages student discovery of cause/effect relationships in a dynamic, hands-on environment and develops the ability to realize the implications of water management alternatives. The DSS model has been utilized in an undergraduate, non-major science class for 5 course hours, each of the past 4 semesters. Accompanying the PC-based model are supplementary materials to improve the effectiveness of implementation by emphasizing important concepts and guiding learners through the model components. These materials include in-class tutorials, introductory questions, role-playing activities and homework extensions that have been revised after each user session, based on student and instructor feedback. Most recently, we have developed individual lessons that teach specific model functions and concepts. These modules provide teachers the flexibility to adapt the model to meet numerous teaching goals. Evaluation results indicate that students improved their understanding of fundamental concepts and system interactions and showed the most improvement in questions related to water use by sector and sustainability issues. Model modifications have also improved student feedback of the model effectiveness and user- friendliness. Positive results from this project have created the demand for a web-based version, which will be online in late 2006.

Decision making in a human population living sustainably.

PubMed

Hicks, John S; Burgman, Mark A; Marewski, Julian N; Fidler, Fiona; Gigerenzer, Gerd

2012-10-01

The Tiwi people of northern Australia have managed natural resources continuously for 6000-8000 years. Tiwi management objectives and outcomes may reflect how they gather information about the environment. We qualitatively analyzed Tiwi documents and management techniques to examine the relation between the social and physical environment of decision makers and their decision-making strategies. We hypothesized that principles of bounded rationality, namely, the use of efficient rules to navigate complex decision problems, explain how Tiwi managers use simple decision strategies (i.e., heuristics) to make robust decisions. Tiwi natural resource managers reduced complexity in decision making through a process that gathers incomplete and uncertain information to quickly guide decisions toward effective outcomes. They used management feedback to validate decisions through an information loop that resulted in long-term sustainability of environmental use. We examined the Tiwi decision-making processes relative to management of barramundi (Lates calcarifer) fisheries and contrasted their management with the state government's management of barramundi. Decisions that enhanced the status of individual people and their attainment of aspiration levels resulted in reliable resource availability for Tiwi consumers. Different decision processes adopted by the state for management of barramundi may not secure similarly sustainable outcomes. ©2012 Society for Conservation Biology.

A decision analysis approach for risk management of near-earth objects

NASA Astrophysics Data System (ADS)

Lee, Robert C.; Jones, Thomas D.; Chapman, Clark R.

2014-10-01

Risk management of near-Earth objects (NEOs; e.g., asteroids and comets) that can potentially impact Earth is an important issue that took on added urgency with the Chelyabinsk event of February 2013. Thousands of NEOs large enough to cause substantial damage are known to exist, although only a small fraction of these have the potential to impact Earth in the next few centuries. The probability and location of a NEO impact are subject to complex physics and great uncertainty, and consequences can range from minimal to devastating, depending upon the size of the NEO and location of impact. Deflecting a potential NEO impactor would be complex and expensive, and inter-agency and international cooperation would be necessary. Such deflection campaigns may be risky in themselves, and mission failure may result in unintended consequences. The benefits, risks, and costs of different potential NEO risk management strategies have not been compared in a systematic fashion. We present a decision analysis framework addressing this hazard. Decision analysis is the science of informing difficult decisions. It is inherently multi-disciplinary, especially with regard to managing catastrophic risks. Note that risk analysis clarifies the nature and magnitude of risks, whereas decision analysis guides rational risk management. Decision analysis can be used to inform strategic, policy, or resource allocation decisions. First, a problem is defined, including the decision situation and context. Second, objectives are defined, based upon what the different decision-makers and stakeholders (i.e., participants in the decision) value as important. Third, quantitative measures or scales for the objectives are determined. Fourth, alternative choices or strategies are defined. Fifth, the problem is then quantitatively modeled, including probabilistic risk analysis, and the alternatives are ranked in terms of how well they satisfy the objectives. Sixth, sensitivity analyses are performed in order to examine the impact of uncertainties. Finally, the need for further analysis, data collection, or refinement is determined. The first steps of defining the problem and the objectives are critical to constructing an informative decision analysis. Such steps must be undertaken with participation from experts, decision-makers, and stakeholders (defined here as "decision participants"). The basic problem here can be framed as: “What is the best strategy to manage risk associated with NEOs?” Some high-level objectives might be to minimize: mortality and injuries, damage to critical infrastructure (e.g., power, communications and food distribution), ecosystem damage, property damage, ungrounded media and public speculation, resources expended, and overall cost. Another valuable objective would be to maximize inter-agency/government coordination. Some of these objectives (e.g., “minimize mortality”) are readily quantified (e.g., deaths and injuries averted). Others are less so (e.g., “maximize inter-agency/government coordination”), but these can be scaled. Objectives may be inversely related: e.g., a strategy that minimizes mortality may cost more. They are also unlikely to be weighted equally. Defining objectives and assessing their relative weight and interactions requires early engagement with decision participants. High-level decisions include whether to deflect a NEO, when to deflect, what is the best alternative for deflection/destruction, and disaster management strategies if an impact occurs. Important influences include, for example: NEO characteristics (orbital characteristics, diameter, mass, spin and composition), impact probability and location, interval between discovery and projected impact date, interval between discovery and deflection target date, costs of information collection, costs and technological feasibility of deflection alternatives, risks of deflection campaigns, requirements for inter-agency and international cooperation, and timing of informing the public. The analytical aspects of decision analysis center on estimation of the expected value (i.e. utility) of different alternatives. The expected value of an alternative is a function of the probability-weighted consequences, estimated using Bayesian calculations in a decision tree or influence diagram model. The result is a set of expected-value estimates for all alternatives evaluated that enables a ranking; the higher the expected value, the more preferred the alternative. A common way to include resource limitations is by framing the decision analysis in the context of economics (e.g., cost-effectiveness analysis). An important aspect of decision analysis in the NEO risk management case is the ability, known as sensitivity analysis, to examine the effect of parameter uncertainty upon decisions. The simplest way to evaluate uncertainty associated with the information used in a decision analysis is to adjust the input values one at a time (or simultaneously) to examine how the results change. Monte Carlo simulations can be used to adjust the inputs over ranges or distributions of values; statistical means then are used to determine the most influential variables. These techniques yield a measure known as the expected value of imperfect information. This value is highly informative, because it allows the decision-maker with imperfect information to evaluate the impact of using experiments, tests, or data collection (e.g. Earth-based observations, space-based remote sensing, etc.) to refine judgments; and indeed to estimate how much should be spent to reduce uncertainty.

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

PubMed

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

2015-01-01

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

29 CFR 99.405 - Management decision.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

29 CFR 99.405 - Management decision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

29 CFR 99.405 - Management decision.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 1 2012-07-01 2012-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

29 CFR 99.405 - Management decision.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

29 CFR 99.405 - Management decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

Mock Pages Are a Valid Construct for Assessment of Clinical Decision Making and Interprofessional Communication.

PubMed

Boehler, Margaret L; Schwind, Cathy J; Markwell, Stephen J; Minter, Rebecca M

2017-01-01

Answering pages from nurses about patients in need of immediate attention is one of the most difficult challenges a resident faces during their first days as a physician. A Mock Page program has been developed and adopted into a national surgical resident preparatory curriculum to prepare senior medical students for this important skill. The purpose of this study is to assess standardized mock page cases as a valid construct to assess clinical decision making and interprofessional communication skills. Mock page cases (n = 16) were administered to 213 senior medical students from 12 medical schools participating in a national surgical resident preparatory curriculum in 2013 and 2014. Clinical decision making and interprofessional communication were measured by case-specific assessments evaluating these skills which have undergone rigorous standard-setting to determine pass/fail cut points. Students' performance improved in general for both communication and clinical decision making over the 4-week course. Cases have been identified that seem to be best suited for differentiating high- from low-performing students. Chest pain, pulmonary embolus, and mental status change cases posed the greatest difficulty for student learners. Simulated mock pages demonstrate an innovative technique for training students in both effective interprofessional communication and management of common postoperative conditions they will encounter as new surgical interns.

A policy evaluation tool: Management of a multiaquifer system using controlled stream recharge

USGS Publications Warehouse

Danskin, Wesley R.; Gorelick, Steven M.

1985-01-01

A model for the optimal allocation of water resources was developed for a multiaquifer groundwater and surface water system near Livermore, California. The complex groundwater system was analyzed using a transient, quasi-three-dimensional model that considers the nonlinear behavior of the unconfined aquifer. The surface water system consists of a reservoir that discharges water to three streams which in turn recharge the upper aquifer. Nonlinear streamflow-recharge relationships were developed based upon synoptic field measurements of streamflow. The management model uses constrained optimization to minimize the cost of allocating surface water subject to physical and economic restrictions. Results indicate that a combined hydrologic and economic management model can be used to evaluate management practices of a complex hydrogeologic system. Questions can be posed which either would be impossible or extremely difficult to solve without the management model. We demonstrate the utility of such a model in three areas. First, the efficiency of intra-basin water allocations is evaluated. Second, critical factors that control management decisions of the basin are identified. Third, the influence of economic incentives that can best satisfy the conflicting objectives of various water users is explored.

Prosthetic replacement for proximal humeral fractures.

PubMed

Kontakis, George; Tosounidis, Theodoros; Galanakis, Ioannis; Megas, Panagiotis

2008-12-01

The ideal management of complex proximal humeral fractures continues to be debatable. Evolution of proximal humeral fracture management, during the past decade, led to the implementation of many innovations in surgical treatment. Even though the pendulum of treatment seems to swing towards new trends such as locked plating, hemiarthroplasty remains a valid and reliable option that serves the patient's needs well. Hemiarthroplasty is indicated for complex proximal humeral fractures in elderly patients with poor bone stock and when internal fixation is difficult or unreliable. Hemiarthroplasty provides a better result when it is performed early post-injury. Stem height, retroversion and tuberosity positioning are technical aspects of utmost importance. Additionally reverse total shoulder arthroplasty is an alternative new modality that can be used as a primary solution in selected patients with proximal humeral fracture treatment. Failed hemiarthroplasty and fracture sequelae can be successfully managed with reverse total shoulder arthroplasty. Individual decision-making and tailored treatment that takes into consideration the personality of the fracture and the patient's characteristics should be used.

[Withdrawal of artificial nutrition and hydration in severe stroke: medical, legal and ethical considerations].

PubMed

Tannier, C; Crozier, S; Zuber, M; Constantinides, Y; Delezie, E; Gisquet, E; Grignoli, N; Lamy, C; Louvet, F; Pinel, J-F

2015-02-01

In the majority of cases, severe stroke is accompanied by difficulty in swallowing and an altered state of consciousness requiring artificial nutrition and hydration. Because of their artificial nature, nutrition and hydration are considered by law as treatment rather basic care. Withdrawal of these treatments is dictated by the refusal of unreasonable obstinacy enshrined in law and is justified by the risk of severe disability and very poor quality of life. It is usually the last among other withholding and withdrawal decisions which have already been made during the long course of the disease. Reaching a collegial consensus on a controversial decision such as artificial nutrition and hydration withdrawal is a difficult and complex process. The reluctance for such decisions is mainly due to the symbolic value of food and hydration, to the fear of "dying badly" while suffering from hunger and thirst, and to the difficult distinction between this medical act and euthanasia. The only way to overcome such reluctance is to ensure flawless accompaniment, associating sedation and appropriate comfort care with a clear explanation (with relatives but also caregivers) of the rationale and implications of this type of decision. All teams dealing with this type of situation must have thoroughly thought through the medical, legal and ethical considerations involved in making this difficult decision. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Difficult decisions in times of constraint: Criteria based Resource Allocation in the Vancouver Coastal Health Authority

PubMed Central

2011-01-01

Objectives The aim of the project was to develop a plan to address a forecasted deficit of approximately $4.65 million for fiscal year 2010/11 in the Vancouver Communities division of the Vancouver Coastal Health Authority. For disinvestment opportunities identified beyond the forecasted deficit, a commitment was made to consider options for resource re-allocation within the Vancouver Communities division. Methods A standard approach to program budgeting and marginal analysis (PBMA) was taken with a priority setting working committee and a broader advisory panel. An experienced, non-vested internal project manager worked closely with the two-member external research team throughout the process. Face to face evaluation interviews were held with 10 decision makers immediately following the process. Results The recommendations of the working committee included the implementation of 44 disinvestment initiatives with an annualized value of CAD $4.9 million, as well as consideration of possible investments if the realized savings match expectations. Overall, decision makers viewed the process favorably and the primary aim of addressing the deficit gap was met. Discussion A key challenge was the tight timeline which likely lead to less evidence informed decision making then one would hope for. Despite this, decision makers felt that better decisions were made then had the process not been in place. In the end, this project adds value in finding that PBMA can be used to cover a deficit and minimize opportunity cost through systematic application of criteria whilst ensuring process fairness through focusing on communication, transparency and decision maker engagement. PMID:21756357

Psychological defense, ideological hideaway, or rational reckoning? The role of uncertainty in local adaptation to climate change

NASA Astrophysics Data System (ADS)

Moser, S. C.

2011-12-01

As adaptation planning is rising rapidly on the agenda of decision-makers, the need for adequate information to inform those decisions is growing. Locally relevant climate change (as well as related impacts and vulnerability) information, however, is difficult to obtain and that which can be obtained carries the burden of significant scientific uncertainty. This paper aims to assess how important such uncertainty is in adaptation planning, decision-making, and related stakeholder engagement. Does uncertainty actually hinder adaptation planning? Is scientific uncertainty used to postpone decisions reflecting ideologically agendas? Or is it a convenient defense against cognitive and affective engagement with the emerging and projected - and in some cases daunting - climate change risks? To whom does such uncertainty matter and how important is it relative to other challenges decision-makers and stakeholders face? The paper draws on four sources of information to answer these questions: (1) a statewide survey of California coastal managers conducted in summer 2011, (2) years of continual engagement with, and observation of, decision-makers in local adaptation efforts, (3) findings from focus groups with lay individuals in coastal California; and (4) a review of relevant adaptation literature to guide and contextualize the empirical research. The findings entail some "inconvenient truths" for those claiming critical technical or political importance. Rather, the insights suggest that some uncertainties matter more than others; they matter at certain times, but not at others; and they matter to some decision-makers, but not to others. Implications for scientists communicating and engaging with communities are discussed.

Multi-objective decision-making under uncertainty: Fuzzy logic methods

NASA Technical Reports Server (NTRS)

Hardy, Terry L.

1994-01-01

Selecting the best option among alternatives is often a difficult process. This process becomes even more difficult when the evaluation criteria are vague or qualitative, and when the objectives vary in importance and scope. Fuzzy logic allows for quantitative representation of vague or fuzzy objectives, and therefore is well-suited for multi-objective decision-making. This paper presents methods employing fuzzy logic concepts to assist in the decision-making process. In addition, this paper describes software developed at NASA Lewis Research Center for assisting in the decision-making process. Two diverse examples are used to illustrate the use of fuzzy logic in choosing an alternative among many options and objectives. One example is the selection of a lunar lander ascent propulsion system, and the other example is the selection of an aeration system for improving the water quality of the Cuyahoga River in Cleveland, Ohio. The fuzzy logic techniques provided here are powerful tools which complement existing approaches, and therefore should be considered in future decision-making activities.

Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance.

PubMed

Hughes, David; Doheny, Shane

2011-11-01

This paper examines audio-recorded data from meetings in which NHS managers decide whether to fund high-cost drugs for individual patients. It investigates the work of a Welsh individual patient commissioning (IPC) panel responsible for sanctioning the purchase of 'un-commissioned' treatments for exceptional cases. The case study presented highlights the changing rationales used for approving or denying a cancer drug, Tarceva, during a period when NICE first suggested it was not cost effective, but then changed its position in a final technology appraisal recommending use when the cost did not exceed that of an alternative product. Our data show how decisions taken in the shadow of NICE guidance remain complex and subject to local discretion. Guidance that takes time to prepare, is released in stages, and relates to particular disease stages, must be interpreted in the context of particular cases. The case-based IPC panel discourse stands in tension with the standardised population-based recommendations in guidance. Panel members, who based their decisions on the central notions of 'efficacy' and 'exceptionality', often struggled to apply NICE information on cost-effectiveness to their deliberations on efficacy (clinical effectiveness). The case study suggests that the complex nature of decision making makes standardization of outcomes very difficult to achieve, so that local professional judgement is likely to remain central to health care rationing at this level. Copyright © 2011 Elsevier Ltd. All rights reserved.

Understanding the Complexities of Communicating Management Decisions on the Subsistence Use of Yukon River Salmon

NASA Astrophysics Data System (ADS)

Brooks, J. F.; Trainor, S.

2017-12-01

Over 20,000 residents in Alaska and Yukon Territory rely upon the Yukon River to provide them harvests of Pacific salmon each year. Salmon are a highly valued food resource and the practice of salmon fishing along the Yukon is deep rooted in local cultures and traditions. Potential future impacts of climate change on the health of Yukon River salmon stocks could be significant. Collaborative managerial processes which incorporate the viewpoints of subsistence stakeholders will be crucial in enabling communities and managerial institutions to adapt and manage these impacts. However, the massive extent of the Yukon River makes it difficult for communities rich with highly localized knowledge to situate themselves within a drainage-wide context of resource availability, and to fully understand the implications that management decisions may have for their harvest. Differences in salmon availability and abundance between the upper and lower Yukon, commercial vs. subsistence fishery interests, and enforcement of the international Pacific Salmon Treaty further complicate understanding and makes the topic of salmon as a subsistence resource a highly contentious issue. A map which synthesizes the presence and absence of Pacific salmon throughout the entire Yukon River drainage was requested by both subsistence fishers and natural resource managers in Alaska in order to help facilitate productive conversations about salmon management decisions. Interviews with Alaskan stakeholders with managerial, biological, and subsistence harvest backgrounds were carried out and a literature review was conducted in order to understand what such a map should and could accomplish. During the research process, numerous data gaps concerning the distribution of salmon along the Yukon River were discovered, and insights about the complexities involved in translating science when it is situated within a charged political, economic, and cultural context were revealed. Preliminary maps depicting the timing of salmon pulses, the data gaps present, and the political landscape of the Yukon River were created. A future step of developing an interactive online mapping tool has been identified as a way to most clearly communicate the complexity of the interwoven systems involved in the status of Yukon River salmon and their management.

Despite Best Intentions: A Critical Analysis of Social Justice Leadership and Decision Making

ERIC Educational Resources Information Center

DeMatthews, David E.; Mungal, Angus Shiva; Carrola, Paul A.

2015-01-01

The purpose of this article is to explore the relationship between social justice leadership and organizational decision making in order to make recommendations for how principals can make more socially just decisions in difficult school contexts. This article begins with a discussion of social justice leadership, facets and theories associated…

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies.

PubMed

Mark, Lynette J; Herzer, Kurt R; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I; Berkow, Lauren C; Haut, Elliott R; Hillel, Alexander T; Miller, Christina R; Feller-Kopman, David J; Schiavi, Adam J; Xie, Yanjun J; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W; Mirski, Marek A

2015-07-01

Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

PubMed Central

Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

2015-01-01

Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which more than 200 providers were trained. Conclusions DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care. PMID:26086513

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

PubMed

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

2012-01-01

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

Dissociated Neural Processing for Decisions in Managers and Non-Managers

PubMed Central

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

2012-01-01

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

A Study on Project Priority Evaluation Method on Road Slope Disaster Prevention Management

NASA Astrophysics Data System (ADS)

Sekiguchi, Nobuyasu; Ohtsu, Hiroyasu; Izu, Ryuutarou

To improve the safety and security of driving while coping with today's stagnant economy and frequent natural disasters, road slopes should be appropriately managed. To achieve the goals, road managers should establish project priority evaluation methods for each stage of road slope management by clarifying social losses that would result by drops in service levels. It is important that road managers evaluate a project priority properly to manage the road slope effectively. From this viewpoint, this study proposed "project priority evaluation methods" in road slope disaster prevention, which use available slope information at each stage of road slope management under limited funds. In addition, this study investigated the effect of managing it from the high slope of the priority by evaluating a risk of slope failure. In terms of the amount of available information, staged information provision is needed ranging from macroscopic studies, which involves evaluation of the entire route at each stage of decision making, to semi- and microscopic investigations for evaluating slopes, and microscopic investigations for evaluating individual slopes. With limited funds, additional detailed surveys are difficult to perform. It is effective to use the slope risk assessment system, which was constructed to complement detailed data, to extract sites to perform precise investigations.

Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

PubMed

Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

2016-09-01

To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

Development of a patient decision aid for people with refractory angina: protocol for a three-phase pilot study

PubMed Central

2014-01-01

Background Refractory angina is a severe chronic disease, defined as angina which cannot be controlled by usual treatments for heart disease. This disease is frightening, debilitating, and difficult to manage. Many people suffering refractory have inadequate pain relief, continually revisit emergency departments for help, undergo repeated cardiac investigations, and struggle with obtaining appropriate care. There is no clear framework to help people understand the risks and benefits of available treatment options in Canada. Some treatments for refractory angina are invasive, while others are not covered by provincial health insurance plans. Effective care for refractory angina sufferers in Canada is critically underdeveloped; it is important that healthcare professionals and refractory angina sufferers alike understand the treatment options and their implications. This proposal builds on the recent Canadian practice guidelines for the management of refractory angina. We propose to develop a decision support tool in order to help people suffering from refractory angina make well-informed decisions about their healthcare and reduce their uncertainty about treatment options. Methods This project will be conducted in three phases: a) development of the support tool with input from clinical experts, the Canadian refractory angina guidelines, and people living with refractory angina, b) pilot testing of the usability of the tool, and c) formal preliminary evaluation of the effectiveness of the support tool to help people make informed decisions about treatment options. Discussion A decision support tool for refractory angina is needed and the available data suggest that by developing such a tool, we may be able to help refractory angina sufferers better understand their condition and the effectiveness of available treatment options (in their respective clinical settings) as well as their implications (e.g. risks vs. benefits). By virtue of this tool, we may also be able to facilitate identification and inclusion of patients’ values and preferences in the decision making process. This is particularly important as refractory angina is an intractable condition, necessitating that the selected course of treatment be lifelong. This study will yield a much needed patient decision aid for people living with refractory angina and pilot data to support a subsequent effectiveness study. PMID:24920518

Water challenges of the future; how scientific understanding can help

NASA Astrophysics Data System (ADS)

Young, G.

2012-04-01

Demands for water resources are diverse and are increasing as human populations grow and become more concentrated in urban areas and as economies develop. Water is essential for many uses including the basic human needs of food and the maintenance of good health, for many industries and the creation of electrical energy and as vital for the sustenance of the natural ecosystems on which all life is dependent. At the same time threats from water - floods, droughts - are increasing with these extreme events becoming more common and more intense in many regions of the world and as more people locate in flood- and drought-prone regions. In general, the challenges for water managers are thus becoming greater; managers not only are having to make increasingly difficult decisions regarding allocation of water resources between competing uses as demand outstrips supply, but they also have to take measures to protect societies from the ravages of extreme events. The intensity of the challenges facing water managers is not uniform throughout the world - many nations in the less developed world experiencing far greater problems than most highly developed nations - but the trend towards greater challenges is clear. Decision-makers, whether at the international, national, provincial or local level benefit from reliable information on water resources. They need information on the availability in quantity and quality of water from a variety of sources - surface waters, aquifers or from artificial sources such as re-cycling of wastewater and desalination techniques. Managers also need reliable predictions on water availability for the various uses to which water is put - such predictions are needed on time scales from weeks to decades to inform decision-making. Predictions are also needed on the probabilities of occurrence of extreme events. Thus hydrological scientists developing predictive models and working within a fast-changing world have much to contribute to the needs of society.

Using climate information for fuels management

USGS Publications Warehouse

Kolden, Crystal A.; Brown, Timothy J.

2008-01-01

Climate has come to the forefront of wildfire discussions in recent years as research contributes to the general understanding of how climate influences fuels availability to burn, the occurrence of severe fire weather conditions and other wildfire parameters. This understanding has crossed over into wildfire management applications through the creation of tools like climate forecasts for wildfire and drought indices, which are now widely used in wildfire suppression and mitigation planning. The overall question is how can climate information help fire managers meet management objectives? Climate underlies weather. For example, a number of days could be generally wet, but that may occur in the context of a two-year overall drought. Knowing the baseline climate is not only critical to preventing escaped prescribed fires, but also how it may affect fire behavior, fire effects and whether or not fire managers will meet their fuels management objectives. Thus, for fire managers to use prescribed and WFU fire safely and effectively, and to minimize the number of escaped fires and conversions to suppression, they need to understand how current climate conditions will impact the use of fire. One example is the need to use prescribed fire under set “burn windows”. Since meteorological conditions vary considerably from year to year for a given day, fire managers will be more successful in utilizing burn windows effectively if they understand those climate thresholds conducive to an increased number of safe burn windows, and are able to predict and take advantage of those burn windows. While climate and wildfire has been studied extensively, climate and fire use has not. The initial goal of this project was to assess how climate impacts prescribed fire use in a more general sense. After a preliminary informal survey in the spring of 2003, we determined that 1) there is insufficient data (less than 10 years) to conduct empirical correlative studies similar to those of the relationships between climate and wildfire (e.g., Swetnam and Betancourt 1990), and 2) prescribed fire policy has many regulations that potentially inhibited the use of climate information for decision-making. It was also determined that because fire use is a human decision, it would be more informative to ask fire managers themselves how climate impacts fire use through their decision-making processes, and whether or not they use climate information for prescribed fire. The first task for this project was to complete a regional survey of prescribed fire managers in California and Nevada. During the second phase of the project, additional prescribed fire managers were surveyed across the country. During the third year a second survey of WFU managers was completed. The goals of these inquiries were to determine: 1) If fire managers use climate information for fuels management; 2) The perspective fire managers have towards climate affecting fuels management; 3) Determine any obstacles that make it difficult to use climate information for fuels management; and 4) Determine climate information managers need to help them make better decisions for fire use.

Scenario Planning Provides a Framework for Climate Change Adaptation in the National Park Service

NASA Astrophysics Data System (ADS)

Welling, L. A.

2012-12-01

Resource management decisions must be based on future expectations. Abundant evidence suggests climate change will have highly consequential effects on the Nation's natural and cultural resources, but specific impacts are difficult to accurately predict. This situation of too much information but not enough specificity can often lead to either paralysis or denial for decision makers. Scenario planning is an emerging tool for climate change adaptation that provides a structured framework for identifying and exploring critical drivers of change and their uncertain outcomes. Since 2007, the National Park Service (NPS) has been working with its partners to develop and apply a scenario-based approach for adaptation planning that integrates quantitative, model-driven, climate change projections with qualitative, participatory exercises to explore management and policy options under a range of future conditions. Major outcomes of this work are (1) increased understanding of key scientific results and uncertainties, (2) incorporation of alternative perspectives into park and landscape level planning, (3) identification of "no brainer" and "no gainer" actions, (4) strengthening of regional science-management partnerships, and (5) overall improved capacity for flexible decision making. The basic approach employed by NPS for scenario planning follows a typical adaptive management process: define the focal question, assess the relevant science, explore plausible futures, identify effective strategies, prioritize and implement actions, and monitor results. Many science and management partners contributed to the process, including NOAA Regional Integrated Science and Assessment teams (RISAs) and Regional Climate Centers (RCCs), USGS Research Centers, and other university and government scientists. The Global Business Network, an internationally recognized leader in scenario development, provided expert facilitation and training techniques. Climate science input is provided through global and regional circulation models and downscaling to arrive at climate driver information that is relevant for parks and the landscapes within which they are found. Considerable effort is necessary to synthesize the information and to effectively communicate uncertainties about both values and trend (e.g. scientists have higher confidence in the trend of temperature over a given time period than the value). Drivers that are determined to be highly consequential and uncertain are used to create management-relevant scenarios using various techniques, including a structured 2X2 matrix approach, a succession of rapid combinations using multiple variables, and the development of a base, "least change" scenario from which alternatives are then constructed. Socio-economic factors are also considered as essential factors that define the full decision environment within which management and policy decisions are made. Resulting scenarios incorporate information about impacts to natural and cultural resources as well as facilities and visitor experience. The NPS conducted prototypes for scenario planning in each of seven regions and has begun to incorporate elements of the process into all planning requirements. A significant outcome of this work is managers and scientists alike understand climate and ecosystem models provide tools for exploring the future rather than predicting it.

Multiobjective assessment of distributed energy storage location in electricity networks

NASA Astrophysics Data System (ADS)

Ribeiro Gonçalves, José António; Neves, Luís Pires; Martins, António Gomes

2017-07-01

This paper presents a methodology to provide information to a decision maker on the associated impacts, both of economic and technical nature, of possible management schemes of storage units for choosing the best location of distributed storage devices, with a multiobjective optimisation approach based on genetic algorithms. The methodology was applied to a case study, a known distribution network model in which the installation of distributed storage units was tested, using lithium-ion batteries. The obtained results show a significant influence of the charging/discharging profile of batteries on the choice of their best location, as well as the relevance that these choices may have for the different network management objectives, for example, for reducing network energy losses or minimising voltage deviations. Results also show a difficult cost-effectiveness of an energy-only service, with the tested systems, both due to capital cost and due to the efficiency of conversion.

Using collaborative tools for energy corridor planning.

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

Kuiper, J. A.; Cantwell, B.; Hlohowskyj, I.

2008-01-01

In November 2007, the Draft Programmatic Environmental Impact Statement on Designation of Energy Corridors on Federal Land in the Western 11 States was released. The draft proposes a network of 6055 miles of energy corridors on lands managed by seven different federal agencies. Determining the proposed locations of the corridors was a large collaborative effort among the agencies and included local, state, and federal land managers. To connect this geographically dispersed group of people, the project team employed a variety of approaches to communicate corridor siting issues, including sharing GIS layers and electronic maps, a downloadable GIS database and ArcReadermore » project, workshops, and Internet webcast teleconferences. This collaborative approach allowed difficult siting issues to be understood and discussed from many perspectives, which resulted in rapid and effective decision making. The result was a proposed corridor system that avoids many sensitive resources and protected lands while accommodating expected energy development.« less

Supporting diagnosis and treatment in medical care based on Big Data processing.

PubMed

Lupşe, Oana-Sorina; Crişan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara; Bernard, Elena

2014-01-01

With information and data in all domains growing every day, it is difficult to manage and extract useful knowledge for specific situations. This paper presents an integrated system architecture to support the activity in the Ob-Gin departments with further developments in using new technology to manage Big Data processing - using Google BigQuery - in the medical domain. The data collected and processed with Google BigQuery results from different sources: two Obstetrics & Gynaecology Departments, the TreatSuggest application - an application for suggesting treatments, and a home foetal surveillance system. Data is uploaded in Google BigQuery from Bega Hospital Timişoara, Romania. The analysed data is useful for the medical staff, researchers and statisticians from public health domain. The current work describes the technological architecture and its processing possibilities that in the future will be proved based on quality criteria to lead to a better decision process in diagnosis and public health.

Mucormycosis in Children: Review and Recommendations for Management.

PubMed

Francis, Joshua R; Villanueva, Paola; Bryant, Penelope; Blyth, Christopher C

2018-05-15

Mucormycosis represents the third most common invasive fungal infection in children, and recent studies have suggested a rising incidence. Its case fatality rate is high, especially for neonates. Clinical presentation is influenced by underlying risk factors; associations with immunosuppression, neutropenia, diabetes, and prematurity have been described. It has been implicated in several hospital outbreaks. Diagnosis requires a high index of suspicion and evaluation with histopathology, culture, and, increasingly, molecular identification. Surgical debridement and antifungal therapies are the cornerstone for combatting invasive mucormycosis. However, the severity and relative rarity of this disease make comparative clinical trials for evaluating antifungal therapies in children difficult to conduct. Hence, therapeutic decisions are derived mainly from retrospective case series, in vitro data, and animal models. In this review, we summarize the literature on the epidemiology and diagnosis of this invasive fungal infection and provide suggestions on the management of mucormycosis in children.

Error Detection-Based Model to Assess Educational Outcomes in Crisis Resource Management Training: A Pilot Study.

PubMed

Bouhabel, Sarah; Kay-Rivest, Emily; Nhan, Carol; Bank, Ilana; Nugus, Peter; Fisher, Rachel; Nguyen, Lily Hp

2017-06-01

Otolaryngology-head and neck surgery (OTL-HNS) residents face a variety of difficult, high-stress situations, which may occur early in their training. Since these events occur infrequently, simulation-based learning has become an important part of residents' training and is already well established in fields such as anesthesia and emergency medicine. In the domain of OTL-HNS, it is gradually gaining in popularity. Crisis Resource Management (CRM), a program adapted from the aviation industry, aims to improve outcomes of crisis situations by attempting to mitigate human errors. Some examples of CRM principles include cultivating situational awareness; promoting proper use of available resources; and improving rapid decision making, particularly in high-acuity, low-frequency clinical situations. Our pilot project sought to integrate CRM principles into an airway simulation course for OTL-HNS residents, but most important, it evaluated whether learning objectives were met, through use of a novel error identification model.

The impact of prescription charges on asthma patients is uneven and unpredictable: evidence from qualitative interviews.

PubMed

Schafheutle, Ellen I

2009-12-01

To explore whether, and how, prescription charges affect asthma patients' disease management behaviour. Thirty qualitative interviews. Interviewees were aged between 21 and 59, 21 were women, 24 were paying individual prescription charges, and six had prepayment certificates (PPCs). Most had a beta2-agonist 'reliever' and a steroid 'preventer' inhaler. Prescription charges posed affordability issues for some, and for two patients cost-related reduction in 'preventer' use affected asthma control negatively. Many described various ways of keeping medication cost down. Affordability issues, negative views on paying charges, and whether interviewees viewed their asthma medication as essential, were influential factors. Steroid inhalers were viewed more commonly as being less essential and affected by cost. The episodic nature of asthma meant that predicting benefit from PPCs was difficult. This study strengthens existing evidence that medication cost is a factor in asthma patients' management decisions, with a potential cost-related impact on asthma control.

Decisions and Macroeconomics: Development and Implementation of a Simulation Game

ERIC Educational Resources Information Center

Woltjer, Geert B.

2005-01-01

For many students macroeconomics is very abstract; it is difficult for them to imagine that the theories are fundamentally about the coordination of human decisions. The author developed a simulation game called Steer the Economy that creates the possibility for students to make the decisions of the firms that are implicit in macroeconomic models.…

A data mining system for providing analytical information on brain tumors to public health decision makers.

PubMed

Santos, R S; Malheiros, S M F; Cavalheiro, S; de Oliveira, J M Parente

2013-03-01

Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries. Malignant brain neoplasms are among the most devastating and incurable forms of cancer, and their treatment may be excessively complex and costly. Public health decision makers require significant amounts of analytical information to manage public treatment programs for these patients. Data mining, a technology that is used to produce analytically useful information, has been employed successfully with medical data. However, the large-scale adoption of this technique has been limited thus far because it is difficult to use, especially for non-expert users. One way to facilitate data mining by non-expert users is to automate the process. Our aim is to present an automated data mining system that allows public health decision makers to access analytical information regarding brain tumors. The emphasis in this study is the use of ontology in an automated data mining process. The non-experts who tried the system obtained useful information about the treatment of brain tumors. These results suggest that future work should be conducted in this area. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Identifying controlling factors of ground-level ozone levels over southwestern Taiwan using a decision tree

NASA Astrophysics Data System (ADS)

Chu, Hone-Jay; Lin, Chuan-Yao; Liau, Churn-Jung; Kuo, Yi-Ming

2012-12-01

Kaohsiung City and the suburban region of southwestern Taiwan have suffered from severe air pollution since becoming the largest center of heavy industry in Taiwan. The complex process of ozone (O3) formation and its precursor compounds (the volatile organic compounds (VOCs) and nitrogen oxide (NOx) emissions), accompanied by meteorological conditions, make controlling ozone difficult. Using a decision tree is especially appropriate for analyzing time series data that contain ozone levels and meteorological and explanatory variables for ozone formation. Results show that dominant variables such as temperature, wind speed, VOCs, and NOx can play vital roles in describing ozone variations among observations. That temperature and wind speed are highly correlated with ozone levels indicates that these meteorological conditions largely affect ozone variability. The results also demonstrate that spatial heterogeneity of ozone patterns are in coastal and inland areas caused by sea-land breeze and pollutant sources during high ozone episodes over southwestern Taiwan. This study used a decision tree to obtain quantitative insight into spatial distributions of precursor compound emissions and effects of meteorological conditions on ozone levels that are useful for refining monitoring plans and developing management strategies.

Sediment source fingerprinting as an aid to catchment management: A review of the current state of knowledge and a methodological decision-tree for end-users

USGS Publications Warehouse

Collins, A.L; Pulley, S.; Foster, I.D.L; Gellis, Allen; Porto, P.; Horowitz, A.J.

2017-01-01

The growing awareness of the environmental significance of fine-grained sediment fluxes through catchment systems continues to underscore the need for reliable information on the principal sources of this material. Source estimates are difficult to obtain using traditional monitoring techniques, but sediment source fingerprinting or tracing procedures, have emerged as a potentially valuable alternative. Despite the rapidly increasing numbers of studies reporting the use of sediment source fingerprinting, several key challenges and uncertainties continue to hamper consensus among the international scientific community on key components of the existing methodological procedures. Accordingly, this contribution reviews and presents recent developments for several key aspects of fingerprinting, namely: sediment source classification, catchment source and target sediment sampling, tracer selection, grain size issues, tracer conservatism, source apportionment modelling, and assessment of source predictions using artificial mixtures. Finally, a decision-tree representing the current state of knowledge is presented, to guide end-users in applying the fingerprinting approach.

Visual Attention Allocation Between Robotic Arm and Environmental Process Control: Validating the STOM Task Switching Model

NASA Technical Reports Server (NTRS)

Wickens, Christopher; Vieanne, Alex; Clegg, Benjamin; Sebok, Angelia; Janes, Jessica

2015-01-01

Fifty six participants time shared a spacecraft environmental control system task with a realistic space robotic arm control task in either a manual or highly automated version. The former could suffer minor failures, whose diagnosis and repair were supported by a decision aid. At the end of the experiment this decision aid unexpectedly failed. We measured visual attention allocation and switching between the two tasks, in each of the eight conditions formed by manual-automated arm X expected-unexpected failure X monitoring- failure management. We also used our multi-attribute task switching model, based on task attributes of priority interest, difficulty and salience that were self-rated by participants, to predict allocation. An un-weighted model based on attributes of difficulty, interest and salience accounted for 96 percent of the task allocation variance across the 8 different conditions. Task difficulty served as an attractor, with more difficult tasks increasing the tendency to stay on task.

25 CFR 217.5 - Management decisions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

38 CFR 41.405 - Management decision.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

25 CFR 217.5 - Management decisions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

38 CFR 41.405 - Management decision.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

25 CFR 217.5 - Management decisions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

38 CFR 41.405 - Management decision.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

25 CFR 217.5 - Management decisions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

38 CFR 41.405 - Management decision.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

25 CFR 217.5 - Management decisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

38 CFR 41.405 - Management decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

Developing cartoons for long-term condition self-management information.

PubMed

Kennedy, Anne; Rogers, Anne; Blickem, Christian; Daker-White, Gavin; Bowen, Robert

2014-02-08

Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD). Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods. In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret. Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management.

Land Treatment Digital Library

USGS Publications Warehouse

Pilliod, David S.

2009-01-01

Across the country, public land managers make hundreds of decisions each year that influence landscapes and ecosystems within the lands they manage. Many of these decisions involve vegetation manipulations known as land treatments. Land treatments include activities such as removal or alteration of plant biomass, seeding burned areas, and herbicide applications. Data on these land treatments are usually stored at local offices, and gathering information across large spatial areas can be difficult. There is a need to centralize and store treatment data for Federal agencies involved in land treatments because these data are useful to land managers for policy and management and to scientists for developing sampling designs and studies. The Land Treatment Digital Library (LTDL) was created by the U.S. Geological Survey (USGS) to catalog information about land treatments on Federal lands in the western United States for all interested parties. The flexible framework of the library allows for the storage of a wide variety of data in different formats. The LTDL currently stores previously established land treatments or what often are called legacy data. The project was developed and has been refined based on feedback from partner agencies and stakeholders, with opportunity for the library holdings to expand as new information becomes available. The library contains data in text, tabular, spatial, and image formats. Specific examples include project plans and implementation reports, monitoring data, spatial data files from geographic information systems, digitized paper maps, and digital images of land treatments. The data are entered by USGS employees and are accessible through a searchable web site. The LTDL can be used to respond to information requests, conduct analyses and other forms of information syntheses, produce maps, and generate reports for DOI managers and scientists and other authorized users.

Ranking landscape development scenarios affecting natterjack toad (Bufo calamita) population dynamics in Central Poland.

PubMed

Franz, Kamila W; Romanowski, Jerzy; Johst, Karin; Grimm, Volker

2013-01-01

When data are limited it is difficult for conservation managers to assess alternative management scenarios and make decisions. The natterjack toad (Bufo calamita) is declining at the edges of its distribution range in Europe and little is known about its current distribution and abundance in Poland. Although different landscape management plans for central Poland exist, it is unclear to what extent they impact this species. Based on these plans, we investigated how four alternative landscape development scenarios would affect the total carrying capacity and population dynamics of the natterjack toad. To facilitate decision-making, we first ranked the scenarios according to their total carrying capacity. We used the software RAMAS GIS to determine the size and location of habitat patches in the landscape. The estimated carrying capacities were very similar for each scenario, and clear ranking was not possible. Only the reforestation scenario showed a marked loss in carrying capacity. We therefore simulated metapopulation dynamics with RAMAS taking into account dynamical processes such as reproduction and dispersal and ranked the scenarios according to the resulting species abundance. In this case, we could clearly rank the development scenarios. We identified road mortality of adults as a key process governing the dynamics and separating the different scenarios. The renaturalisation scenario clearly ranked highest due to its decreased road mortality. Taken together our results suggest that road infrastructure development might be much more important for natterjack toad conservation than changes in the amount of habitat in the semi-natural river valley. We gained these insights by considering both the resulting metapopulation structure and dynamics in the form of a PVA. We conclude that the consideration of dynamic processes in amphibian conservation management may be indispensable for ranking management scenarios.

Using Semantic Components to Represent Dynamics of an Interdisciplinary Healthcare Team in a Multi-Agent Decision Support System.

PubMed

Wilk, Szymon; Kezadri-Hamiaz, Mounira; Rosu, Daniela; Kuziemsky, Craig; Michalowski, Wojtek; Amyot, Daniel; Carrier, Marc

2016-02-01

In healthcare organizations, clinical workflows are executed by interdisciplinary healthcare teams (IHTs) that operate in ways that are difficult to manage. Responding to a need to support such teams, we designed and developed the MET4 multi-agent system that allows IHTs to manage patients according to presentation-specific clinical workflows. In this paper, we describe a significant extension of the MET4 system that allows for supporting rich team dynamics (understood as team formation, management and task-practitioner allocation), including selection and maintenance of the most responsible physician and more complex rules of selecting practitioners for the workflow tasks. In order to develop this extension, we introduced three semantic components: (1) a revised ontology describing concepts and relations pertinent to IHTs, workflows, and managed patients, (2) a set of behavioral rules describing the team dynamics, and (3) an instance base that stores facts corresponding to instances of concepts from the ontology and to relations between these instances. The semantic components are represented in first-order logic and they can be automatically processed using theorem proving and model finding techniques. We employ these techniques to find models that correspond to specific decisions controlling the dynamics of IHT. In the paper, we present the design of extended MET4 with a special focus on the new semantic components. We then describe its proof-of-concept implementation using the WADE multi-agent platform and the Z3 solver (theorem prover/model finder). We illustrate the main ideas discussed in the paper with a clinical scenario of an IHT managing a patient with chronic kidney disease.

How to win the blame game.

PubMed

Baldwin, D G

2001-01-01

At some companies, people are all too quick to point fingers, leaving employees more concerned about avoiding blame than about achieving results. Such organizations, ruled by "CYA," have given blame a bum rap. David Baldwin, a former Major League pitcher, says blame can be a powerful and constructive force. It can be an effective teaching tool that helps people avoid repeating their mistakes. When used judiciously--and sparingly--blame can also prod people to put forth their best efforts, while maintaining both their confidence and their focus on goals. Indeed, blame can have a very positive effect when it's done for the right reasons. The key, then, is the way that blame is managed, which can influence how people make decisions and perform their jobs and ultimately affect the culture and character of an organization. In the course of his research on how Major League Baseball managers make decisions, Baldwin became fascinated by the subject of blame--what functions it serves and how it's best managed. His observations led him to identify five rules of blame, which, he says, apply to any organization, whether it's the LA Dodgers, General Motors, or a small start-up. First, know when to blame--and when not to. Second, blame in private and praise in public. Third, realize that the absence of blame can be far worse than its presence. Fourth, manage misguided blame. And fifth, be aware that confidence is the first casualty of blame. Managers who follow these rules will use blame in the most positive and effective ways possible, Baldwin says. Without these rules, blame becomes an ever-more difficult balancing act: Too much erodes people's confidence, while too little hinders them from reaching their full potential.

Helping Resource Managers Understand Hydroclimatic Variability and Forecasts: A Case Study in Research Equity

NASA Astrophysics Data System (ADS)

Hartmann, H. C.; Pagano, T. C.; Sorooshian, S.; Bales, R.

2002-12-01

Expectations for hydroclimatic research are evolving as changes in the contract between science and society require researchers to provide "usable science" that can improve resource management policies and practices. However, decision makers have a broad range of abilities to access, interpret, and apply scientific research. "High-end users" have technical capabilities and operational flexibility capable of readily exploiting new information and products. "Low-end users" have fewer resources and are less likely to change their decision making processes without clear demonstration of benefits by influential early adopters (i.e., high-end users). Should research programs aim for efficiency, targeting high-end users? Should they aim for impact, targeting decisions with high economic value or great influence (e.g., state or national agencies)? Or should they focus on equity, whereby outcomes benefit groups across a range of capabilities? In this case study, we focus on hydroclimatic variability and forecasts. Agencies and individuals responsible for resource management decisions have varying perspectives about hydroclimatic variability and opportunities for using forecasts to improve decision outcomes. Improper interpretation of forecasts is widespread and many individuals find it difficult to place forecasts in an appropriate regional historical context. In addressing these issues, we attempted to mitigate traditional inequities in the scope, communication, and accessibility of hydroclimatic research results. High-end users were important in prioritizing information needs, while low-end users were important in determining how information should be communicated. For example, high-end users expressed hesitancy to use seasonal forecasts in the absence of quantitative performance evaluations. Our subsequently developed forecast evaluation framework and research products, however, were guided by the need for a continuum of evaluation measures and interpretive materials to enable low-end users to increase their understanding of probabilistic forecasts, credibility concepts, and implications for decision making. We also developed an interactive forecast assessment tool accessible over the Internet, to support resource decisions by individuals as well as agencies. The tool provides tutorials for guiding forecast interpretation, including quizzes that allow users to test their forecast interpretation skills. Users can monitor recent and historical observations for selected regions, communicated using terminology consistent with available forecast products. The tool also allows users to evaluate forecast performance for the regions, seasons, forecast lead times, and performance criteria relevant to their specific decision making situations. Using consistent product formats, the evaluation component allows individuals to use results at the level they are capable of understanding, while offering opportunity to shift to more sophisticated criteria. Recognizing that many individuals lack Internet access, the forecast assessment webtool design also includes capabilities for customized report generation so extension agents or other trusted information intermediaries can provide material to decision makers at meetings or site visits.

Casualisation of the nursing workforce in Australia: driving forces and implications.

PubMed

Creegan, Reta; Duffield, Christine; Forrester, Kim

2003-01-01

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

Dengue hemorrhagic fever and severe thrombocytopenia in a patient on mandatory anticoagulation: balancing two life threatening conditions: a case report.

PubMed

Gamakaranage, Champika; Rodrigo, Chaturaka; Samarawickrama, Sincy; Wijayaratne, Dilushi; Jayawardane, Malaka; Karunanayake, Panduka; Jayasinghe, Saroj

2012-10-26

Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. This is the first case report in published literature describing this therapeutic dilemma. A fifty one year old Sri Lankan woman was diagnosed with dengue haemorrhagic fever with bleeding manifestations. During the critical phase of her illness, the platelet count dropped to 5,000/ɥl. She was also on warfarin 7 mg daily following a prosthetic mitral valve insertion. In managing the patient, the risk of bleeding had to be balanced against the risk of valve thrombosis without anticoagulation. Warfarin was withheld when the platelet count dropped to 100,000/ɥl and restarted when it recovered above 50,000/ɥl. The patient was off anticoagulation for 10 days. We managed this patient with close observation and continuous risk benefit assessments of management decisions. However, experience with one patient cannot be generalized to others. Therefore, it is essential that clinicians share their experiences in managing such difficult patients.

Environmental strategies: A case study of systematic evaluation

NASA Astrophysics Data System (ADS)

Sherman, Douglas J.; Garès, Paul A.

1982-09-01

A major problem facing environmental managers is the necessity to effectively evaluate management alternatives. Traditional environmental assessments have emphasized the use of economic analyses. These approaches are often deficient due to difficulty in assigning dollar values to environmental systems and to social amenities. A more flexible decisionmaking model has been developed to analyze management options for coping with beach erosion problems at the Sandy Hook Unit of Gateway National Recreation Area in New Jersey. This model is comprised of decision-making variables which are formulated from a combination of environmental and management criteria, and it has an accept-reject format in which the management options are analyzed in terms of the variables. Through logical ordering of the insertion of the variables into the model, stepwise elimination of alternatives is possible. A hierarchy of variables is determined through estimating work required to complete an assessment of the alternatives for each variable. The assessment requiring the least work is performed first so that the more difficult evaluation will be limited to fewer alternatives. The application of this approach is illustrated with a case study in which beach protection alternatives were evaluated for the United States National Park Service.

Demographics of reintroduced populations: estimation, modeling, and decision analysis

USGS Publications Warehouse

Converse, Sarah J.; Moore, Clinton T.; Armstrong, Doug P.

2013-01-01

Reintroduction can be necessary for recovering populations of threatened species. However, the success of reintroduction efforts has been poorer than many biologists and managers would hope. To increase the benefits gained from reintroduction, management decision making should be couched within formal decision-analytic frameworks. Decision analysis is a structured process for informing decision making that recognizes that all decisions have a set of components—objectives, alternative management actions, predictive models, and optimization methods—that can be decomposed, analyzed, and recomposed to facilitate optimal, transparent decisions. Because the outcome of interest in reintroduction efforts is typically population viability or related metrics, models used in decision analysis efforts for reintroductions will need to include population models. In this special section of the Journal of Wildlife Management, we highlight examples of the construction and use of models for informing management decisions in reintroduced populations. In this introductory contribution, we review concepts in decision analysis, population modeling for analysis of decisions in reintroduction settings, and future directions. Increased use of formal decision analysis, including adaptive management, has great potential to inform reintroduction efforts. Adopting these practices will require close collaboration among managers, decision analysts, population modelers, and field biologists.

Remote sensing for the sustainable management and conservation of forest environments biodiversity: the conservation managers perspective.

NASA Astrophysics Data System (ADS)

Aguilar-Amuchas, N.; Henebry, G. M.; Blanchard, J.; Sutter, R.

2008-12-01

The potential use of remote sensing for the design and implementation of sustainable management, conservation, and monitoring of forest biodiversity has been well documented in the scientific literature. However, when we look into how often remote sensing is actually being used in the decision making processes affecting biodiversity conservation and sustainable management, we find that, apart from specific study cases, its use is not as widespread as we know it should. There is an enormous gap between our scientific achievements and their use in the real world towards the preservation of a rapidly vanishing biodiversity. Conservation managers understand the potential remote sensing has. However, logistical constraints and high technical skills requirements render the use of remote sensing data difficult. Sound and easy approaches need to be developed and implemented. We present two study cases that illustrate 1st. How the interaction between tropical forest managers and remote sensing specialist allowed developing a simple method for the identification of priority areas for field surveys of tropical forests management ecological sustainability indicators and, 2nd. How remote sensing is being used by The Nature Conservancy as a first level approach towards the assessment of forest conservation strategies effectiveness in for areas located in 11 states, covering different forest types and a variety of conservation objectives.

Internet of things and Big Data as potential solutions to the problems in waste electrical and electronic equipment management: An exploratory study.

PubMed

Gu, Fu; Ma, Buqing; Guo, Jianfeng; Summers, Peter A; Hall, Philip

2017-10-01

Management of Waste Electrical and Electronic Equipment (WEEE) is a vital part in solid waste management, there are still some difficult issues require attentionss. This paper investigates the potential of applying Internet of Things (IoT) and Big Data as the solutions to the WEEE management problems. The massive data generated during the production, consumption and disposal of Electrical and Electronic Equipment (EEE) fits the characteristics of Big Data. Through using the state-of-the-art communication technologies, the IoT derives the WEEE "Big Data" from the life cycle of EEE, and the Big Data technologies process the WEEE "Big Data" for supporting decision making in WEEE management. The framework of implementing the IoT and the Big Data technologies is proposed, with its multiple layers are illustrated. Case studies with the potential application scenarios of the framework are presented and discussed. As an unprecedented exploration, the combined application of the IoT and the Big Data technologies in WEEE management brings a series of opportunities as well as new challenges. This study provides insights and visions for stakeholders in solving the WEEE management problems under the context of IoT and Big Data. Copyright © 2017 Elsevier Ltd. All rights reserved.

A multi-criteria decision-making approach to rank supplier selection criteria for hospital waste management: A case from Pakistan.

PubMed

Ishtiaq, Palvisha; Khan, Sharfuddin Ahmed; Haq, Moiz-Ul

2018-04-01

To address environmental issues and cost effectiveness, waste management is necessary for healthcare facilities. Most importantly, segregation of hazardous and non-hazardous waste must be done as in many developing countries; disposal of both types of healthcare waste is done together, which is an unsafe practice. Waste generated in hospitals needs proper management to minimise hazards for patient and healthcare workers. At the same time, it is quite difficult for hospitals to find a systematic way to select appropriate suppliers for hospital waste management. Therefore, the purpose of this article is to identify, validate, and rank criteria that are essential for hospital waste management suppliers' selection. The analytical hierarchal process approach has been used and a survey from Pakistan's largest city (Karachi) has been considered to rank the most appropriate criteria that is necessary to select the supplier, especially in a developing country like Pakistan. Results show that waste management cost (45.5%) and suppliers' details (31.5%) are the top two main criteria for supplier selection; and storage cost (15.7%), waste handling cost (14.7%), and qualification of the suppliers (10.9%) are the top three most important overall sub-criteria for supplier selection for hospital waste management.

Using play therapy in paediatric palliative care: listening to the story and caring for the body.

PubMed

van Breemen, Camara

2009-10-01

To be truly comprehensive, palliative care for children must address more than pain control and symptom management. Holistic care also encompasses attention to the child's relationships, hopes, fears and wishes. Parents and caregivers of dying children are generally the primary decision-makers in the child's care and can find the transition from active, to palliative care, particularly difficult. Nurses who understand the parents' perspective can better support them. Children reveal their hopes and fears through play. By being attuned to symbols and themes in play, nurses can better interpret the dying child's journey. Nurses can facilitate communication and connection between parents and child and thereby promote healing during the dying process.

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

USGS Publications Warehouse

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

2016-01-01

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

Multi-criteria analysis for municipal solid waste management in a Brazilian metropolitan area.

PubMed

Santos, Simone Machado; Silva, Maisa Mendonça; Melo, Renata Maciel; Gavazza, Savia; Florencio, Lourdinha; Kato, Mario T

2017-10-15

The decision-making process involved in municipal solid waste management (MSWM) must consider more than just financial aspects, which makes it a difficult task in developing countries. The Recife Metropolitan Region (RMR) in the Northeast of Brazil faces a MSWM problem that has been ongoing since the 1970s, with no common solution. In order to direct short-term solutions, three MSWM alternatives were outlined for the RMR, considering the current and future situations, the time and cost involved and social/environmental criteria. A multi-criteria approach, based on the Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE), was proposed to rank these alternatives. The alternative that included two private landfill sites and seven transfer, sorting and composting stations was confirmed as the most suitable and stable option for short-term MSWM, considering the two scenarios for the criteria weights. Sensitivity analysis was also performed to support the robustness of the results. The implementation of separate collections would minimize the amount of waste buried, while maximizing the useful life of landfill sites and increasing the timeframe of the alternative. Overall, the multi-criteria analysis was helpful and accurate during the alternative selection process, considering the similarities and restrictions of each option, which can lead to difficulties during the decision-making process.

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.

Bringing freight components into statewide and regional travel demand forecasting: part 1 : final report.

DOT National Transportation Integrated Search

2016-01-01

Transportation decision makers have the difficult task of investment decision making having limited resources while : maximizing benefit to the transportation system. Given the growth in freight transport and its importance to national, : state, and ...

Integrating Human Health and Ecological Integrity into a Systems Framework

EPA Science Inventory

Unintended and long-term effects of environmental decisions on public health, social welfare and economic stability are difficult to understand, much less anticipate. This is partly because environmental decisions are too often considered separate from factors that determine indi...

Conservation status and recovery strategies for endemic Hawaiian birds

USGS Publications Warehouse

Banko, Paul C.; David, Reginald E.; Jacobi, James D.; Banko, Winston E.

2001-01-01

Populations of endemic Hawaiian birds declined catastrophically following the colonization of the islands by Polynesians and later cultures. Extinction is still occurring, and recovery programs are urgently needed to prevent the disappearance of many other species. Programs to recover the endemic avifauna incorporate a variety of conceptual and practical approaches that are constrained by biological, financial, social, and legal factors. Avian recovery is difficult to implement in Hawai‘i because a variety of challenging biological factors limit bird populations. Hawaiian birds are threatened by alien predatory mammals, introduced mosquitoes that transmit diseases, alien invertebrate parasites and predators that reduce invertebrate food resources, and alien animals and plants that destroy and alter habitats. Life in the remote Hawaiian Archipelago has imposed other biological constraints to avian recovery, including limited geographical distributions and small population sizes. Recovery of the endemic avifauna is also challenging because resources are insufficient to mitigate the many complex, interacting factors that limit populations. Decisions must be made for allocating limited resources to species teetering on the brink of extinction and those in decline. If funds are spent primarily on saving the rarest species, more abundant species will decline and become more difficult to recover. However, critically rare species will disappear if efforts are directed mainly towards restoring species that are declining but not in immediate danger of becoming extinct. Determining priorities is difficult also because management is needed both to supplement bird populations and to restore habitats of many species. Rare species cannot respond quickly to management efforts intended only to improve habitat and reduce limiting factors. Recovery is slow, if it occurs at all, because years or decades are generally required for habitat rehabilitation and because small populations of birds initially increase slowly even when habitat conditions are favorable. Consequently, even as habitat conditions begin to improve, small populations may disappear unless they are supplemented directly. Hawaiian bird conservation is also affected by social and legal factors, including hunting alien game species, commercial land use practices, and lawsuits and policies concerning endangered species and critical habitat. Influenced by this mixture of conflicting and competing issues, Hawaiian bird recovery programs range from management of single species and some components of their habitats to limited forms of community or ecosystem management. Although the effectiveness of most programs is difficult to evaluate because of monitoring limitations, several programs exemplify species and community management. Programs primarily intended to recover single species include Hawaiian Goose or Nene (Branta sandvicensis), Hawaiian Crow or ‘Alala (Corvus hawaiiensis), and Palila (Loxioides bailleui). Programs attempting to manage entire communities of forest birds include Hakalau Forest National Wildlife Refuge and Hawai‘i Volcanoes National Park on Hawai‘i, and Waikamoi Preserve, Hanawi Natural Area Reserve, and Haleakala National Park on Maui.

Decision Support for Ecosystem Management (Chapter 28)

Treesearch

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

1999-01-01

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

[Quality assurance in airway management: education and training for difficult airway management].

PubMed

Kaminoh, Yoshiroh

2006-01-01

Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.

Interior's Climate Science Centers: Focus or Fail

NASA Astrophysics Data System (ADS)

Udall, B.

2012-12-01

After a whirlwind two years of impressive and critical infrastructure building, the Department of Interior's Climate Science Centers are now in a position to either succeed or fail. The CSCs have a number of difficult structural problems including too many constituencies relative to the available resources, an uneasy relationship among many of the constituencies including the DOI agencies themselves, a need to do science in a new, difficult and non-traditional way, and a short timeframe to produce useful products. The CSCs have built a broad and impressive network of scientists and stakeholders. These entities include science providers of the universities and the USGS, and decision makers from the states, tribes, DOI land managers and other federal agencies and NGOs. Rather than try to support all of these constituencies the CSCs would be better served by refocusing on a core mission of supporting DOI climate related decision making. The CSCs were designed to service the climate science needs of DOI agencies, many of which lost their scientific capabilities in the 1990s due to a well-intentioned but ultimately harmful re-organization at DOI involving the now defunct National Biological Survey. Many of these agencies would like to have their own scientists, have an uneasy relationship with the nominal DOI science provider, the USGS, and don't communicate effectively among themselves. The CSCs must not succumb to pursuing science in either the traditional mode of the USGS or in the traditional mode of the universities, or worse, both of them. These scientific partners will need to be flexible, learn how to collaborate and should expect to see fewer resources. Useful CSC processes and outputs should start with the recommendations of the 2009 NRC Report Informing Decisions in a Changing Climate: (1) begin with users' needs; (2) give priority to process over products; (3) link information producers and users; (4) build connections across disciplines and organizations; (5) seek institutional stability; and (6) design processes for learning. In addition, CSC outputs should help decision makers to embrace and focus on uncertainty rather than on attempts to reduce uncertainty. Model building can be a useful exercise if used as a broad intellectual exercise to understand systems instead of narrow projection-based efforts. In some cases DOI agencies may want very simple products including scientific syntheses. Social science work including but not limited to economics and policy should be considered when appropriate to decision maker needs. One method for allocating CSC resources would involve a limited number of small scoping meetings with climate sensitive regional DOI agencies. In the Southwest, for example, regional entities would include at least the Landscape Conservation Cooperatives, National Park Service, Fish and Wildlife Service, Bureau of Land Management, Reclamation and the US Forest Service, a critically important land manager with a well-funded and well-structured climate program. Given DOI's trust responsibility to the tribes, at least one project should be focused on meeting those needs in this region. The goal of these meetings would be to identify a small number of projects each with adequate funding for interdisciplinary teams of university and USGS scientists and DOI decision makers. Done correctly, the CSCs should be able to leverage resources with these DOI partners.

Proper Edging and Trimming Will Help Improve Lumber Value

Treesearch

Philip A. Araman

1991-01-01

Decisions on where to edge and trim waning edged boards, or to trim other boards, can have a major effect on the performance of a sawmill. Optimum decisions are difficult for a number of reasons, including: complexity of grading rules; operator skills; operator fatigue or lack of interest at times; and, the inability of operators to include lumber prices in decisions....

Can Wide Consultation Help with Setting Priorities for Large-Scale Biodiversity Monitoring Programs?

PubMed Central

Boivin, Frédéric; Simard, Anouk; Peres-Neto, Pedro

2014-01-01

Climate and other global change phenomena affecting biodiversity require monitoring to track ecosystem changes and guide policy and management actions. Designing a biodiversity monitoring program is a difficult task that requires making decisions that often lack consensus due to budgetary constrains. As monitoring programs require long-term investment, they also require strong and continuing support from all interested parties. As such, stakeholder consultation is key to identify priorities and make sound design decisions that have as much support as possible. Here, we present the results of a consultation conducted to serve as an aid for designing a large-scale biodiversity monitoring program for the province of Québec (Canada). The consultation took the form of a survey with 13 discrete choices involving tradeoffs in respect to design priorities and 10 demographic questions (e.g., age, profession). The survey was sent to thousands of individuals having expected interests and knowledge about biodiversity and was completed by 621 participants. Overall, consensuses were few and it appeared difficult to create a design fulfilling the priorities of the majority. Most participants wanted 1) a monitoring design covering the entire territory and focusing on natural habitats; 2) a focus on species related to ecosystem services, on threatened and on invasive species. The only demographic characteristic that was related to the type of prioritization was the declared level of knowledge in biodiversity (null to high), but even then the influence was quite small. PMID:25525798

Can wide consultation help with setting priorities for large-scale biodiversity monitoring programs?

PubMed

Boivin, Frédéric; Simard, Anouk; Peres-Neto, Pedro

2014-01-01

Climate and other global change phenomena affecting biodiversity require monitoring to track ecosystem changes and guide policy and management actions. Designing a biodiversity monitoring program is a difficult task that requires making decisions that often lack consensus due to budgetary constrains. As monitoring programs require long-term investment, they also require strong and continuing support from all interested parties. As such, stakeholder consultation is key to identify priorities and make sound design decisions that have as much support as possible. Here, we present the results of a consultation conducted to serve as an aid for designing a large-scale biodiversity monitoring program for the province of Québec (Canada). The consultation took the form of a survey with 13 discrete choices involving tradeoffs in respect to design priorities and 10 demographic questions (e.g., age, profession). The survey was sent to thousands of individuals having expected interests and knowledge about biodiversity and was completed by 621 participants. Overall, consensuses were few and it appeared difficult to create a design fulfilling the priorities of the majority. Most participants wanted 1) a monitoring design covering the entire territory and focusing on natural habitats; 2) a focus on species related to ecosystem services, on threatened and on invasive species. The only demographic characteristic that was related to the type of prioritization was the declared level of knowledge in biodiversity (null to high), but even then the influence was quite small.

Thresholds for conservation and management: structured decision making as a conceptual framework

USGS Publications Warehouse

Nichols, James D.; Eaton, Mitchell J.; Martin, Julien; Edited by Guntenspergen, Glenn R.

2014-01-01

changes in system dynamics. They are frequently incorporated into ecological models used to project system responses to management actions. Utility thresholds are components of management objectives and are values of state or performance variables at which small changes yield substantial changes in the value of the management outcome. Decision thresholds are values of system state variables at which small changes prompt changes in management actions in order to reach specified management objectives. Decision thresholds are derived from the other components of the decision process.We advocate a structured decision making (SDM) approach within which the following components are identified: objectives (possibly including utility thresholds), potential actions, models (possibly including ecological thresholds), monitoring program, and a solution algorithm (which produces decision thresholds). Adaptive resource management (ARM) is described as a special case of SDM developed for recurrent decision problems that are characterized by uncertainty. We believe that SDM, in general, and ARM, in particular, provide good approaches to conservation and management. Use of SDM and ARM also clarifies the distinct roles of ecological thresholds, utility thresholds, and decision thresholds in informed decision processes.

A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births.

PubMed

Tucker Edmonds, Brownsyne; McKenzie, Fatima; Panoch, Janet E; White, Douglas B; Barnato, Amber E

2016-07-01

Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions. We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?" Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice.

Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi.

PubMed

Honkoop, Persijn J; Pinnock, Hilary; Kievits-Smeets, Regien M M; Sterk, Peter J; Dekhuijzen, P N Richard; In 't Veen, Johannes C C M

2017-02-09

Patients with difficult-to-manage asthma represent a heterogeneous subgroup of asthma patients who require extensive assessment and tailored management. The International Primary Care Respiratory Group approach emphasises the importance of differentiating patients with asthma that is difficult to manage from those with severe disease. Local adaptation of this approach, however, is required to ensure an appropriate strategy for implementation in the Dutch context. We used a modified three-round e-Delphi approach to assess the opinion of all relevant stakeholders (general practitioners, pulmonologists, practice nurses, pulmonary nurses and people with asthma). In the first round, the participants were asked to provide potentially relevant items for a difficult-to-manage asthma programme, which resulted in 67 items. In the second round, we asked participants to rate the relevance of specific items on a seven-point Likert scale, and 46 items were selected as relevant. In the third round, the selected items were categorised and items were ranked within the categories according to relevance. Finally, we created the alphabet acronym for the categories 'the A-I of difficult-to-manage asthma' to resonate with an established Dutch 'A-E acronym for determining asthma control'. This should facilitate implementation of this programme within the existing structure of educational material on asthma and chronic obstructive pulmonary disease (COPD) in primary care, with potential for improving management of difficult-to-manage asthma. Other countries could use a similar approach to create a locally adapted version of such a programme.

Optimal allocation of conservation resources to species that may be extinct.

PubMed

Rout, Tracy M; Heinze, Dean; McCarthy, Michael A

2010-08-01

Statements of extinction will always be uncertain because of imperfect detection of species in the wild. Two errors can be made when declaring a species extinct. Extinction can be declared prematurely, with a resulting loss of protection and management intervention. Alternatively, limited conservation resources can be wasted attempting to protect a species that no longer exists. Rather than setting an arbitrary level of certainty at which to declare extinction, we argue that the decision must trade off the expected costs of both errors. Optimal decisions depend on the cost of continued intervention, the probability the species is extant, and the estimated value of management (the benefit of management times the value of the species). We illustrated our approach with three examples: the Dodo (Raphus cucullatus), the Ivory-billed Woodpecker (U.S. subspecies Campephilus principalis principalis), and the mountain pygmy-possum (Burramys parvus). The dodo was extremely unlikely to be extant, so managing and monitoring for it today would not be cost-effective unless the value of management was extremely high. The probability the Ivory-billed woodpecker is extant depended on whether recent controversial sightings were accepted. Without the recent controversial sightings, it was optimal to declare extinction of the species in 1965 at the latest. Accepting the recent controversial sightings, it was optimal to continue monitoring and managing until 2032 at the latest. The mountain pygmy-possum is currently extant, with a rapidly declining sighting rate. It was optimal to conduct as many as 66 surveys without sighting before declaring the species extinct. The probability of persistence remained high even after many surveys without sighting because it was difficult to determine whether the species was extinct or undetected. If the value of management is high enough, continued intervention can be cost-effective even if the species is likely to be extinct.

Multi-Stakeholder Dynamic Optimization Framework for System-of-Systems Development and Evolution

NASA Astrophysics Data System (ADS)

Fang, Zhemei

Architecture design for an "acknowledged" System-of-Systems (SoS), under performance uncertainty and constrained resources, remains a difficult problem. Composing an SoS via a proper mix of systems under the special control structure of an "acknowledged" SoS requires efficient distribution of the limited resources. However, due to the special traits of SoS, achieving an efficient distribution of the resources is not a trivial challenge. Currently, the major causes that lead to inefficient resource management for an "acknowledged" SoS include: 1) no central SoS managers with absolute authority to address conflict; 2) difficult balance between current and future decisions; 3) various uncertainties during development and operations (e.g., technology maturation, policy stability); 4) diverse sources of the resources; 5) high complexity in efficient formulation and computation due to the previous four factors. Although it is beyond the scope of this dissertation to simultaneously address all the five items, the thesis will focus on the first, second, and fifth points, and partially cover the third point. In a word, the dissertation aims to develop a generic framework for "acknowledged" SoS that leads to appropriate mathematical formulation and a solution approach that generates a near-optimal set of multi-stage architectural decisions with limited collaboration between conflicted and independent stakeholders. This dissertation proposes a multi-stakeholder dynamic optimization (MUSTDO) method, which integrates approximate dynamic programming and transfer contract coordination mechanism. The method solves a multi-stage architecture selection problem with an embedded formal, but simple, transfer contract coordination mechanism to address resource conflict. Once the values of transfer contract are calculated appropriately, even though the SoS participants make independent decisions, the aggregate solutions are close to the solutions from a hypothetical ideal centralized case where the top-level SoS managers have full authority. In addition, the thesis builds the bridge between a given SoS problem and the mathematical interpretations of the MUSTDO method using a three-phase approach for real world applications. The method is applied to two case studies: one in the defense realm and one in the commercial realm. The first application uses a naval warfare scenario to demonstrate that the aggregated capabilities in the decentralized case using MUSTDO method are close to the aggregated capabilities in a hypothetical centralized case. This evidence demonstrates that the MUSTDO method can help approach the SoS-level optimality with limited funding resource even if the participants make independent decisions. The solution also provides suggestions to the participants about the sequence of architecting decisions and the amount of transfer contract to be sent out to maximize individual capability over time. The suggested decisions incorporate the potential capability increase in the future, which differentiates itself from allocating all the resources to the current development. The quantified numbers of transfer contract in this case study are equivalent capabilities that are relevant to equipment loan or technology transfer. The second case study applies the MUSTDO-based framework to address a multi-airline fleet allocation problem with emissions allowances constraint provided by the regulators. Two representative airlines including the low-cost airline and the legacy airline aim to maximize individual profit by allocating six type of aircraft to a given ten-route network under the emissions constraint. Both the deterministic and stochastic experiments verify the effectiveness of the MUSTDO method by comparing the profit in the decentralized case and profit in a utopian centralized case. Meanwhile, sensitivity studies demonstrate that higher minimum demand requirement and lower discount factor can further improve the efficiency of emissions allowances utilization in MUSTDO method. Comparing to an alternate grandfathering approach, the MUSTDO method can guarantee a high-level efficiency of resource allocation by avoiding failed allocation decisions due to inaccurate information for the regulators. In summary, the framework aids the SoS managers and participants in the selection of the best architecture over a period of time with limited resources; the framework helps the decision makers to understand how they can affect each other and cooperate to achieve a more efficient solution without sharing full information. The major contribution of this dissertation includes: 1) provide a method to address multi-stage SoS composition decisions over time with resource constraint; 2) provide a method to manage resource conflict for stakeholders in an "acknowledged" system-of-systems; 2) provide a new perspective of long-term interactions between stakeholders in an SoS; 3) provide procedural framework to implement the MUSTDO method; 4) provide comparison of different applications of the MUSTDO framework in distinct fields.

Integrated groundwater management: An overview of concepts and challenges

USGS Publications Warehouse

Jakeman, Anthony J.; Barreteau, Olivier; Hunt, Randall J.; Rinaudo, Jean-Daniel; Ross, Andrew; Jakeman, Anthony J.; Barreteau, Olivier; Hunt, Randall J.; Rinaudo, Jean-Daniel; Ross, Andrew

2016-01-01

Managing water is a grand challenge problem and has become one of humanity’s foremost priorities. Surface water resources are typically societally managed and relatively well understood; groundwater resources, however, are often hidden and more difficult to conceptualize. Replenishment rates of groundwater cannot match past and current rates of depletion in many parts of the world. In addition, declining quality of the remaining groundwater commonly cannot support all agricultural, industrial and urban demands and ecosystem functioning, especially in the developed world. In the developing world, it can fail to even meet essential human needs. The issue is: how do we manage this crucial resource in an acceptable way, one that considers the sustainability of the resource for future generations and the socioeconomic and environmental impacts? In many cases this means restoring aquifers of concern to some sustainable equilibrium over a negotiated period of time, and seeking opportunities for better managing groundwater conjunctively with surface water and other resource uses. However, there are many, often-interrelated, dimensions to managing groundwater effectively. Effective groundwater management is underpinned by sound science (biophysical and social) that actively engages the wider community and relevant stakeholders in the decision making process. Generally, an integrated approach will mean “thinking beyond the aquifer”, a view which considers the wider context of surface water links, catchment management and cross-sectoral issues with economics, energy, climate, agriculture and the environment. The aim of the book is to document for the first time the dimensions and requirements of sound integrated groundwater management (IGM). The primary focus is on groundwater management within its system, but integrates linkages beyond the aquifer. The book provides an encompassing synthesis for researchers, practitioners and water resource managers on the concepts and tools required for defensible IGM, including how IGM can be applied to achieve more sustainable socioeconomic and environmental outcomes, and key challenges of IGM. The book is divided into five parts: integration overview and problem settings; governance; socioeconomics; biophysical aspects; and modelling and decision support. However, IGM is integrated by definition, thus these divisions should be considered a convenience for presenting the topics rather than hard and fast demarcations of the topic area.

Use of case-based reasoning to enhance intensive management of patients on insulin pump therapy.

PubMed

Schwartz, Frank L; Shubrook, Jay H; Marling, Cynthia R

2008-07-01

This study was conducted to develop case-based decision support software to improve glucose control in patients with type 1 diabetes mellitus (T1DM) on insulin pump therapy. While the benefits of good glucose control are well known, achieving and maintaining good glucose control remains a difficult task. Case-based decision support software may assist by recalling past problems in glucose control and their associated therapeutic adjustments. Twenty patients with T1DM on insulin pumps were enrolled in a 6-week study. Subjects performed self-glucose monitoring and provided daily logs via the Internet, tracking insulin dosages, work, sleep, exercise, meals, stress, illness, menstrual cycles, infusion set changes, pump problems, hypoglycemic episodes, and other events. Subjects wore a continuous glucose monitoring system at weeks 1, 3, and 6. Clinical data were interpreted by physicians, who explained the relationship between life events and observed glucose patterns as well as treatment rationales to knowledge engineers. Knowledge engineers built a prototypical system that contained cases of problems in glucose control together with their associated solutions. Twelve patients completed the study. Fifty cases of clinical problems and solutions were developed and stored in a case base. The prototypical system detected 12 distinct types of clinical problems. It displayed the stored problems that are most similar to the problems detected, and offered learned solutions as decision support to the physician. This software can screen large volumes of clinical data and glucose levels from patients with T1DM, identify clinical problems, and offer solutions. It has potential application in managing all forms of diabetes.

Incorporating climate change into ecosystem service assessments and decisions: a review.

PubMed

Runting, Rebecca K; Bryan, Brett A; Dee, Laura E; Maseyk, Fleur J F; Mandle, Lisa; Hamel, Perrine; Wilson, Kerrie A; Yetka, Kathleen; Possingham, Hugh P; Rhodes, Jonathan R

2017-01-01

Climate change is having a significant impact on ecosystem services and is likely to become increasingly important as this phenomenon intensifies. Future impacts can be difficult to assess as they often involve long timescales, dynamic systems with high uncertainties, and are typically confounded by other drivers of change. Despite a growing literature on climate change impacts on ecosystem services, no quantitative syntheses exist. Hence, we lack an overarching understanding of the impacts of climate change, how they are being assessed, and the extent to which other drivers, uncertainties, and decision making are incorporated. To address this, we systematically reviewed the peer-reviewed literature that assesses climate change impacts on ecosystem services at subglobal scales. We found that the impact of climate change on most types of services was predominantly negative (59% negative, 24% mixed, 4% neutral, 13% positive), but varied across services, drivers, and assessment methods. Although uncertainty was usually incorporated, there were substantial gaps in the sources of uncertainty included, along with the methods used to incorporate them. We found that relatively few studies integrated decision making, and even fewer studies aimed to identify solutions that were robust to uncertainty. For management or policy to ensure the delivery of ecosystem services, integrated approaches that incorporate multiple drivers of change and account for multiple sources of uncertainty are needed. This is undoubtedly a challenging task, but ignoring these complexities can result in misleading assessments of the impacts of climate change, suboptimal management outcomes, and the inefficient allocation of resources for climate adaptation. © 2016 John Wiley & Sons Ltd.

43 CFR 4190.1 - Effect of wildfire management decisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

43 CFR 4190.1 - Effect of wildfire management decisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

43 CFR 4190.1 - Effect of wildfire management decisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

43 CFR 4190.1 - Effect of wildfire management decisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence.

PubMed

Janvier, Annie; Lorenz, John M; Lantos, John D

2012-08-01

When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines. We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

A Pilot Study of Pedestrians with Visual Impairments Detecting Traffic Gaps and Surges Containing Hybrid Vehicles

PubMed Central

Emerson, Robert Wall; Naghshineh, Koorosh; Hapeman, Julie; Wiener, William

2010-01-01

The increasing number of hybrid and quiet internal combustion engine vehicles may impact the travel abilities of pedestrians who are blind. Pedestrians who rely on auditory cues for structuring their travel may face challenges in making crossing decisions in the presence of quiet vehicles. This article describes results of initial studies looking at the crossing decisions of pedestrians who are blind at an uncontrolled crossing (no traffic control) and a light controlled intersection. The presence of hybrid vehicles was a factor in each situation. At the uncontrolled crossing, Toyota hybrids were most difficult to detect but crossing decisions were made more often in small gaps ended by a Honda hybrid. These effects were seen only at speed under 20 mph. At the light controlled intersection, parallel surges of traffic were most difficult to detect when made up only of a Ford Escape hybrid. Results suggest that more controlled studies of vehicle characteristics impacting crossing decisions of pedestrians who are blind are warranted. PMID:21379367

A Pilot Study of Pedestrians with Visual Impairments Detecting Traffic Gaps and Surges Containing Hybrid Vehicles.

PubMed

Emerson, Robert Wall; Naghshineh, Koorosh; Hapeman, Julie; Wiener, William

2011-03-01

The increasing number of hybrid and quiet internal combustion engine vehicles may impact the travel abilities of pedestrians who are blind. Pedestrians who rely on auditory cues for structuring their travel may face challenges in making crossing decisions in the presence of quiet vehicles. This article describes results of initial studies looking at the crossing decisions of pedestrians who are blind at an uncontrolled crossing (no traffic control) and a light controlled intersection. The presence of hybrid vehicles was a factor in each situation. At the uncontrolled crossing, Toyota hybrids were most difficult to detect but crossing decisions were made more often in small gaps ended by a Honda hybrid. These effects were seen only at speed under 20 mph. At the light controlled intersection, parallel surges of traffic were most difficult to detect when made up only of a Ford Escape hybrid. Results suggest that more controlled studies of vehicle characteristics impacting crossing decisions of pedestrians who are blind are warranted.

Scientific, Social, and Institutional Constraints Facing Coastal Restoration in Louisiana

NASA Astrophysics Data System (ADS)

Kleiss, B.; Shabman, L. A.; Brown, G.

2017-12-01

Due to multiple stressors, including subsidence, accelerated sea level rise, canal construction, tropical storm damages, and basin-wide river management decisions, southern Louisiana is experiencing some of the world's highest rates of coastal land loss. Although ideas abound, the solutions proposed to mitigate for land loss are often uncertain, complex, expensive, and difficult. There are significant scientific uncertainties associated with fundamental processes including the spatial distribution of rates of subsidence, the anticipated impacts of increased inundation on marsh plant species and questions about the resilience of engineered solutions. Socially and politically, there is the need to balance navigation, flood risk management and environmental restoration with the fact that the land involved is largely privately owned and includes many communities and towns. And layered within this, there are federal and state regulatory constraints which seek to follow a myriad of existing State and Federal laws, protect the benefits realized from previous federal investments, and balance the conflicting interests of a large number of stakeholders. Additionally, current practice when implementing some environmental regulations is to assess impacts against the baseline of current conditions, not projected future, non-project conditions, making it difficult to receive a permit for projects which may have a short-term detriment, but hope for a long-term benefit. The resolution (or lack thereof) of these issues will serve to inform similar future struggles in other low lying coastal areas around the globe.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Assessing the Value of Information of Geophysical Data For Groundwater Management

NASA Astrophysics Data System (ADS)

Trainor, W. J.; Caers, J. K.; Mukerji, T.; Auken, E.; Knight, R. J.

2008-12-01

Effective groundwater management requires hydrogeologic models informed by various data sources. The long-term goal of our research is to develop methodologies that quantify the value of information (VOI) of geophysical data for water managers. We present an initial sensitivity study on assessing the reliability of airborne electro-magnetic (EM) data for detecting channel orientation. The reliability results are used to calculate VOI regarding decisions of artificial recharge to mitigate seawater intrusion. To demonstrate how a hydrogeologic problem can be framed in decision analysis terms, a hypothetical example is built, where water managers are considering artificial recharge to remediate seawater intrusion. Is the cost of recharge justified given the large uncertainty of subsurface heterogeneity that may interfere in a successful recharge? Thus, the decision is should recharge be performed, and if yes, where should recharge wells be located? This decision is difficult because of the large uncertainty of the aquifer heterogeneity that influences flow. The expected value of all possible outcomes to the decision without gathering additional EM information is the prior value VPRIOR. The value of information (VOI) is calculated as the expected gain in value after including the relevant new information, or the difference between the value after a free experiment (VFE) and the value prior (VPRIOR): VOI = VFE - VPRIOR Airborne EM has been used to detect confining clay layers and flow barriers. However, geophysical information rarely identifies the subsurface perfectly. Many challenges impact data quality and the resulting models (interpretation uncertainty). To evaluate how well airborne EM data detect the orientation of subsurface channel systems, 125 alternative binary, fluvial lithology models are generated, each categorized into one of three subsurface scenarios: northwest, southwest and mixed channel orientation. Using rock property relations, the lithology models are converted into electrical resistivity models for EM forward modeling, to generate time-domain EM data. Noise is added to the late times of the EM data to better represent typical airborne acquisition. Inversions are performed to obtain 125 inverted resistivity images. From the images, we calculate the angle of maximum spatial correlation at every cell, and compare it with the truth - the original lithology model. These synthetic models serve as a proxy to estimate misclassification probabilities of channel orientation from actual EM data. The misclassification probabilities are then used in the VOI calculations. Results are presented demonstrating how the reliability measure and the pumping schedule can impact VOI. Lastly, reliability and VOI are calculated and compared for land-based EM data, which has different spatial sampling and resolution than air-borne data.

Managing System of Systems Requirements with a Requirements Screening Group

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

Ronald R. Barden

2012-07-01

Figuring out an effective and efficient way to manage not only your Requirement’s Baseline, but also the development of all your individual requirements during a Program’s/Project’s Conceptual and Development Life Cycle Stages can be both daunting and difficult. This is especially so when you are dealing with a complex and large System of Systems (SoS) Program with potentially thousands and thousands of Top Level Requirements as well as an equal number of lower level System, Subsystem and Configuration Item requirements that need to be managed. This task is made even more overwhelming when you have to add in integration withmore » multiple requirements’ development teams (e.g., Integrated Product Development Teams (IPTs)) and/or numerous System/Subsystem Design Teams. One solution for tackling this difficult activity on a recent large System of Systems Program was to develop and make use of a Requirements Screening Group (RSG). This group is essentially a Team made up of co-chairs from the various Stakeholders with an interest in the Program of record that are enabled and accountable for Requirements Development on the Program/Project. The RSG co-chairs, often with the help of individual support team, work together as a Program Board to monitor, make decisions on, and provide guidance on all Requirements Development activities during the Conceptual and Development Life Cycle Stages of a Program/Project. In addition, the RSG can establish and maintain the Requirements Baseline, monitor and enforce requirements traceability across the entire Program, and work with other elements of the Program/Project to ensure integration and coordination.« less

Waste-to-energy: What are the issues?

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

Merritt, J.A.

1995-09-01

It is very difficult to have been associated with the Waste-to-Energy ({open_quotes}WTE{close_quotes}) Industry during the past twelve months without feeling a profound sense of being under attack and more than a little shell shocked. That is not to say that scrutiny and regulation haven`t been an important factor for WTE from its inception, only that it seems that certain difficult issues have been thrust to the fore through the recent actions of the courts and regulatory agencies. While ash management and flow control hit center stage with a flourish in a one-two punch last Spring with the Supreme Court inmore » the City of Chicago and Carbone decisions, significant compliance issues still remain with respect to implementing the Clean Air Act Amendments of 1990 ({open_quotes}CAAA{close_quotes}). In my state, the long term plans for waste management have WTE facilities responsible for turning 50% of the total waste stream into electricity, with other recycling accounting for all but 4% of the rest. With similar reliance upon WTE facilities elsewhere, it is critical that cost effective ways of managing these issues be found. Beyond these primarily regulatory and legal issues, there are also numerous challenges in the marketplace with increased reliance on recycling and the normal ebb and flow of the business cycle. Finally, there are always issues, including those already mentioned, which are best addressed in the political arena. Working together as an industry and regulated community will be essential if we are to make progress in addressing many of our challenges.« less

Personalized Medicine for Chronic Respiratory Infectious Diseases: Tuberculosis, Nontuberculous Mycobacterial Pulmonary Diseases, and Chronic Pulmonary Aspergillosis.

PubMed

Salzer, Helmut J F; Wassilew, Nasstasja; Köhler, Niklas; Olaru, Ioana D; Günther, Gunar; Herzmann, Christian; Kalsdorf, Barbara; Sanchez-Carballo, Patricia; Terhalle, Elena; Rolling, Thierry; Lange, Christoph; Heyckendorf, Jan

2016-01-01

Chronic respiratory infectious diseases are causing high rates of morbidity and mortality worldwide. Tuberculosis, a major cause of chronic pulmonary infection, is currently responsible for approximately 1.5 million deaths per year. Although important advances in the fight against tuberculosis have been made, the progress towards eradication of this disease is being challenged by the dramatic increase in multidrug-resistant bacilli. Nontuberculous mycobacteria causing pulmonary disease and chronic pulmonary aspergillosis are emerging infectious diseases. In contrast to other infectious diseases, chronic respiratory infections share the trait of having highly variable treatment outcomes despite longstanding antimicrobial therapy. Recent scientific progress indicates that medicine is presently at a transition stage from programmatic to personalized management. We explain current state-of-the-art management concepts of chronic pulmonary infectious diseases as well as the underlying methods for therapeutic decisions and their implications for personalized medicine. Furthermore, we describe promising biomarkers and techniques with the potential to serve future individual treatment concepts in this field of difficult-to-treat patients. These include candidate markers to improve individual risk assessment for disease development, the design of tailor-made drug therapy regimens, and individualized biomarker-guided therapy duration to achieve relapse-free cure. In addition, the use of therapeutic drug monitoring to reach optimal drug dosing with the smallest rate of adverse events as well as candidate agents for future host-directed therapies are described. Taken together, personalized medicine will provide opportunities to substantially improve the management and treatment outcome of difficult-to-treat patients with chronic respiratory infections. © 2016 S. Karger AG, Basel.

Making Things Difficult in Lexical Decision: The Impact of Pseudohomophones and Transposed-Letter Nonwords on Frequency and Semantic Priming Effects

ERIC Educational Resources Information Center

Lupker, Stephen J.; Pexman, Penny M.

2010-01-01

Performance in a lexical decision task is crucially dependent on the difficulty of the word-nonword discrimination. More wordlike nonwords cause not only a latency increase for words but also, as reported by Stone and Van Orden (1993), larger word frequency effects. Several current models of lexical decision making can explain these types of…

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

ERIC Educational Resources Information Center

Donovan, Paul

2011-01-01

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

Evidence-based management.

PubMed

Pfeffer, Jeffrey; Sutton, Robert I

2006-01-01

For the most part, managers looking to cure their organizational ills rely on obsolete knowledge they picked up in school, long-standing but never proven traditions, patterns gleaned from experience, methods they happen to be skilled in applying, and information from vendors. They could learn a thing or two from practitioners of evidence-based medicine, a movement that has taken the medical establishment by storm over the past decade. A growing number of physicians are eschewing the usual, flawed resources and are instead identifying, disseminating, and applying research that is soundly conducted and clinically relevant. It's time for managers to do the same. The challenge is, quite simply, to ground decisions in the latest and best knowledge of what actually works. In some ways, that's more difficult to do in business than in medicine. The evidence is weaker in business; almost anyone can (and many people do) claim to be a management expert; and a motley crew of sources--Shakespeare, Billy Graham,Jack Welch, Attila the Hunare used to generate management advice. Still, it makes sense that when managers act on better logic and strong evidence, their companies will beat the competition. Like medicine, management is learned through practice and experience. Yet managers (like doctors) can practice their craft more effectively if they relentlessly seek new knowledge and insight, from both inside and outside their companies, so they can keep updating their assumptions, skills, and knowledge.

Designing a Decision Support System (DSS) for Academic Library Managers Using Preprogrammed Application Software on a Microcomputer.

ERIC Educational Resources Information Center

McDonald, Joseph

1986-01-01

Focusing on management decisions in academic libraries, this article compares management information systems (MIS) with decision support systems (DSS) and discusses the decision-making process, information needs of library managers, sources of data, reasons for choosing microcomputer, preprogrammed application software, prototyping a system, and…

Integrating info-gap decision theory with robust population management: a case study using the Mountain Plover.

PubMed

van der Burg, Max Post; Tyre, Andrew J

2011-01-01

Wildlife managers often make decisions under considerable uncertainty. In the most extreme case, a complete lack of data leads to uncertainty that is unquantifiable. Information-gap decision theory deals with assessing management decisions under extreme uncertainty, but it is not widely used in wildlife management. So too, robust population management methods were developed to deal with uncertainties in multiple-model parameters. However, the two methods have not, as yet, been used in tandem to assess population management decisions. We provide a novel combination of the robust population management approach for matrix models with the information-gap decision theory framework for making conservation decisions under extreme uncertainty. We applied our model to the problem of nest survival management in an endangered bird species, the Mountain Plover (Charadrius montanus). Our results showed that matrix sensitivities suggest that nest management is unlikely to have a strong effect on population growth rate, confirming previous analyses. However, given the amount of uncertainty about adult and juvenile survival, our analysis suggested that maximizing nest marking effort was a more robust decision to maintain a stable population. Focusing on the twin concepts of opportunity and robustness in an information-gap model provides a useful method of assessing conservation decisions under extreme uncertainty.

Ethical Decisions in Turbulent Times

ERIC Educational Resources Information Center

Shapiro, Joan Poliner; Gross, Steven Jay; Shapiro, Susan H.

2008-01-01

Education leaders make difficult ethical decisions each day. Using the story of a preschool director in lower Manhattan on September 11, 2001, the authors detail a series of paradigms to help educational leaders navigate rationally through challenging and complex circumstances when they are under considerable emotional stress. One approach which…

Evaluation and purchase of confocal microscopes: Numerous factors to consider

EPA Science Inventory

The purchase of a confocal microscope can be a complex and difficult decision for an individual scientist, group or evaluation committee. This is true even for scientists that have used confocal technology for many years. The task of reaching the optimal decision becomes almost i...

78 FR 58160 - Certification Process for State Capital Counsel System

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... make such independent assessments in the context of making certification decisions under chapter 154... decisions concerning the objectives of representation,'' ABA Model Rule 1.2(a), making it difficult to... certification procedures. The Attorney General determined that chapter 154 gave him greater discretion in making...

Adaptation of a difficult-to-manage asthma programme for implementation in the Dutch context: a modified e-Delphi

PubMed Central

Honkoop, Persijn J; Pinnock, Hilary; Kievits-Smeets, Regien M M; Sterk, Peter J; Dekhuijzen, P N Richard; in ’t Veen, Johannes C C M

2017-01-01

Patients with difficult-to-manage asthma represent a heterogeneous subgroup of asthma patients who require extensive assessment and tailored management. The International Primary Care Respiratory Group approach emphasises the importance of differentiating patients with asthma that is difficult to manage from those with severe disease. Local adaptation of this approach, however, is required to ensure an appropriate strategy for implementation in the Dutch context. We used a modified three-round e-Delphi approach to assess the opinion of all relevant stakeholders (general practitioners, pulmonologists, practice nurses, pulmonary nurses and people with asthma). In the first round, the participants were asked to provide potentially relevant items for a difficult-to-manage asthma programme, which resulted in 67 items. In the second round, we asked participants to rate the relevance of specific items on a seven-point Likert scale, and 46 items were selected as relevant. In the third round, the selected items were categorised and items were ranked within the categories according to relevance. Finally, we created the alphabet acronym for the categories ‘the A–I of difficult-to-manage asthma’ to resonate with an established Dutch ‘A–E acronym for determining asthma control’. This should facilitate implementation of this programme within the existing structure of educational material on asthma and chronic obstructive pulmonary disease (COPD) in primary care, with potential for improving management of difficult-to-manage asthma. Other countries could use a similar approach to create a locally adapted version of such a programme. PMID:28184039

Ethical challenges related to elder care. High level decision-makers' experiences

PubMed Central

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-01-01

Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. PMID:17419880

Ethical challenges related to elder care. High level decision-makers' experiences.

PubMed

Mamhidir, Anna-Greta; Kihlgren, Mona; Sorlie, Venke

2007-04-10

Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet.

Making decisions at the end of life when caring for a person with dementia: a literature review to explore the potential use of heuristics in difficult decision-making.

PubMed

Mathew, R; Davies, N; Manthorpe, J; Iliffe, S

2016-07-19

Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used. A narrative literature review was conducted taking a systematic approach to the search strategy, using the Centre for Reviews and Dissemination guidelines. Rapid appraisal methodology was used in order to source specific and relevant literature regarding the use of heuristics in end of life dementia care. A search using terms related to dementia, palliative care and decision-making was conducted across 4 English language electronic databases (MEDLINE, EMBASE, PsycINFO and CINAHL) in 2015. The search identified 12 papers that contained an algorithm, guideline, decision tool or set of principles that we considered compatible with heuristic decision-making. The papers addressed swallowing and feeding difficulties, the treatment of pneumonia, management of pain and agitation, rationalising medication, ending life-sustaining treatment, and ensuring a good death. The use of heuristics in palliative or end of life dementia care is not described in the research literature. However, this review identified important decision-making principles, which are largely a reflection of expert opinion. These principles may have the potential to be developed into simple heuristics that could be used in practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Making decisions at the end of life when caring for a person with dementia: a literature review to explore the potential use of heuristics in difficult decision-making

PubMed Central

Mathew, R; Davies, N; Manthorpe, J; Iliffe, S

2016-01-01

Objective Decision-making, when providing care and treatment for a person with dementia at the end of life, can be complex and challenging. There is a lack of guidance available to support practitioners and family carers, and even those experienced in end of life dementia care report a lack of confidence in decision-making. It is thought that the use of heuristics (rules of thumb) may aid decision-making. The aim of this study is to identify whether heuristics are used in end of life dementia care, and if so, to identify the context in which they are being used. Design A narrative literature review was conducted taking a systematic approach to the search strategy, using the Centre for Reviews and Dissemination guidelines. Rapid appraisal methodology was used in order to source specific and relevant literature regarding the use of heuristics in end of life dementia care. Data sources A search using terms related to dementia, palliative care and decision-making was conducted across 4 English language electronic databases (MEDLINE, EMBASE, PsycINFO and CINAHL) in 2015. Results The search identified 12 papers that contained an algorithm, guideline, decision tool or set of principles that we considered compatible with heuristic decision-making. The papers addressed swallowing and feeding difficulties, the treatment of pneumonia, management of pain and agitation, rationalising medication, ending life-sustaining treatment, and ensuring a good death. Conclusions The use of heuristics in palliative or end of life dementia care is not described in the research literature. However, this review identified important decision-making principles, which are largely a reflection of expert opinion. These principles may have the potential to be developed into simple heuristics that could be used in practice. PMID:27436665

Using genomics to characterize evolutionary potential for conservation of wild populations

PubMed Central

Harrisson, Katherine A; Pavlova, Alexandra; Telonis-Scott, Marina; Sunnucks, Paul

2014-01-01

Genomics promises exciting advances towards the important conservation goal of maximizing evolutionary potential, notwithstanding associated challenges. Here, we explore some of the complexity of adaptation genetics and discuss the strengths and limitations of genomics as a tool for characterizing evolutionary potential in the context of conservation management. Many traits are polygenic and can be strongly influenced by minor differences in regulatory networks and by epigenetic variation not visible in DNA sequence. Much of this critical complexity is difficult to detect using methods commonly used to identify adaptive variation, and this needs appropriate consideration when planning genomic screens, and when basing management decisions on genomic data. When the genomic basis of adaptation and future threats are well understood, it may be appropriate to focus management on particular adaptive traits. For more typical conservations scenarios, we argue that screening genome-wide variation should be a sensible approach that may provide a generalized measure of evolutionary potential that accounts for the contributions of small-effect loci and cryptic variation and is robust to uncertainty about future change and required adaptive response(s). The best conservation outcomes should be achieved when genomic estimates of evolutionary potential are used within an adaptive management framework. PMID:25553064

Management of Organic Mitral Regurgitation: Guideline Recommendations and Controversies

PubMed Central

Gurzun, Maria-Magdalena; Popescu, Andreea C.; Ginghina, Carmen

2015-01-01

Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients. PMID:25810729

The Feasibility of a Decision Support System for the Determination of Source Selection Evaluation Criteria

DTIC Science & Technology

1984-09-01

is not only difficult and time consuming , but also crucial to the success of the project, the question is whether a decision support system designed...KtI I - uAujvhIMtf IENE In THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR THE DETERMINATION OF SOURCE SELECTION EVALUATION ’CRITERIA THESIS .2...INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DZM=0N STATEMENT A ,’r !’ILMILSHIM S /8 4 THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR

Risky communication: pitfalls in counseling about risk, and how to avoid them.

PubMed

O'Doherty, K; Suthers, G K

2007-08-01

A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them.

Difficult Discharge in Pediatric Rehabilitation Medicine Causing Moral Distress.

PubMed

Green, Michael; Carter, Brian; Lasky, Andrew

2016-01-01

An ethical dimension exists in nearly all decisions made. Yet, there are clinical decisions in which the ethical dilemma is so difficult for the clinician that it results in moral distress. We present one example of a morally distressing situation in which care was provided for a child who had altered physical abilities after a trauma and was being discharged to a suboptimal family environment. Caring for a child with an acquired spinal cord injury requires significant resources. When a family is able to physically care for the child, but has demonstrated incomplete follow-through, the team is at risk for experiencing significant moral distress.

Managing wildfire events: risk-based decision making among a group of federal fire managers

Treesearch

Robyn S. Wilson; Patricia L. Winter; Lynn A. Maguire; Timothy Ascher

2011-01-01

Managing wildfire events to achieve multiple management objectives involves a high degree of decision complexity and uncertainty, increasing the likelihood that decisions will be informed by experience-based heuristics triggered by available cues at the time of the decision. The research reported here tests the prevalence of three risk-based biases among 206...

Encountering unexpected difficult airway: relationship with the intubation difficulty scale

PubMed Central

Koh, Wonuk; Kim, Hajung; Kim, Kyongsun; Ro, Young-Jin

2016-01-01

Background An unexpected difficult intubation can be very challenging and if it is not managed properly, it may expose the encountered patient to significant risks. The intubation difficulty scale (IDS) has been used as a validated method to evaluate a global degree of intubation difficulty. The aims of this study were to evaluate the prevalence and characteristics of unexpected difficult intubation using the IDS. Methods We retrospectively reviewed 951 patients undergoing elective surgery in a single medical center. Patients expected to have a difficult intubation or who had history of difficult intubation were excluded. Each patient was assessed by the IDS scoring system with seven variables. Total prevalence of difficult intubation and the contributing individual factors were further analyzed. Results For the 951 patients, the difficult intubation cases presenting IDS > 5 was 5.8% of total cases (n = 55). The prevalence of Cormack-Lehane Grade 3 or 4 was 16.2% (n = 154). Most of the difficult intubation cases were managed by simple additional maneuvers and techniques such as stylet application, additional lifting force and laryngeal pressure. Conclusions Unexpected difficult airway was present in 5.8% of patients and most was managed effectively. Among the components of IDS, the Cormack-Lehane grade was most sensitive for predicting difficult intubation. PMID:27274369

A cost and economic evaluation of the Leeds personality disorder managed clinical network-A service and commissioning development initiative.

PubMed

Kane, Eddie; Reeder, Neil; Keane, Kimberley; Prince, Sharon

2016-08-01

In the UK, patients with personality disorders presenting complex needs frequently experience an unhelpful pattern of acute treatment followed by community care-with associated high cost implications for services. With UK mental health resources under severe pressure, this leaves commissioners with difficult decisions to make. Yet studies on cost-effectiveness in respect of personality disorder treatment are scarce, particularly for treatments taking place outside of major teaching hospitals in the USA. This paper studies the benefits of an intensive, holistic approach and finds that the Network achieved substantial reductions in health care usage and expenditure in the short to medium term. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Structured decision making: Chapter 5

USGS Publications Warehouse

Runge, Michael C.; Grand, James B.; Mitchell, Michael S.; Krausman, Paul R.; Cain, James W. III

2013-01-01

Wildlife management is a decision-focused discipline. It needs to integrate traditional wildlife science and social science to identify actions that are most likely to achieve the array of desires society has surrounding wildlife populations. Decision science, a vast field with roots in economics, operations research, and psychology, offers a rich set of tools to help wildlife managers frame, decompose, analyze, and synthesize their decisions. The nature of wildlife management as a decision science has been recognized since the inception of the field, but formal methods of decision analysis have been underused. There is tremendous potential for wildlife management to grow further through the use of formal decision analysis. First, the wildlife science and human dimensions of wildlife disciplines can be readily integrated. Second, decisions can become more efficient. Third, decisions makers can communicate more clearly with stakeholders and the public. Fourth, good, intuitive wildlife managers, by explicitly examining how they make decisions, can translate their art into a science that is readily used by the next generation.

Advances in Laryngoscopy.

PubMed

Aziz, Michael

2015-01-01

Recent technological advances have made airway management safer. Because difficult intubation remains challenging to predict, having tools readily available that can be used to manage a difficult airway in any setting is critical. Fortunately, video technology has resulted in improvements for intubation performance while using laryngoscopy by various means. These technologies have been applied to rigid optical stylets, flexible intubation scopes, and, most notably, rigid laryngoscopes. These tools have proven effective for the anticipated difficult airway as well as the unanticipated difficult airway.

Bringing Reality to "Real Options": An Experiential Exercise

ERIC Educational Resources Information Center

Turner, Craig; Turner, Kyle Dean

2015-01-01

Issues surrounding the contextual environment in which strategic decisions are made are difficult concepts to grasp, particularly for undergraduate students with little business experience. They are also problematic for graduate students that have not been called on to make such decisions within their career. The authors propose an exercise that…

Accreditation, ROI, and the Online Academic Library

ERIC Educational Resources Information Center

Stielow, Fred

2011-01-01

Today's academic libraries must demonstrate their value to cost-conscious university administrators. Budget trade-off decisions that involve the library can be difficult for any university administrator to make, and such decisions are complicated by the recent appearance of massive global digital libraries that seem poised to replace the…

Teaching the Ethics of Biology.

ERIC Educational Resources Information Center

Johansen, Carol K.; Harris, David E.

2000-01-01

Points out the challenges of educating students about bioethics and the limited training of many biologists on ethics. Discusses the basic principles of ethics and ethical decision making as applied to biology. Explains the models of ethical decision making that are often difficult for students to determine where to begin analyzing. (Contains 28…

Quality Assurance Decisions with Air Models: A Case Study of ImputatIon of Missing Input Data Using EPA's Multi-Layer Model

EPA Science Inventory

Abstract Environmental models are frequently used within regulatory and policy frameworks to estimate environmental metrics that are difficult or impossible to physically measure. As important decision tools, the uncertainty associated with the model outputs should impact their ...

Implementing a Quality Needs Assessment

ERIC Educational Resources Information Center

Cuiccio, Cary

2012-01-01

Districts nationwide are facing budget cuts that, to some, feel more like funding cliffs. Accordingly, school teams are re-examining their personnel, programs, and schedules so that they can make difficult decisions about where to spend resources to realize the greatest improvement. The principals who are able to make decisions with data from…

The Effect of Multimedia Replacing Text in Resident Clinical Decision-Making Assessment

ERIC Educational Resources Information Center

Chang, Todd P.; Schrager, Sheree M.; Rake, Alyssa J.; Chan, Michael W.; Pham, Phung K.; Christman, Grant

2017-01-01

Multimedia in assessing clinical decision-making skills (CDMS) has been poorly studied, particularly in comparison to traditional text-based assessments. The literature suggests multimedia is more difficult for trainees. We hypothesize that pediatric residents score lower in diagnostic skill when clinical vignettes use multimedia rather than text…

Gender Equity, Sport Sponsorship, and Participation

ERIC Educational Resources Information Center

Yiamouyiannis, Athena

2009-01-01

As the pressure to win in select collegiate sports escalates, financial pressures mount, and the need to comply with Title IX regulations and gender equity policies continues, athletics administrators are faced with having to make difficult decisions regarding their sport programs. To assist in the decision-making process regarding sport programs,…

Climate science informs participatory scenario development and applications to decision making in Alaska

NASA Astrophysics Data System (ADS)

Welling, L. A.; Winfree, R.; Mow, J.

2012-12-01

Climate change presents unprecedented challenges for managing natural and cultural resources into the future. Impacts are expected to be highly consequential but specific effects are difficult to predict, requiring a flexible process for adaptation planning that is tightly coupled to climate science delivery systems. Scenario planning offers a tool for making science-based decisions under uncertainty. The National Park Service (NPS) is working with the Department of the Interior Climate Science Centers (CSCs), the NOAA Regional Integrated Science and Assessment teams (RISAs), and other academic, government, non-profit, and private partners to develop and apply scenarios to long-range planning and decision frameworks. In April 2012, Alaska became the first region of the NPS to complete climate change scenario planning for every national park, preserve, and monument. These areas, which collectively make up two-thirds of the total area of the NPS, are experiencing visible and measurable effects attributable to climate change. For example, thawing sea ice, glaciers and permafrost have resulted in coastal erosion, loss of irreplaceable cultural sites, slope failures, flooding of visitor access routes, and infrastructure damage. With higher temperatures and changed weather patterns, woody vegetation has expanded into northern tundra, spruce and cedar diebacks have occurred in southern Alaska, and wildland fire severity has increased. Working with partners at the Alaska Climate Science Center and the Scenario Network for Alaska Planning the NPS integrates quantitative, model-driven data with qualitative, participatory techniques to scenario creation. The approach enables managers to access and understand current climate change science in a form that is relevant for their decision making. Collaborative workshops conducted over the past two years grouped parks from Alaska's southwest, northwest, southeast, interior and central areas. The emphasis was to identify and connect climate and social drivers of change to ecological processes and decision making. Components included review and synthesis of climate observations and projections, effects and impacts, and information on other relevant factors (e.g., subsistence activities, land cover, fire activity, land use change, sea level shifts). Although workshops focused primarily on park lands and waters, nearby communities and other land management units also participated. Results include a framework through which managers are beginning to analyze uncertainties associated with climate change and ecosystem responses and evaluate appropriate and effective actions. For example, at Kenai Fjords National Park, melting from the Harding Icefield and Exit Glacier is changing how managers respond to local flooding issues. The Exit Glacier is one of the park's iconic visitor experiences and in the last four years, the road to the glacier has been subject to mid-summer/fair weather flooding which are outside the historic norms. Rather than seek a traditional solution to the issue, park management has been working with highway engineers to evolve interim solutions as this dynamic system continues to rapidly change. Climate change scenarios established a set of possible plausible futures for the park and are also being used to "wind tunnel" potential responses.

A narrative method for analyzing transitions in urban water management: The case of the Miami-Dade Water and Sewer Department

NASA Astrophysics Data System (ADS)

Treuer, Galen; Koebele, Elizabeth; Deslatte, Aaron; Ernst, Kathleen; Garcia, Margaret; Manago, Kim

2017-01-01

Although the water management sector is often characterized as resistant to risk and change, urban areas across the United States are increasingly interested in creating opportunities to transition toward more sustainable water management practices. These transitions are complex and difficult to predict - the product of water managers acting in response to numerous biophysical, regulatory, political, and financial factors within institutional constraints. Gaining a better understanding of how these transitions occur is crucial for continuing to improve water management. This paper presents a replicable methodology for analyzing how urban water utilities transition toward sustainability. The method combines standardized quantitative measures of variables that influence transitions with contextual qualitative information about a utility's unique decision making context to produce structured, data-driven narratives. Data-narratives document the broader context, the utility's pretransition history, key events during an accelerated period of change, and the consequences of transition. Eventually, these narratives should be compared across cases to develop empirically-testable hypotheses about the drivers of and barriers to utility-level urban water management transition. The methodology is illustrated through the case of the Miami-Dade Water and Sewer Department (WASD) in Miami-Dade County, Florida, and its transition toward more sustainable water management in the 2000s, during which per capita water use declined, conservation measures were enacted, water rates increased, and climate adaptive planning became the new norm.

Economic evaluation of preventive dental programs: what can they tell us?

PubMed

Morgan, Mike; Mariño, Rodrigo; Wright, Clive; Bailey, Denise; Hopcraft, Matthew

2012-10-01

The role of public health program planners is to determine the effectiveness of public health programs, what recommendations should be made, what future initiatives should be taken, and what policies should be developed. At a basic level, to choose between competing alternatives, two characteristics of an intervention must be considered; these are its outcome and its cost. Based on cost and outcome, planners must select the option that offers the most advantages. Economic evaluation is commonly adopted by decision makers in the health sector to investigate the effectiveness of public health programs and to help plan future initiatives. Economic evaluation assists decision makers who must weigh the information it provides in the context of many and often competing options. In this way, an economic evaluation is an aid to decision making rather than the decision itself. Economic evaluation is becoming essential for informed decision making, with potential implications for public health policy and practice and for clinical practice too. While economic evaluations are commonly used in decision-making processes about health programs, few examples exist in the oral health literature. In the case of preventive oral health programs, economic analysis is often difficult, largely because it makes demands on epidemiological and demographic data that are hard to meet. This study will address the concepts and tools required to conduct economic evaluations of prevention programs. The emphasis will be on oral health and preventive dental programs, although the concepts presented could be useful for other public health programs by practitioners and managers with the aim of producing effective and efficient oral health programs. © 2012 John Wiley & Sons A/S.

Diverse decisions. How culture affects ethical decision making.

PubMed

Wright, F; Cohen, S; Caroselli, C

1997-03-01

Even under optimal conditions, assisting patients and families in making ethical decisions is difficult at best. Often these decisions revolve around the end-of-life issues that require acknowledgement that the patient is unlikely to survive, which may be perceived as a failure to both the family and the staff. At the very least, it can be a sad time, fraught with uncertainty and indecision. When these difficulties are coupled with ineffective communication related to cultural insensitivity or unawareness, the effects can be devastating to the decision-making process. All CCNs are expected to master the skills necessary for assisting patients and families through the harrowing experience of life-threatening illness. Whereas much of critical care focuses on managing pathophysiologic disturbances, emotional needs are equally important. It follows then that the CCN must assume responsibility for assisting patients and families in coping with the crisis of critical illness and working through ethical issues, which often include end-of-life decisions and organ donation. Culturally competent care is required when addressing patient needs holistically, but it is so much more. It is an opportunity to enrich and deepen the CCN/patient/family relationship, advocate for the patient, and broaden the opportunities for communication among staff. This article has provided some beginning steps for increasing nursing cultural awareness and has offered some initial strategies to consider when designing a plan of care. Through continuing efforts, CCNs and organizations can do much to decrease the alienation that many patients and families have traditionally encountered in the CCU, an estrangement that is exacerbated when their culture is different from the predominant culture of the unit. The effort to become more culturally aware may appear to require extraordinary effort; however, the rewards of optimizing patient care are unsurpassed.

Controlled Donation After Circulatory Determination of Death.

PubMed

Dalle Ave, Anne L; Shaw, David M

2017-03-01

Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts of interest in the decision of W-LST and in the process of W-LST exists, this should be acknowledged and disclosed. Finally, when cDCDD programs interfere with W-LST and end-of-life care, this should be transparently disclosed to the family, and specific informed consent is necessary.

[Evidence-based Risk and Benefit Communication for Shared Decision Making].

PubMed

Nakayama, Takeo

2018-01-01

　Evidence-based medicine (EBM) can be defined as "the integration of the best research evidence with clinical expertise and a patient's unique values and circumstances". However, even with the best research evidence, many uncertainties can make clinical decisions difficult. As the social requirement of respecting patient values and preferences has been increasingly recognized, shared decision making (SDM) and consensus development between patients and clinicians have attracted attention. SDM is a process by which patients and clinicians make decisions and arrive at a consensus through interactive conversations and communications. During the process of SDM, patients and clinicians share information with each other on the goals they hope to achieve and responsibilities in meeting those goals. From the clinician's standpoint, information regarding the benefits and risks of potential treatment options based on current evidence and professional experience is provided to patients. From the patient's standpoint, information on personal values, preferences, and social roles is provided to clinicians. SDM is a sort of "wisdom" in the context of making autonomous decisions in uncertain, difficult situations through interactions and cooperation between patients and clinicians. Joint development of EBM and SDM will help facilitate patient-clinician relationships and improve the quality of healthcare.

From environmental to ecological ethics: toward a practical ethics for ecologists and conservationists.

PubMed

Minteer, Ben A; Collins, James P

2008-12-01

Ecological research and conservation practice frequently raise difficult and varied ethical questions for scientific investigators and managers, including duties to public welfare, nonhuman individuals (i.e., animals and plants), populations, and ecosystems. The field of environmental ethics has contributed much to the understanding of general duties and values to nature, but it has not developed the resources to address the diverse and often unique practical concerns of ecological researchers and managers in the field, lab, and conservation facility. The emerging field of "ecological ethics" is a practical or scientific ethics that offers a superior approach to the ethical dilemmas of the ecologist and conservation manager. Even though ecological ethics necessarily draws from the principles and commitments of mainstream environmental ethics, it is normatively pluralistic, including as well the frameworks of animal, research, and professional ethics. It is also methodologically pragmatic, focused on the practical problems of researchers and managers and informed by these problems in turn. The ecological ethics model offers environmental scientists and practitioners a useful analytical tool for identifying, clarifying, and harmonizing values and positions in challenging ecological research and management situations. Just as bioethics provides a critical intellectual and problem-solving service to the biomedical community, ecological ethics can help inform and improve ethical decision making in the ecology and conservation communities.

Information technology skills and training needs of health information management professionals in Nigeria: a nationwide study.

PubMed

Taiwo Adeleke, Ibrahim; Hakeem Lawal, Adedeji; Adetona Adio, Razzaq; Adisa Adebisi, AbdulLateef

There is a lack of effective health information management systems in Nigeria due to the prevalence of cumbersome paper-based and disjointed health data management systems. This can make informed healthcare decision making difficult. This study examined the information technology (IT) skills, utilisation and training needs of Nigerian health information management professionals. We deployed a cross-sectional structured questionnaire to determine the IT skills and training needs of health information management professionals who have leadership roles in the nation's healthcare information systems (n=374). It was found that ownership of a computer, level of education and age were associated with knowledge and perception of IT. The vast majority of participants (98.8%) acknowledged the importance and relevance of IT in healthcare information systems and many expressed a desire for further IT training, especially in statistical analysis. Despite this, few (8.1 %) worked in settings where such systems operate and there exists an IT skill gap among these professionals which is not compatible with their roles in healthcare information systems. To rectify this anomaly they require continuing professional development education, especially in the areas of health IT. Government intervention in the provision of IT infrastructure in order to put into practice a computerised healthcare information system would therefore be a worthwhile undertaking.

First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy

PubMed Central

Adams, David; Suhr, Ole B.; Hund, Ernst; Obici, Laura; Tournev, Ivailo; Campistol, Josep M.; Slama, Michel S.; Hazenberg, Bouke P.; Coelho, Teresa

2016-01-01

Purpose of review Early and accurate diagnosis of transthyretin familial amyloid polyneuropathy (TTR-FAP) represents one of the major challenges faced by physicians when caring for patients with idiopathic progressive neuropathy. There is little consensus in diagnostic and management approaches across Europe. Recent findings The low prevalence of TTR-FAP across Europe and the high variation in both genotype and phenotypic expression of the disease means that recognizing symptoms can be difficult outside of a specialized diagnostic environment. The resulting delay in diagnosis and the possibility of misdiagnosis can misguide clinical decision-making and negatively impact subsequent treatment approaches and outcomes. Summary This review summarizes the findings from two meetings of the European Network for TTR-FAP (ATTReuNET). This is an emerging group comprising representatives from 10 European countries with expertise in the diagnosis and management of TTR-FAP, including nine National Reference Centres. The current review presents management strategies and a consensus on the gold standard for diagnosis of TTR-FAP as well as a structured approach to ongoing multidisciplinary care for the patient. Greater communication, not just between members of an individual patient's treatment team, but also between regional and national centres of expertise, is the key to the effective management of TTR-FAP. PMID:26734952

Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making

PubMed Central

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2016-01-01

Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019

Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.

PubMed

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2014-09-01

Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.

Native Prairie Adaptive Management: a multi region adaptive approach to invasive plant management on Fish and Wildlife Service owned native prairies

USGS Publications Warehouse

Gannon, Jill J.; Shaffer, Terry L.; Moore, Clinton T.

2013-01-01

Much of the native prairie managed by the U.S. Fish and Wildlife Service (FWS) in the Prairie Pothole Region (PPR) of the northern Great Plains is extensively invaded by the introduced cool-season grasses, smooth brome (Bromus inermis) and Kentucky bluegrass (Poa pratensis). Management to suppress these invasive plants has had poor to inconsistent success. The central challenge to managers is selecting appropriate management actions in the face of biological and environmental uncertainties. In partnership with the FWS, the U.S. Geological Survey (USGS) developed an adaptive decision support framework to assist managers in selecting management actions under uncertainty and maximizing learning from management outcomes. This joint partnership is known as the Native Prairie Adaptive Management (NPAM) initiative. The NPAM decision framework is built around practical constraints faced by FWS 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 FWS field stations, spanning four states of the PPR, have participated in the initiative. These FWS cooperators share a common management objective, available management strategies, and biological uncertainties. Though the scope is broad, the initiative interfaces with individual land managers who provide site-specific information and receive updated decision guidance that incorporates understanding gained from the collective experience of all cooperators. We describe the technical components of this approach, 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. During an initial scoping workshop, FWS cooperators developed a consensus management objective: increase the composition of native grasses and forbs on native sod while minimizing cost. Cooperators agreed that decision guidance should be provided annually and should account for local, real-time vegetation conditions observed on the ground. Over the course of development, two prototypes of the decision framework were considered. The final framework recognized four alternative actions that managers could take in any given year: (1) Graze—targeted use of grazing ungulates to achieve defoliation, (2) Burn—application of prescribed fire as the single form of defoliation, (3) Burn/Graze—a combination treatment, and (4) Rest—no action. The study area included northern mixed-grass and tallgrass prairie. Native vegetation in mixed–grass prairie has a strong cool-season component and thus the dominant native species have a phenology similar to that of smooth brome and Kentucky bluegrass, making management of those species challenging. In contrast, tallgrass prairie has a strong warm-season native component, leading to an existence of cool-season windows, periods of time in the fall and spring when cool‐season invasive grass species are actively growing and vulnerable to damage via select management actions, but warm‐season grass species are not active and are thus less susceptible to damage via the same actions. This dichotomy between prairie types necessitated the development of separate but parallel decision support systems for mixed-grass and tallgrass biomes. Management units are parcels of native prairie that receive a single management treatment at any one time over their entire extent. At any particular time, the vegetation state of each management unit is characterized by the amount of cover of native grasses and forbs and the type of invasive grass that is dominant. In addition, each unit has a defoliation state which reflects the number of years since the last defoliation event and an index to how intensively the unit was managed during the previous 7 years. State-transition models are used to predict the state of a management unit in year t+1 from its state in year t and a prescribed management action that was applied between the two monitoring events. Alternative models are built around key uncertainties that make choice of a management action difficult. Three uncertainties revolve around whether the effect of management actions depends on (1) type of dominant invader, (2) past defoliation history, and (3) level of invasion. Two additional uncertainties are considered when choosing a management action for tallgrass units: (4) the effectiveness of grazing within the cool-season window as a surrogate for burning when smooth brome is the dominant invader, and (5) the differential effect of active management outside the window as compared to rest. Because data on the probability of transitioning from one state to another under the various models were lacking, expert opinion and elicitation were used to parameterize the models. In addition, cooperators participated in elicitation exercises to extract their beliefs regarding the value of having native prairie compared to the cost of achieving it. Quantifying the subjective expression of utility in this way allowed for mathematical representation of the management objective into an objective function. By maximizing the objective function, cumulative utility is maximized, leading to the identification of a sequence of decisions that will achieve the management objective. The NPAM system adopted a vegetation monitoring protocol that was rapid, inexpensive, and familiar to many of the cooperators. The monitoring protocol served three purposes: (1) determining current vegetation and defoliation states of each unit, (2) evaluating progress toward the management objective, and (3) assessing predictive performance of the alternative models. The management year runs from September 1 to August 31. Management can be applied anytime during that period and monitoring takes places from late June to mid-August. Cooperators enter vegetation data and management information into a centralized database by August 25 of each year. Given the current state of the system (vegetation and defoliation states) and the current understanding of the system (or the belief state), identifying the current best management decision is a matter of looking up the combination (that is, system state and belief state) in the appropriate (mixed-grass or tallgrass) optimal decision table. Given complete uncertainty at the outset of decision-making, initial assignment of equal belief weights to each model was believed reasonable. The decisions in the optimal decision table that correspond to the current belief state constitute the current optimal decision policy. By August 31 of each year, individual cooperators are provided with a recommended management action for each of their management units for the upcoming management year. Upon receiving the management recommendations for their units, managers consider the recommendation, along with other relevant information, and at some point during the year one of the management alternatives is carried out. This iterative cycle of making and implementing a management decision, predicting the response, monitoring the outcome, comparing predicted and observed outcomes, updating model weights, and recommending a management action for the next cycle is expected to result in an accumulation of weight on a representative model of system dynamics, thereby increasing understanding needed to effectively manage native prairies. The NPAM system is now entering its second full year of complete operation, and represents one of only a few fully implemented applications of adaptive management within the U.S. Fish and Wildlife Service. NPAM is truly unique in that it originated from the ground up as a result of the leadership and steadfastness of several refuge biologists and managers confronted with a common problem. These biologists recognized that working together across a large landscape presented perhaps the best opportunity for halting and reversing the invasion of native grasslands by non-native cool-season grasses. Importantly, the NPAM system encapsulates the collective thinking and experience of tens if not hundreds of individuals who have battled this vexing problem for much of their careers. The NPAM initiative is rooted in principles of adaptive management, thereby affording the opportunity for grassland managers to pursue management objectives while acquiring information to reduce uncertainty and improve future management. The project introduced a number of technical innovations that will serve as templates for conservation efforts throughout and beyond the U.S. Fish and Wildlife Service. First, NPAM is an on-the-ground implementation of active adaptive management—possibly the first of its kind in conservation management—in which recommended management actions result from a prospective analysis of future learning (Williams, 1996). Second, by the use of dynamic optimization, NPAM demonstrates how decisions can be made that take into account possible future transitions of the system. Third, NPAM demonstrates how models of partial controllability are an effective means of accommodating unpredictable circumstances that cause a manager to follow a different course than was intended. Finally, the database developed for NPAM is an unparalleled system that enables the rapid integration of data from the field for the generation of ‘just-in-time’ management recommendations. In all, NPAM provides an example of how a science-management partnership can be forged to achieve large-scale conservation objectives.

A qualitative study of women's decision-making at the end of IVF treatment.

PubMed

Peddie, V L; van Teijlingen, E; Bhattacharya, S

2005-07-01

The decision not to pursue further in vitro fertilization (IVF) after one or more unsuccessful attempts is an important and often difficult one for couples. Relatively little is known about the woman's perception of this decision-making process. The aim of this study was to examine patients' perspectives of decision-making, including circumstances influencing it and satisfaction with the decision-making process. Semi-structured interviews were conducted with a purposive sample of 25 women who had decided to end treatment after unsuccessful IVF treatment. Interviews were tape-recorded and transcribed by means of thematic analysis using the open coding technique. Women experienced difficulty in accepting that their infertility would remain unresolved. Many felt that they had started with unrealistic expectations of treatment success and felt vulnerable to the pressures of both the media and society. Although the decision to end treatment was difficult, it offered many women a way out of the emotional distress caused by IVF; however, the process of decision-making created a sense of 'confrontation' for the women in which they had to address issues they had previously avoided. Adoptive parents perceived less societal pressure than those who remained childless. Efforts to improve the psychological preparation of couples who decide to end IVF treatment should be directed towards examination of the existing system of consultation, which has certain limitations in terms of the quality of communication and the provision of post-treatment support. Further efforts to develop strategies, which facilitate the decision-making process, should be considered.

Food choice decision-making by women with gestational diabetes.

PubMed

Hui, Amy Leung; Sevenhuysen, Gustaaf; Harvey, Dexter; Salamon, Elizabeth

2014-02-01

To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional. Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries. Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin. Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Incompetent Patients, Substitute Decision Making, and Quality of Life: Some Ethical Considerations

PubMed Central

Kluge, Eike-Henner W.

2008-01-01

One of the most difficult situations facing physicians involves decision making by substitute decision makers for patients who have never been competent. This paper begins with a brief examination of the ethics of substitute decision making for previously competent patients. It then applies the results to substitute decision making for patients who have never been competent, and critically analyzes 5 models of substitute decision making for such patients, showing why each either contravenes basic ethical principles or fails to guarantee the use of ethically appropriate values. It concludes by sketching a modified objective reasonable person standard for substitute decision making that avoids valuational difficulties and allows for a protocol that satisfies ethical principles. PMID:19099031

Jungle Giants: Assessing Sustainable Harvesting in a Difficult-to-Survey Species (Python reticulatus).

PubMed

Natusch, Daniel J D; Lyons, Jessica A; Mumpuni; Riyanto, Awal; Shine, Richard

2016-01-01

Sustainability of wildlife harvests is critical but difficult to assess. Evaluations of sustainability typically combine modelling with the measurement of underlying abundances. For many taxa harvested in developing countries, however, abundances are near-impossible to survey and a lack of detailed ecological information impedes the reliability of models. In such cases, repeated surveys of the attributes of harvested individuals may provide more robust information on sustainability. If the numbers, sizes and other demographic attributes of animals taken for the commercial trade do not change over biologically significant time intervals (decades), there is a prima facie case that the harvest is indeed sustainable. Here, we report the results of examinations of > 4,200 reticulated pythons (Python reticulatus) taken for the commercial leather industry in northern and southern Sumatra, Indonesia. The numbers, mean body sizes, clutch sizes, sizes at maturity and proportion of giant specimens have not decreased between our first surveys (1995) and repeat surveys (2015). Thus, despite assumptions to the contrary, the harvest appears to be sustainable. We use our data to inform the design of future monitoring programs for this species. Our study underpins the need for robust science to inform wildlife trade policy and decision-making, and urges wildlife managers to assess sustainability of difficult-to-survey terrestrial wildlife by drawing inferences directly from the harvest itself.

Jungle Giants: Assessing Sustainable Harvesting in a Difficult-to-Survey Species (Python reticulatus)

PubMed Central

Natusch, Daniel J. D.; Lyons, Jessica A.; Mumpuni; Riyanto, Awal; Shine, Richard

2016-01-01

Sustainability of wildlife harvests is critical but difficult to assess. Evaluations of sustainability typically combine modelling with the measurement of underlying abundances. For many taxa harvested in developing countries, however, abundances are near-impossible to survey and a lack of detailed ecological information impedes the reliability of models. In such cases, repeated surveys of the attributes of harvested individuals may provide more robust information on sustainability. If the numbers, sizes and other demographic attributes of animals taken for the commercial trade do not change over biologically significant time intervals (decades), there is a prima facie case that the harvest is indeed sustainable. Here, we report the results of examinations of > 4,200 reticulated pythons (Python reticulatus) taken for the commercial leather industry in northern and southern Sumatra, Indonesia. The numbers, mean body sizes, clutch sizes, sizes at maturity and proportion of giant specimens have not decreased between our first surveys (1995) and repeat surveys (2015). Thus, despite assumptions to the contrary, the harvest appears to be sustainable. We use our data to inform the design of future monitoring programs for this species. Our study underpins the need for robust science to inform wildlife trade policy and decision-making, and urges wildlife managers to assess sustainability of difficult-to-survey terrestrial wildlife by drawing inferences directly from the harvest itself. PMID:27391138

Voice, perceived fairness, agency trust, and acceptance of management decisions among Minnesota anglers

USGS Publications Warehouse

Schroeder, Susan A.; Fulton, David C.

2017-01-01

Although researchers agree that public participation in natural resource decision making is critical to institutional acceptance by stakeholders and the general public, the processes to gain public perceptions of fairness, agency trust, and acceptance of management decisions are not clear. Using results from a mail survey of Minnesota resident anglers, we used structural equation modeling to examine how instrumental versus symbolic motives related to anglers’ perceptions of agency fairness, trustworthiness, and ultimately acceptance of fisheries management decisions. We applied laboratory research on relationships among procedural fairness, trust, and management acceptance, and then tested models incorporating anglers’ perceptions of voice for anglers and nonanglers in management decisions. Results suggested that trust fully mediated the relationship between procedural fairness and management acceptance. Angler perceptions of angler and nonangler voice both related to views of procedural fairness, but angler voice was more strongly related and was also significantly related to acceptance of management decisions.

Integrating Land Cover Modeling and Adaptive Management to Conserve Endangered Species and Reduce Catastrophic Fire Risk

NASA Technical Reports Server (NTRS)

Breininger, David; Duncan, Brean; Eaton, Mitchell; Johnson, Fred; Nichols, James

2014-01-01

Land cover modeling is used to inform land management, but most often via a two-step process where science informs how management alternatives can influence resources and then decision makers can use this to make decisions. A more efficient process is to directly integrate science and decision making, where science allows us to learn to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuels monitoring with decision making focused on dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy, but habitat trajectories suggest tradeoffs. Knowledge about system responses to actions can be informed by applying competing management actions to different land units in the same system state and by ideas about fire behavior. Monitoring and management integration is important to optimize state-specific management decisions and increase knowledge about system responses. We believe this approach has broad utility for and cover modeling programs intended to inform decision making.

Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study.

PubMed

Walshe, Catherine; Todd, Chris; Caress, Ann-Louise; Chew-Graham, Carolyn

2008-04-01

Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. To explore the influences on referrals within general and specialist community palliative care services. Qualitative, multiple-case study. Three primary care trusts in the north-west of England. Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. Judgements -- positive and negative -- about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional "game playing" to achieve professionals' desired outcomes. Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.

Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

USDA-ARS?s Scientific Manuscript database

Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...

Families as Decision-Makers: When Researchers and Advocates Work Together

ERIC Educational Resources Information Center

Fields-Smith, Cheryl; Neuharth-Pritchett, Stacey

2009-01-01

Families across the United States must routinely make difficult choices about child care arrangements because of the need to resume a job, continue an education or training program, or care for other family members. Leaving children in the care of others for the first time can be difficult (Sayer, Bianchi, & Robinson, 2004; Van Horn, Ramey,…

Reaction Workup Planning: A Structured Flowchart Approach, Exemplified in Difficult Aqueous Workup of Hydrophilic Products

ERIC Educational Resources Information Center

Hill, George B.; Sweeney, Joseph B.

2015-01-01

Reaction workup can be a complex problem for those facing novel synthesis of difficult compounds for the first time. Workup problem solving by systematic thinking should be inculcated as mid-graduate-level is reached. A structured approach is proposed, building decision tree flowcharts to analyze challenges, and an exemplar flowchart is presented…

Managing for value. It's not just about the numbers.

PubMed

Haspeslagh, P; Noda, T; Boulos, F

2001-01-01

In theory, value-based management programs sound seductively simple. Just adopt an economic profit metric, tie compensation to agreed-upon improvement targets in that metric, and voilà! Managers and employees will start making all kinds of value-creating decisions. If only it were that easy. The reality is, almost half of the companies that have adopted a VBM metric have met with mediocre success. That's because, the authors contend, the successful VBM program is really about introducing fundamental changes to a big company's culture. Results from their major research project into the practice of VBM reveal that putting VBM into practice is far more complicated than many of its proponents make it out to be, requiring a great deal of patience, effort, and money. According to the authors' study, companies that successfully use VBM programs share five main characteristics. First, nearly all made explicit and public their commitment to shareholder value. Second, through training, they created an environment receptive to the changes the program would engender. Third, they reinforced that training with broad-based incentive systems closely tied to the VBM performance measures, which gave employees a sense of ownership in both the company and the program. Fourth, they were willing to craft major organizational changes to allow all their workers to make those value-creating decisions. Finally, the changes they introduced to the company's systems and processes were broad and inclusive rather than focused narrowly on financial reports and compensation. A VBM program is difficult and expensive. Still, the authors argue, properly applied, it will put your company's profitability firmly on track.

Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia.

PubMed

Donyai, Parastou

2017-10-01

Dementia can result in cognitive, noncognitive and behavioural symptoms which are difficult to manage. Formal guidelines for the care and management of dementia in the UK state that antipsychotics should only be prescribed where fully justified. This is because inappropriate use, particularly problematic in care-home settings, can produce severe side effects including death. The aim of this study was to explore the use of fallacious arguments in professionals' deliberations about antipsychotic prescribing in dementia in care-home settings. Fallacious arguments have the potential to become unremarkable discourses that construct and validate practices which are counter to guidelines. This qualitative study involved interviews with 28 care-home managers and health professionals involved in caring for patients with dementia. Potentially fallacious arguments were identified using qualitative content analysis and a coding framework constructed from existing explanatory models of fallacious reasoning. Fallacious arguments were identified in a range of explanations and reasons that participants gave for in answer to questions about initiating, reducing doses of and stopping antipsychotics in dementia. The dominant fallacy was false dichotomy. Appeal to popularity, tradition, consequence, emotion, or fear, and the slippery slope argument was also identified. Fallacious arguments were often formulated to present convincing cases whereby prescribing antipsychotics or maintaining existing doses (versus not starting medication or reducing the dose, for example) appeared as the only acceptable decision but this is not always the case. The findings could help health professionals to recognise and mitigate the effect of logic-based errors in decisions about the prescribing of antipsychotics in dementia. © 2016 Royal Pharmaceutical Society.

Sports hernia/athletic pubalgia: evaluation and management.

PubMed

Larson, Christopher M

2014-03-01

Sports hernia/athletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes. PubMed database through January 2013 and hand searches of the reference lists of pertinent articles. Review article. Level 5. Nonsurgical outcomes have not been well reported. Various surgical approaches have return-to-athletic activity rates of >80% regardless of the approach. The variety of procedures and lack of outcomes measures in these studies make it difficult to compare one surgical approach to another. There is increasing evidence that there is an association between range of motion-limiting hip disorders (femoroacetabular impingement) and sports hernia/athletic pubalgia in a subset of athletes. This has added increased complexity to the decision-making process regarding treatment. An association between femoroacetabular impingement and athletic pubalgia has been recognized, with better outcomes reported when both are managed concurrently or in a staged manner.

From clinical uncertainties to precision medicine: the emerging role of the gut barrier and microbiome in small bowel functional diseases.

PubMed

Marlicz, Wojciech; Yung, Diana E; Skonieczna-Żydecka, Karolina; Loniewski, Igor; van Hemert, Saskia; Loniewska, Beata; Koulaouzidis, Anastasios

2017-10-01

Over the last decade, remarkable progress has been made in the understanding of disease pathophysiology. Many new theories expound on the importance of emerging factors such as microbiome influences, genomics/omics, stem cells, innate intestinal immunity or mucosal barrier complexities. This has introduced a further dimension of uncertainty into clinical decision-making, but equally, may shed some light on less well-understood and difficult to manage conditions. Areas covered: Comprehensive review of the literature on gut barrier and microbiome relevant to small bowel pathology. A PubMed/Medline search from 1990 to April 2017 was undertaken and papers from this range were included. Expert commentary: The scenario of clinical uncertainty is well-illustrated by functional gastrointestinal disorders (FGIDs). The movement towards achieving a better understanding of FGIDs is expressed in the Rome IV guidelines. Novel diagnostic and therapeutic protocols focused on the GB and SB microbiome can facilitate diagnosis, management and improve our understanding of the underlying pathological mechanisms in FGIDs.

Bartonella Endocarditis and Pauci-Immune Glomerulonephritis

PubMed Central

Raybould, Jillian E.; Raybould, Alison L.; Morales, Megan K.; Zaheer, Misbah; Lipkowitz, Michael S.; Timpone, Joseph G.; Kumar, Princy N.

2016-01-01

Abstract Among culture-negative endocarditis in the United States, Bartonella species are the most common cause, with Bartonella henselae and Bartonella quintana comprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of all Bartonella patients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis–associated glomerulonephritis, it is rarely reported in Bartonella endocarditis. Anti–neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported with Bartonella species. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate between Bartonella endocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positive Bartonella endocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone. PMID:27885316

Software Defined Networking challenges and future direction: A case study of implementing SDN features on OpenStack private cloud

NASA Astrophysics Data System (ADS)

Shamugam, Veeramani; Murray, I.; Leong, J. A.; Sidhu, Amandeep S.

2016-03-01

Cloud computing provides services on demand instantly, such as access to network infrastructure consisting of computing hardware, operating systems, network storage, database and applications. Network usage and demands are growing at a very fast rate and to meet the current requirements, there is a need for automatic infrastructure scaling. Traditional networks are difficult to automate because of the distributed nature of their decision making process for switching or routing which are collocated on the same device. Managing complex environments using traditional networks is time-consuming and expensive, especially in the case of generating virtual machines, migration and network configuration. To mitigate the challenges, network operations require efficient, flexible, agile and scalable software defined networks (SDN). This paper discuss various issues in SDN and suggests how to mitigate the network management related issues. A private cloud prototype test bed was setup to implement the SDN on the OpenStack platform to test and evaluate the various network performances provided by the various configurations.

Stakeholder Perceptions of Risk in Construction.

PubMed

Zhao, Dong; McCoy, Andrew P; Kleiner, Brian M; Mills, Thomas H; Lingard, Helen

2016-02-01

Safety management in construction is an integral effort and its success requires inputs from all stakeholders across design and construction phases. Effective risk mitigation relies on the concordance of all stakeholders' risk perceptions. Many researchers have noticed the discordance of risk perceptions among critical stakeholders in safe construction work, however few have provided quantifiable evidence describing them. In an effort to fill this perception gap, this research performs an experiment that investigates stakeholder perceptions of risk in construction. Data analysis confirms the existence of such discordance, and indicates a trend in risk likelihood estimation. With risk perceptions from low to high, the stakeholders are architects, contractors/safety professionals, and engineers. Including prior studies, results also suggest that designers have improved their knowledge in building construction safety, but compared to builders they present more difficultly in reaching a consensus of perception. Findings of this research are intended to be used by risk management and decision makers to reassess stakeholders' varying judgments when considering injury prevention and hazard assessment.

Stakeholder Perceptions of Risk in Construction

PubMed Central

Zhao, Dong; McCoy, Andrew P.; Kleiner, Brian M.; Mills, Thomas H.; Lingard, Helen

2015-01-01

Safety management in construction is an integral effort and its success requires inputs from all stakeholders across design and construction phases. Effective risk mitigation relies on the concordance of all stakeholders’ risk perceptions. Many researchers have noticed the discordance of risk perceptions among critical stakeholders in safe construction work, however few have provided quantifiable evidence describing them. In an effort to fill this perception gap, this research performs an experiment that investigates stakeholder perceptions of risk in construction. Data analysis confirms the existence of such discordance, and indicates a trend in risk likelihood estimation. With risk perceptions from low to high, the stakeholders are architects, contractors/safety professionals, and engineers. Including prior studies, results also suggest that designers have improved their knowledge in building construction safety, but compared to builders they present more difficultly in reaching a consensus of perception. Findings of this research are intended to be used by risk management and decision makers to reassess stakeholders’ varying judgments when considering injury prevention and hazard assessment. PMID:26441481

Spatial variation in risk and consequence of Batrachochytrium salamandrivorans introduction in the USA

USGS Publications Warehouse

Richgels, Katherine L. D.; Russell, Robin E.; Adams, Michael J.; White, C. LeAnn; Campbell Grant, Evan H.

2016-01-01

A newly identified fungal pathogen, Batrachochytrium salamandrivorans (Bsal), is responsible for mass mortality events and severe population declines in European salamanders. The eastern USA has the highest diversity of salamanders in the world and the introduction of this pathogen is likely to be devastating. Although data are inevitably limited for new pathogens, disease-risk assessments use best available data to inform management decisions. Using characteristics of Bsal ecology, spatial data on imports and pet trade establishments, and salamander species diversity, we identify high-risk areas with both a high likelihood of introduction and severe consequences for local salamanders. We predict that the Pacific coast, southern Appalachian Mountains and mid-Atlantic regions will have the highest relative risk from Bsal. Management of invasive pathogens becomes difficult once they are established in wildlife populations; therefore, import restrictions to limit pathogen introduction and early detection through surveillance of high-risk areas are priorities for preventing the next crisis for North American salamanders.

Gastro-oesophageal reflux in children--what's the worry?

PubMed

Allen, Katie; Ho, Shaun S C

2012-05-01

Gastro-oesophageal reflux is common and benign in children, especially during infancy. Distinguishing between gastrooesophageal reflux, gastro-oesophageal reflux disease and other illnesses presenting as chronic vomiting can be difficult. The general practitioner has a key role to play in identifying if a child requires referral for further investigation. This article outlines the main differential diagnoses to be considered in children presenting with chronic vomiting and/ or regurgitation. We also discuss key management decisions regarding gastro-oesophageal reflux disease in children and when to refer to a specialist for further investigation. Chronic vomiting and regurgitation frequently occurs in infancy and is most commonly due to simple, benign gastrooesophageal reflux, which is usually self limiting without requirement for further investigation. In contrast, gastrooesophageal reflux disease requires considered management and may be a presenting symptom of food allergy requiring more intensive therapy than simple acid suppression. Regular review by the general practitioner to ascertain warning signs will ensure that other serious illnesses are not overlooked and that appropriate investigation and specialist referral are made.

Administrative decision making: a stepwise method.

PubMed

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

2008-01-01

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

Using decision pathway surveys to inform climate engineering policy choices

PubMed Central

Gregory, Robin; Satterfield, Terre; Hasell, Ariel

2016-01-01

Over the coming decades citizens living in North America and Europe will be asked about a variety of new technological and behavioral initiatives intended to mitigate the worst impacts of climate change. A common approach to public input has been surveys whereby respondents’ attitudes about climate change are explained by individuals’ demographic background, values, and beliefs. In parallel, recent deliberative research seeks to more fully address the complex value tradeoffs linked to novel technologies and difficult ethical questions that characterize leading climate mitigation alternatives. New methods such as decision pathway surveys may offer important insights for policy makers by capturing much of the depth and reasoning of small-group deliberations while meeting standard survey goals including large-sample stakeholder engagement. Pathway surveys also can help participants to deepen their factual knowledge base and arrive at a more complete understanding of their own values as they apply to proposed policy alternatives. The pathway results indicate more fully the conditional and context-specific nature of support for several “upstream” climate interventions, including solar radiation management techniques and carbon dioxide removal technologies. PMID:26729883

Sediment source fingerprinting as an aid to catchment management: A review of the current state of knowledge and a methodological decision-tree for end-users.

PubMed

Collins, A L; Pulley, S; Foster, I D L; Gellis, A; Porto, P; Horowitz, A J

2017-06-01

The growing awareness of the environmental significance of fine-grained sediment fluxes through catchment systems continues to underscore the need for reliable information on the principal sources of this material. Source estimates are difficult to obtain using traditional monitoring techniques, but sediment source fingerprinting or tracing procedures, have emerged as a potentially valuable alternative. Despite the rapidly increasing numbers of studies reporting the use of sediment source fingerprinting, several key challenges and uncertainties continue to hamper consensus among the international scientific community on key components of the existing methodological procedures. Accordingly, this contribution reviews and presents recent developments for several key aspects of fingerprinting, namely: sediment source classification, catchment source and target sediment sampling, tracer selection, grain size issues, tracer conservatism, source apportionment modelling, and assessment of source predictions using artificial mixtures. Finally, a decision-tree representing the current state of knowledge is presented, to guide end-users in applying the fingerprinting approach. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

PubMed

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

2018-01-01

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

Using decision pathway surveys to inform climate engineering policy choices.

PubMed

Gregory, Robin; Satterfield, Terre; Hasell, Ariel

2016-01-19

Over the coming decades citizens living in North America and Europe will be asked about a variety of new technological and behavioral initiatives intended to mitigate the worst impacts of climate change. A common approach to public input has been surveys whereby respondents' attitudes about climate change are explained by individuals' demographic background, values, and beliefs. In parallel, recent deliberative research seeks to more fully address the complex value tradeoffs linked to novel technologies and difficult ethical questions that characterize leading climate mitigation alternatives. New methods such as decision pathway surveys may offer important insights for policy makers by capturing much of the depth and reasoning of small-group deliberations while meeting standard survey goals including large-sample stakeholder engagement. Pathway surveys also can help participants to deepen their factual knowledge base and arrive at a more complete understanding of their own values as they apply to proposed policy alternatives. The pathway results indicate more fully the conditional and context-specific nature of support for several "upstream" climate interventions, including solar radiation management techniques and carbon dioxide removal technologies.

"Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

PubMed

Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-04-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

“Making Do” Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards

PubMed Central

Wills, Celia E.; Polivka, Barbara J.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-01-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. PMID:26669605

Disputes over science and dispute resolution approaches - A survey of Bureau of Reclamation employees

USGS Publications Warehouse

Burkardt, Nina; Ruell, Emily W.

2012-01-01

Water resources in parts of the Western United States are over-allocated, which intensifies the pressure to support water management decisions with strong scientific evidence. Because scientific studies sometimes provide uncertain or competing results or recommendations, science can become a source of disputes during decision-making processes. The Bureau of Reclamation (Reclamation) is an important water manager in the Western United States, and Reclamation decision processes are often contested by a variety of affected constituencies. We conducted a Web-based survey of Reclamation employees to determine (1) which types of disputes over science are occurring and how common they are, (2) which approaches have been used by Reclamation to try to resolve these different types of disputes, (3) how useful Reclamation employees find these approaches at resolving these types of disputes, (4) the final outcomes of these disputes and the decision-making processes that were hindered by the disputes over science, and (5) the potential usefulness of several different types of dispute resolution resources that Reclamation could provide for employees that become involved in disputes over science. The calculated minimum response rate for the survey was 59 percent. Twenty-five percent of respondents indicated that they had been involved in a dispute over science while working at Reclamation. Native species and species listed under the Endangered Species Act of 1973 were the most common issue types reported in these disputes over science. Survey respondents indicated that they used a variety of approaches to resolve disputes over science and rated most approaches as either neutral or somewhat helpful in these endeavors. Future research is needed to determine whether there are additional variables underlying these disputes that were not measured in this survey that may identify when dispute resolution methods are most effective, or whether resolving aspects of these disputes, such as differing interpretations of science, is very difficult or impossible regardless of the dispute resolution methods used.

What does the new breed of decision-making methodologies mean for choices and norms in hydrological science?

NASA Astrophysics Data System (ADS)

Wikman-Svahn, Per

2013-04-01

Hydrological sciences are increasingly utilized in decision-making contexts that need to manage deep uncertainty, changing conditions and very long-lead times and lifetimes. Traditional optimizing approaches become problematic in such situations. For example, optimizing approaches may underestimate the importance of low probability outcomes, or very uncertain outcomes. Alternative decision-making strategies are therefore increasingly used in hydrological applications, including "bottom-up/top-down", "context-first", "decision-scaling", "assess risk of policy", "robust", "resilient" or "flexible" approaches. These kinds of strategies are typically designed to handle very uncertain and diverse outcomes, and often start from the particular decision-making context, in contrast to more traditional "predict-then-act" or "science first" approaches. Contemporary research in philosophy of science stress the influence of value judgments and norms in scientific assessments. In particular, this literature points out that implicit anticipated applications often influence choices made in scientific assessments. Furthermore, this literature also emphasize that choices made at within scientific assessments have consequences for decision-making later on. One reason is that it is often difficult for decision-makers to see what choices are made and the implications of these choices. Another reason is that information that could be of use for decision-makers are lost at an early stage. For example, the choice to focus on central estimates and not providing assessments on more unlikely outcomes is a choice that has consequences for what outcomes are taken into account in the decision-making process. This paper develops this argument and then analyzes the implications of these new developments for hydrological science. One implication of the increasing use of the new breed of planning strategies is that a broader range of uncertainty in scientific assessments becomes desirable in order to fully benefit from the power of the new decision-making strategies. Another implication is that bayesian probability assessments become more important. Finally, advantages and risks involved in changing scientific assessments in order to anticipate the new decision-making strategies are discussed.

Development of Decision Analysis Specifically for Arctic Offshore Drilling Islands.

DTIC Science & Technology

1985-12-01

the decision analysis method will - give tradeoffs between costs and design wave height, production and depth • :of water for an oil platform , etc...optimizing the type of platform that is best suited for a particular site has become an extremely difficult decision. Over fifty- one different types of...drilling and production platforms have been identified for the Arctic environment, with new concepts being developed - every year, Boslov et al (198j

Everyday ethics: learning from an ‘ordinary’ consultation in general practice

PubMed Central

2011-01-01

The author uses a constructed case to analyse some of the ethical decisions that UK general practitioners face in everyday settings. A variety of ethical frameworks and empirical primary healthcare literature are used to demonstrate how ethical tools may be used by clinicians in primary healthcare to reflect on their decisions in practice. The GP consultation context can make ‘on the spot’ ethical decisions difficult and varied. PMID:25949652

A Navy Officer Assignment Model

DTIC Science & Technology

1982-03-01

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

Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: an introduction.

PubMed

Gent, David H; De Wolf, Erick; Pethybridge, Sarah J

2011-06-01

Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.

A dataset of human decision-making in teamwork management.

PubMed

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

2017-01-17

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

A dataset of human decision-making in teamwork management

PubMed Central

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

2017-01-01

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

A dataset of human decision-making in teamwork management

NASA Astrophysics Data System (ADS)

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

2017-01-01

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

How stakeholder roles, power, and negotiation impact natural resource policy: A political economy view

USGS Publications Warehouse

Caughlan, L.

2002-01-01

Natural resource management decisions are complicated by multiple property rights, management objectives, and stakeholders with varying degrees of influence over the decision making process. In order to make efficient decisions, managers must incorporate the opinions and values of the involved stakeholders as well as understand the complex institutional constraints and opportunities that influence the decision-making process. Often this type of information is not understood until after a decision has been made, which can result in wasted time and effort.The purpose of my dissertation was to show how institutional frameworks and stakeholder involvement influence the various phases of the resource management decision-making process in a public choice framework. The intent was to assist decision makers and stakeholders by developing a methodology for formally incorporating stakeholders'' objectives and influence into the resource management planning process and to predict the potential success of rent-seeking activity based on stakeholder preferences and level of influence. Concepts from decision analysis, institutional analysis, and public choice economics were used in designing this interdisciplinary framework. The framework was then applied to an actual case study concerning elk and bison management on the National Elk Refuge and Grand Teton National Park near Jackson, Wyoming. The framework allowed for the prediction of the level of support and conflict for all relevant policy decisions, and the identification of each stakeholder''s level of support or opposition for each management decision.

Choosing Child Care: Birth to Three

ERIC Educational Resources Information Center

Child Care, Inc., 2012

2012-01-01

Like all difficult decisions, choosing child care can seem overwhelming, and this is particularly true when choosing care for children under three. The better you understand what your child's and your own personal needs are, and what is available and affordable to you, the more confident you will become in your decision-making process. This…

Family Health and Financial Literacy--Forging the Connection

ERIC Educational Resources Information Center

Braun, Bonnie; Kim, Jinhee; Anderson, Elaine A.

2009-01-01

Families are at-risk of or experiencing a diminished quality of living and life in current economic times and difficult decisions are required. Health and financial literacy are the basis for wise personal and public decision making. Family and consumer sciences (FCS) professionals can forge connections between health and financial literacy to…

Student's Local Top-Up Higher Education Choices

ERIC Educational Resources Information Center

Agbola, Frank W.; Cheng, Calvin

2017-01-01

Making decisions about education choices is challenging and difficult for students. Utilising the theory of reasoned action, we specify and estimate a conceptual framework that captures the cognitive process of decision making of students in choosing top-up higher degrees in Hong Kong. Top-up higher or bachelor's degrees are top-up undergraduate…

Security Design Flaws That Affect Usability in Online Banking

ERIC Educational Resources Information Center

Gurlen, Stephanie

2013-01-01

As the popularity of online banking Websites has increased, the security of these sites has become increasingly critical as attacks against these sites are on the rise. However, the design decisions made during construction of the sites could make usability more difficult, where the user has difficulty making good security decisions. This study…