An interactive dynamic analysis and decision support software for MR mammography.

PubMed

Ertaş, Gökhan; Gülçür, H Ozcan; Tunaci, Mehtap

2008-06-01

A fully automated software is introduced to facilitate MR mammography (MRM) examinations and overcome subjectiveness in diagnosis using normalized maximum intensity-time ratio (nMITR) maps. These maps inherently suppress enhancements due to normal parenchyma and blood vessels that surround lesions and have natural tolerance to small field inhomogeneities and motion artifacts. The classifier embedded within the software is trained with normalized complexity and maximum nMITR of 22 lesions and tested with the features of remaining 22 lesions. Achieved diagnostic performances are 92% sensitivity, 90% specificity, 91% accuracy, 92% positive predictive value and 90% negative predictive value. DynaMammoAnalyst shortens evaluation time considerably and reduces inter and intra-observer variability by providing decision support.

The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial.

PubMed

LeBlanc, Annie; Ruud, Kari L; Branda, Megan E; Tiedje, Kristina; Boehmer, Kasey R; Pencille, Laurie J; Van Houten, Holly; Matthews, Marc; Shah, Nilay D; May, Carl R; Yawn, Barbara P; Montori, Victor M

2012-05-28

Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient's values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. NCT00388050.

Embedding the Positive Behavioral Interventions and Supports Framework into the Complex Array of Practices within Alternative Education Settings: A Decision-Making Process

ERIC Educational Resources Information Center

Jolivette, Kristine; McDaniel, Sara C.; Sprague, Jeffrey; Swain-Bradway, Jessica; Ennis, Robin Parks

2012-01-01

Alternative education (AE) programs and schools usually serve distinct populations of students with educational disabilities and mental health or other needs. AE program staff often employ a range of curricula, interventions, and strategies that form an eclectic approach to addressing student needs. This may result in practices that are…

Towards generic online multicriteria decision support in patient-centred health care.

PubMed

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

2015-10-01

To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided. © 2013 The Authors. Health Expectations published by John Wiley & Sons Ltd.

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

PubMed

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

2018-05-01

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

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

PubMed Central

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

2018-01-01

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

Decision aids for randomised controlled trials: a qualitative exploration of stakeholders’ views

PubMed Central

Gillies, Katie; Skea, Zoë C; Campbell, Marion K

2014-01-01

Objectives To explore stakeholders’ perceptions of decision aids designed to support the informed consent decision-making process for randomised controlled trials. Design Qualitative semistructured interviews. Participants were provided with prototype trial decision aids in advance to stimulate discussion. Interviews were analysed using an established interpretive approach. Participants 23 stakeholders: Trial Managers (n=5); Research Nurses (n=5); Ethics Committee Chairs (n=5); patients (n=4) and Clinical Principal Investigators (n=4). Setting Embedded within two ongoing randomised controlled trials. All interviews conducted with UK-based participants. Results Certain key aspects (eg, values clarification exercises, presentation of probabilities, experiences of others and balance of options) in the prototype decision aids were perceived by all stakeholders as having a significant advantage (over existing patient information leaflets) in terms of supporting well informed appropriate decisions. However, there were some important differences between the stakeholder groups on specific content (eg, language used in the section on positive and negative features of taking part in a trial and the overall length of the trial decision aids). Generally the stakeholders believed trial decision aids have the potential to better engage potential participants in the decision-making process and allow them to make more personally relevant decisions about their participation. Conclusions Compared to existing patient information leaflets, stakeholders perceived decision aids for trial participation to have the potential to promote a more ‘informed’ decision-making process. Further efforts to develop, refine and formally evaluate trial decision aids should be explored. PMID:25138811

Embedding health policy and systems research into decision-making processes in low- and middle-income countries

PubMed Central

2013-01-01

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems. PMID:23924162

Embedding health policy and systems research into decision-making processes in low- and middle-income countries.

PubMed

Koon, Adam D; Rao, Krishna D; Tran, Nhan T; Ghaffar, Abdul

2013-08-08

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization's Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.

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

PubMed

Marshall, Helen; Sprung, Sally

2017-08-02

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

Design and usability of heuristic-based deliberation tools for women facing amniocentesis.

PubMed

Durand, Marie-Anne; Wegwarth, Odette; Boivin, Jacky; Elwyn, Glyn

2012-03-01

Evidence suggests that in decision contexts characterized by uncertainty and time constraints (e.g. health-care decisions), fast and frugal decision-making strategies (heuristics) may perform better than complex rules of reasoning. To examine whether it is possible to design deliberation components in decision support interventions using simple models (fast and frugal heuristics). The 'Take The Best' heuristic (i.e. selection of a 'most important reason') and 'The Tallying' integration algorithm (i.e. unitary weighing of pros and cons) were used to develop two deliberation components embedded in a Web-based decision support intervention for women facing amniocentesis testing. Ten researchers (recruited from 15), nine health-care providers (recruited from 28) and ten pregnant women (recruited from 14) who had recently been offered amniocentesis testing appraised evolving versions of 'your most important reason' (Take The Best) and 'weighing it up' (Tallying). Most researchers found the tools useful in facilitating decision making although emphasized the need for simple instructions and clear layouts. Health-care providers however expressed concerns regarding the usability and clarity of the tools. By contrast, 7 out of 10 pregnant women found the tools useful in weighing up the pros and cons of each option, helpful in structuring and clarifying their thoughts and visualizing their decision efforts. Several pregnant women felt that 'weighing it up' and 'your most important reason' were not appropriate when facing such a difficult and emotional decision. Theoretical approaches based on fast and frugal heuristics can be used to develop deliberation tools that provide helpful support to patients facing real-world decisions about amniocentesis. © 2011 Blackwell Publishing Ltd.

Development the conceptual design of Knowledge Based System for Integrated Maintenance Strategy and Operation

NASA Astrophysics Data System (ADS)

Milana; Khan, M. K.; Munive, J. E.

2014-07-01

The importance of maintenance has escalated significantly by the increasing of automation in manufacturing process. This condition switches traditional maintenance perspective of inevitable cost into the business competitive driver. Consequently, maintenance strategy and operation decision needs to be synchronized to business and manufacturing concerns. This paper shows the development of conceptual design of Knowledge Based System for Integrated Maintenance Strategy and Operation (KBIMSO). The framework of KBIMSO is elaborated to show the process of how the KBIMSO works to reach the maintenance decision. By considering the multi-criteria of maintenance decision making, the KB system embedded with GAP and AHP to support integrated maintenance strategy and operation which is novel in this area. The KBIMSO is useful to review the existing maintenance system and give reasonable recommendation of maintenance decisions in respect to business and manufacturing perspective.

Design Recommendations for Pharmacogenomics Clinical Decision Support Systems

PubMed Central

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

2017-01-01

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

Testing framework for embedded languages

NASA Astrophysics Data System (ADS)

Leskó, Dániel; Tejfel, Máté

2012-09-01

Embedding a new programming language into an existing one is a widely used technique, because it fastens the development process and gives a part of a language infrastructure for free (e.g. lexical, syntactical analyzers). In this paper we are presenting a new advantage of this development approach regarding to adding testing support for these new languages. Tool support for testing is a crucial point for a newly designed programming language. It could be done in the hard way by creating a testing tool from scratch, or we could try to reuse existing testing tools by extending them with an interface to our new language. The second approach requires less work, and also it fits very well for the embedded approach. The problem is that the creation of such interfaces is not straightforward at all, because the existing testing tools were mostly not designed to be extendable and to be able to deal with new languages. This paper presents an extendable and modular model of a testing framework, in which the most basic design decision was to keep the - previously mentioned - interface creation simple and straightforward. Other important aspects of our model are the test data generation, the oracle problem and the customizability of the whole testing phase.

A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system.

PubMed

Knerr, Sarah; Wernli, Karen J; Leppig, Kathleen; Ehrlich, Kelly; Graham, Amanda L; Farrell, David; Evans, Chalanda; Luta, George; Schwartz, Marc D; O'Neill, Suzanne C

2017-05-01

Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286. Copyright © 2017 Elsevier Inc. All rights reserved.

Family involvement for breast cancer decision making among Chinese-American women.

PubMed

Lee, Shiuyu Katie C; Knobf, M Tish

2016-12-01

To describe family involvement in decision making for primary treatment in Chinese-American women with early-stage breast cancer. Qualitative data were collected in 2003 from semi-structured questions in interviews with a sample of Chinese-American (ChA) women with breast cancer, who were recruited from the metropolitan New York area. Responses to the questions were written in Chinese immediately during the interview and read back to the subject for accuracy and validation. Content analysis was used to inductively code and analyze the data to generate themes. The participants consisted of 123 ChA women with early stage breast cancer with a mean age of 48.7 years (±9.3) and who had lived in the United States a median of 13.6 years. Support and Caring was the major theme that described family involvement in the breast cancer decision-making process. Gathering Information, Being There, Navigating the Health Care System, Maintaining Family Life and Making the Decision described the aspects of family support in the process. The majority of women described the treatment decision making as a collaborative supportive process with the family, but limited English fluency, strong opinions, lack of a shared perspective, distant living proximity and competing work responsibilities of family members were stressful for the women and perceived as non-supportive. Family involvement in health care decision making is culturally embedded in Asian populations. Culturally sensitive patient and family consultation strategies are needed to assist informed treatment decision making in Chinese-American women diagnosed with breast cancer. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Heuristic decomposition for non-hierarchic systems

NASA Technical Reports Server (NTRS)

Bloebaum, Christina L.; Hajela, P.

1991-01-01

Design and optimization is substantially more complex in multidisciplinary and large-scale engineering applications due to the existing inherently coupled interactions. The paper introduces a quasi-procedural methodology for multidisciplinary optimization that is applicable for nonhierarchic systems. The necessary decision-making support for the design process is provided by means of an embedded expert systems capability. The method employs a decomposition approach whose modularity allows for implementation of specialized methods for analysis and optimization within disciplines.

Configuration Management (CM) Support for KM Processes at NASA/Johnson Space Center (JSC)

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2010-01-01

Collection and processing of information are critical aspects of every business activity from raw data to information to an executable decision. Configuration Management (CM) supports KM practices through its automated business practices and its integrated operations within the organization. This presentation delivers an overview of JSC/Space Life Sciences Directorate (SLSD) and its methods to encourage innovation through collaboration and participation. Specifically, this presentation will illustrate how SLSD CM creates an embedded KM activity with an established IT platform to control and update baselines, requirements, documents, schedules, budgets, while tracking changes essentially managing critical knowledge elements.

Exploring differences in the use of the statin choice decision aid and diabetes medication choice decision aid in primary care.

PubMed

Ballard, Aimee Yu; Kessler, Maya; Scheitel, Marianne; Montori, Victor M; Chaudhry, Rajeev

2017-08-10

Shared decision making is essential to patient centered care, but can be difficult for busy clinicians to implement into practice. Tools have been developed to aid in shared decision making and embedded in electronic medical records (EMRs) to facilitate use. This study was undertaken to explore the patterns of use and barriers and facilitators to use of two decision aids, the Statin Choice Decision Aid (SCDA) and the Diabetes Medication Choice Decision Aid (DMCDA), in primary care practices where the decision aids are embedded in the EMR. A survey exploring factors that influenced use of each decision aid was sent to eligible primary care clinicians affiliated with the Mayo Clinic in Rochester, MN. Survey data was collected and clinician use of each decision aid via links from the EMR was tracked. The survey response rate was 40% (105/262). Log file data indicated 51% of clinicians used the SCDA and 9% of clinicians used the DMCDA. Reasons for lack of use included lack of knowledge of the EMR link, not finding the decision aids helpful, and time constraints. Survey responses indicated that use of the tool as intended was low, with many clinicians only discussing decision aid topics that they found relevant. Although guidelines for both the treatment of blood cholesterol with a statin and for the treatment of hyperglycemia in type 2 diabetes recommend shared decision making, tools that facilitate shared decision making are not routinely used even when embedded in the EMR. Even when decision aids are used, their use may not reflect patient centered care.

Public health policy decisions on medical innovations: what role can early economic evaluation play?

PubMed

Hartz, Susanne; John, Jürgen

2009-02-01

Our contribution aims to explore the different ways in which early economic data can inform public health policy decisions on new medical technologies. A literature research was conducted to detect methodological contributions covering the health policy perspective. Early economic data on new technologies can support public health policy decisions in several ways. Embedded in horizon scanning and HTA activities, it adds to monitoring and assessment of innovations. It can play a role in the control of technology diffusion by informing coverage and reimbursement decisions as well as the direct public promotion of healthcare technologies, leading to increased efficiency. Major problems include the uncertainty related to economic data at early stages as well as the timing of the evaluation of an innovation. Decision-makers can benefit from the information supplied by early economic data, but the actual use in practice is difficult to determine. Further empirical evidence should be gathered, while the use could be promoted by further standardization.

Decision Support System for Evaluation of Gunnison River Flow Regimes With Respect To Resources of the Black Canyon of the Gunnison National Park

USGS Publications Warehouse

Auble, Gregor T.; Wondzell, Mark; Talbert, Colin

2009-01-01

This report describes and documents a decision support system for the Gunnison River in Black Canyon of the Gunnison National Park. It is a macro-embedded EXCEL program that calculates and displays indicators representing valued characteristics or processes in the Black Canyon based on daily flows of the Gunnison River. The program is designed to easily accept input from downloaded stream gage records or output from the RIVERWARE reservoir operations model being used for the upstream Aspinall Unit. The decision support system is structured to compare as many as eight alternative flow regimes, where each alternative is represented by a daily sequence of at least 20 calendar years of streamflow. Indicators include selected flow statistics, riparian plant community distribution, clearing of box elder by inundation and scour, several measures of sediment mobilization, trout fry habitat, and federal reserved water rights. Calculation of variables representing National Park Service federal reserved water rights requires additional secondary input files pertaining to forecast and actual basin inflows and storage levels in Blue Mesa reservoir. Example input files representing a range of situations including historical, reconstructed natural, and simulated alternative reservoir operations are provided with the software.

The Impact of Electronic Knowledge-Based Nursing Content and Decision-Support on Nursing-Sensitive Patient Outcomes

DTIC Science & Technology

2016-02-01

other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a ...Based Nursing (KBN) innovation, a customized design featuring actionable EB recommendations embedded into policy and the content and CDS tools in the...will have a positive effect on nursing knowledge, use of evidence-based practices, and the achievement of nurse-sensitive patient outcomes at

Design and usability of heuristic‐based deliberation tools for women facing amniocentesis

PubMed Central

Durand, Marie‐Anne; Wegwarth, Odette; Boivin, Jacky; Elwyn, Glyn

2011-01-01

Abstract Background  Evidence suggests that in decision contexts characterized by uncertainty and time constraints (e.g. health‐care decisions), fast and frugal decision‐making strategies (heuristics) may perform better than complex rules of reasoning. Objective  To examine whether it is possible to design deliberation components in decision support interventions using simple models (fast and frugal heuristics). Design  The ‘Take The Best’ heuristic (i.e. selection of a ‘most important reason’) and ‘The Tallying’ integration algorithm (i.e. unitary weighing of pros and cons) were used to develop two deliberation components embedded in a Web‐based decision support intervention for women facing amniocentesis testing. Ten researchers (recruited from 15), nine health‐care providers (recruited from 28) and ten pregnant women (recruited from 14) who had recently been offered amniocentesis testing appraised evolving versions of ‘your most important reason’ (Take The Best) and ‘weighing it up’ (Tallying). Results  Most researchers found the tools useful in facilitating decision making although emphasized the need for simple instructions and clear layouts. Health‐care providers however expressed concerns regarding the usability and clarity of the tools. By contrast, 7 out of 10 pregnant women found the tools useful in weighing up the pros and cons of each option, helpful in structuring and clarifying their thoughts and visualizing their decision efforts. Several pregnant women felt that ‘weighing it up’ and ‘your most important reason’ were not appropriate when facing such a difficult and emotional decision. Conclusion  Theoretical approaches based on fast and frugal heuristics can be used to develop deliberation tools that provide helpful support to patients facing real‐world decisions about amniocentesis. PMID:21241434

Software Products

NASA Technical Reports Server (NTRS)

1993-01-01

MAST is a decision support system to help in the management of dairy herds. Data is collected on dairy herds around the country and processed at regional centers. One center is Cornell University, where Dr. Lawrence Jones and his team developed MAST. The system draws conclusions from the data and summarizes it graphically. CLIPS, which is embedded in MAST, gives the system the ability to make decisions without user interaction. With this technique, dairy managers can identify herd problems quickly, resulting in improved animal health and higher milk quality. CLIPS (C Language Integrated Production System) was developed by NASA's Johnson Space Center. It is a shell for developing expert systems designed to permit research, development and delivery on conventional computers.

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

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

2015-01-01

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

Decision support tool for diagnosing the source of variation

NASA Astrophysics Data System (ADS)

Masood, Ibrahim; Azrul Azhad Haizan, Mohamad; Norbaya Jumali, Siti; Ghazali, Farah Najihah Mohd; Razali, Hazlin Syafinaz Md; Shahir Yahya, Mohd; Azlan, Mohd Azwir bin

2017-08-01

Identifying the source of unnatural variation (SOV) in manufacturing process is essential for quality control. The Shewhart control chart patterns (CCPs) are commonly used to monitor the SOV. However, a proper interpretation of CCPs associated to its SOV requires a high skill industrial practitioner. Lack of knowledge in process engineering will lead to erroneous corrective action. The objective of this study is to design the operating procedures of computerized decision support tool (DST) for process diagnosis. The DST is an embedded tool in CCPs recognition scheme. Design methodology involves analysis of relationship between geometrical features, manufacturing process and CCPs. The DST contents information about CCPs and its possible root cause error and description on SOV phenomenon such as process deterioration in tool bluntness, offsetting tool, loading error, and changes in materials hardness. The DST will be useful for an industrial practitioner in making effective troubleshooting.

Chronic Disease Self-Management by People With HIV.

PubMed

McDonald, Karalyn; Slavin, Sean; Pitts, Marian K; Elliott, Julian H

2016-05-01

As HIV has transitioned into a chronic disease, reappraisal of clinical management has occurred with chronic disease self-management (CDSM) as one possibility. However, despite extensive work on CDSM across a range of diseases, little attention has focused on psychosocial contexts of the lives of people for whom programs are intended. This article reports semi-structured interviews used to explore health practices and motivations of 33 people with HIV (PWHIV) in Australia. Within participants' accounts, different forms of subjectivity and agency emerged with implications for how they understood and valued health-related behaviors. Four themes arose: health support and disclosure, social support and stigma, employment/structure, and health decisions beyond HIV. The experience of stigma and its intersection with CDSM remains relatively un-chartered. This study found stigma shapes agency and engagement with health. Decisions concerning health behaviors are often driven by perceived social and emotional benefit embedded in concerns of disclosure and stigma. © The Author(s) 2015.

Run-time implementation issues for real-time embedded Ada

NASA Technical Reports Server (NTRS)

Maule, Ruth A.

1986-01-01

A motivating factor in the development of Ada as the department of defense standard language was the high cost of embedded system software development. It was with embedded system requirements in mind that many of the features of the language were incorporated. Yet it is the designers of embedded systems that seem to comprise the majority of the Ada community dissatisfied with the language. There are a variety of reasons for this dissatisfaction, but many seem to be related in some way to the Ada run-time support system. Some of the areas in which the inconsistencies were found to have the greatest impact on performance from the standpoint of real-time systems are presented. In particular, a large part of the duties of the tasking supervisor are subject to the design decisions of the implementer. These include scheduling, rendezvous, delay processing, and task activation and termination. Some of the more general issues presented include time and space efficiencies, generic expansions, memory management, pragmas, and tracing features. As validated compilers become available for bare computer targets, it is important for a designer to be aware that, at least for many real-time issues, all validated Ada compilers are not created equal.

Rotorcraft Diagnostics

NASA Technical Reports Server (NTRS)

Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James

2012-01-01

Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer decision support for optimal maintenance.

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

PubMed

Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter

2014-07-01

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and useful ways. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The development of control and monitoring system on marine current renewable energy Case study: strait of Toyapakeh - Nusa Penida, Bali

NASA Astrophysics Data System (ADS)

Arief, I. S.; Suherman, I. H.; Wardani, A. Y.; Baidowi, A.

2017-05-01

Control and monitoring system is a continuous process of securing the asset in the Marine Current Renewable Energy. A control and monitoring system is existed each critical components which is embedded in Failure Mode Effect Analysis (FMEA) method. As the result, the process in this paper developed through a matrix sensor. The matrix correlated to critical components and monitoring system which supported by sensors to conduct decision-making.

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

PubMed

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

2013-01-01

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

Environmental education: A blueprint for achievement?

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

McErlean, A.J.; Williams, E.; Wittwer, F.

1995-09-01

The present national effort devoted to environmental education (EE), particularly as it relates to K-12 education, is examined and indexed to other current events and their support levels. For the most part, EE efforts are embedded in science, mathematics, and engineering programs (SME), and the relationships to these other areas are discussed. In the present context, many aspects such as social, ethical, and religious consideration of EE are not addressed. The relationships between EE and the expectation for scientific literacy (SL) and improved environmental decision-making in both short- and long-term contexts are also examined. Under existing programs, the prognosis formore » serious, effective accomplishment, or credible impact on universal EE literacy or enhanced decision-making, is doubtful.« less

Developmental telomere attrition predicts impulsive decision-making in adult starlings

PubMed Central

Bateson, Melissa; Brilot, Ben O.; Gillespie, Robert; Monaghan, Pat; Nettle, Daniel

2015-01-01

Animals in a poor biological state face reduced life expectancy, and as a consequence should make decisions that prioritize immediate survival and reproduction over long-term benefits. We tested the prediction that if, as has been suggested, developmental telomere attrition is a biomarker of state and future life expectancy, then individuals who have undergone greater developmental telomere attrition should display greater choice impulsivity as adults. We measured impulsive decision-making in a cohort of European starlings (Sturnus vulgaris) in which we had previously manipulated developmental telomere attrition by cross-fostering sibling chicks into broods of different sizes. We show that as predicted by state-dependent optimality models, individuals who had sustained greater developmental telomere attrition and who had shorter current telomeres made more impulsive foraging decisions as adults, valuing smaller, sooner food rewards more highly than birds with less attrition and longer telomeres. Our findings shed light on the biological embedding of early adversity and support a functional explanation for its consequences that could be applicable to other species, including humans. PMID:25473012

Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target for Decision Support?

PubMed Central

Kerber, Kevin A.; Morgenstern, Lewis B.; Meurer, William J.; McLaughlin, Thomas; Hall, Pamela A.; Forman, Jane; Fendrick, A. Mark; Newman-Toker, David E.

2011-01-01

Objectives Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important target in decision support efforts. Methods Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population-based cohort study. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made. Results Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 185 out of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis. Conclusions Nystagmus assessments are frequently documented in acute dizziness presentations, but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations. PMID:21676060

Case-based ethics instruction: the influence of contextual and individual factors in case content on ethical decision-making.

PubMed

Bagdasarov, Zhanna; Thiel, Chase E; Johnson, James F; Connelly, Shane; Harkrider, Lauren N; Devenport, Lynn D; Mumford, Michael D

2013-09-01

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sense making processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.

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

PubMed

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

2015-11-11

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

Embedded CLIPS for SDI BM/C3 simulation and analysis

NASA Technical Reports Server (NTRS)

Gossage, Brett; Nanney, Van

1990-01-01

Nichols Research Corporation is developing the BM/C3 Requirements Analysis Tool (BRAT) for the U.S. Army Strategic Defense Command. BRAT uses embedded CLIPS/Ada to model the decision making processes used by the human commander of a defense system. Embedding CLlPS/Ada in BRAT allows the user to explore the role of the human in Command and Control (C2) and the use of expert systems for automated C2. BRAT models assert facts about the current state of the system, the simulated scenario, and threat information into CLIPS/Ada. A user-defined rule set describes the decision criteria for the commander. We have extended CLIPS/Ada with user-defined functions that allow the firing of a rule to invoke a system action such as weapons release or a change in strategy. The use of embedded CLIPS/Ada will provide a powerful modeling tool for our customer at minimal cost.

Development of a Protocol for Automated Glucose Measurement Transmission Used in Clinical Decision Support Systems Based on the Continua Design Guidelines.

PubMed

Meyer, Markus; Donsa, Klaus; Truskaller, Thomas; Frohner, Matthias; Pohn, Birgit; Felfernig, Alexander; Sinner, Frank; Pieber, Thomas

2018-01-01

A fast and accurate data transmission from glucose meter to clinical decision support systems (CDSSs) is crucial for the management of type 2 diabetes mellitus since almost all therapeutic interventions are derived from glucose measurements. Aim was to develop a prototype of an automated glucose measurement transmission protocol based on the Continua Design Guidelines and to embed the protocol into a CDSS used by healthcare professionals. A literature and market research was performed to analyze the state-of-the-art and thereupon develop, integrate and validate an automated glucose measurement transmission protocol in an iterative process. Findings from literature and market research guided towards the development of a standardized glucose measurement transmission protocol using a middleware. The interface description to communicate with the glucose meter was illustrated and embedded into a CDSS. A prototype of an interoperable transmission of glucose measurements was developed and implemented in a CDSS presenting a promising way to reduce medication errors and improve user satisfaction.

Human health improvement in Sub-Saharan Africa through integrated management of arthropod transmitted diseases and natural resources.

PubMed

Baumgärtner, J; Bieri, M; Buffoni, G; Gilioli, G; Gopalan, H; Greiling, J; Tikubet, G; Van Schayk, I

2001-01-01

A concept of an ecosystem approach to human health improvement in Sub-Saharan Africa is presented here. Three factors mainly affect the physical condition of the human body: the abiotic environment, vector-transmitted diseases, and natural resources. Our concept relies on ecological principles embedded in a social context and identifies three sets of subsystems for study and management: human disease subsystems, natural resource subsystems, and decision-support subsystems. To control human diseases and to secure food from resource subsystems including livestock or crops, integrated preventive approaches are preferred over exclusively curative and sectorial approaches. Environmental sustainability - the basis for managing matter and water flows - contributes to a healthy human environment and constitutes the basis for social sustainability. For planning and implementation of the human health improvement scheme, participatory decision-support subsystems adapted to the local conditions need to be designed through institutional arrangements. The applicability of this scheme is demonstrated in urban and rural Ethiopia.

Apostolic faith church organization contexts for health and wellbeing in women and children.

PubMed

Mpofu, Elias; Dune, Tinashe Moira; Hallfors, Denise Dion; Mapfumo, John; Mutepfa, Magen Mhaka; January, James

2011-12-01

The study explored contexts for health and wellbeing for women and children influenced by the structural behavior of an Apostolic faith church organization in Zimbabwe. Twenty-three purposively selected members of an African indigenous Apostolic church (males = 12; females = 11; age range 22-95 years) were informants to a focus group discussion session. They provided data on the institutional behaviors that were culturally-historically embedded in the organization's activities. Data were analyzed thematically and using cultural-historical activity theory (CHAT) to foreground essential themes. The church organization provided social capital to support health and wellbeing in members. However, the culturally embedded practices to minimize decision making by women and child members potentially compromised their health and wellbeing. The findings suggest that the structural activities of the church for health and wellbeing could also have the paradoxical effect of exposing women and children to health risks from obligatory roles.

Enabling the use of enhanced medical SOPs by an mLearning training solution.

PubMed

Papakonstantinou, Despina; Poulymenopoulou, Mikaela; Malamateniou, Flora; Vassilacopoulos, George

2013-01-01

Standard Operating Procedures (SOPs) has been introduced as a way to provide direction, improve communication, reduce training time and improve work consistency. In healthcare, SOPs may be considered as a means that can fundamentally change the way healthcare is provided, affecting all types of healthcare stakeholders and improving healthcare decisions and patient safety. Nowadays, providing ehealth services is a necessity, even though some healthcare organizations are reluctant to fully use them. An online mobile training facility embedded within ehealth services may increase the likelihood of their adoption by healthcare professionals, who feel that, when needed, they are provided the necessary support for performing each task, as handheld devices and other mobile technologies are showing increased adoption rates. This paper presents a mobile service that provides training content on SOPs, that can be embedded in a relevant ehealth service and can be accessed by authorized healthcare professionals where and when needed.

Construction of a Clinical Decision Support System for Undergoing Surgery Based on Domain Ontology and Rules Reasoning

PubMed Central

Bau, Cho-Tsan; Huang, Chung-Yi

2014-01-01

Abstract Objective: To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. Materials and Methods: The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé–Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. Results: The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. Conclusions: The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia. PMID:24730353

Construction of a clinical decision support system for undergoing surgery based on domain ontology and rules reasoning.

PubMed

Bau, Cho-Tsan; Chen, Rung-Ching; Huang, Chung-Yi

2014-05-01

To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé-Web Ontology Language editor was used to implement the ontology. Embedded clinical knowledge was elicited to complement the domain ontology with formal concept analysis. The decision rules were translated into JENA format, which JENA can use to infer recommendations based on patient clinical situations. The ontology includes 31 classes and 13 properties, plus 38 JENA rules that were built to generate recommendations. The evaluation studies confirmed the correctness of the ontology, acceptance of recommendations, satisfaction with the system, and usefulness of the ontology for glycemic management of diabetic patients undergoing surgery, especially for domain experts. The contribution of this research is to set up an evidence-based hybrid ontology and an evaluation method for CDSS. The system can help clinicians to achieve inpatient glycemic control in diabetic patients undergoing surgery while avoiding hypoglycemia.

Embedded arrays of vertically aligned carbon nanotube carpets and methods for making them

DOEpatents

Kim, Myung Jong; Nicholas, Nolan Walker; Kittrell, W. Carter; Schmidt, Howard K.

2015-06-30

According to some embodiments, the present invention provides a system and method for supporting a carbon nanotube array that involve an entangled carbon nanotube mat integral with the array, where the mat is embedded in an embedding material. The embedding material may be depositable on a carbon nanotube. A depositable material may be metallic or nonmetallic. The embedding material may be an adhesive material. The adhesive material may optionally be mixed with a metal powder. The embedding material may be supported by a substrate or self-supportive. The embedding material may be conductive or nonconductive. The system and method provide superior mechanical and, when applicable, electrical, contact between the carbon nanotubes in the array and the embedding material. The optional use of a conductive material for the embedding material provides a mechanism useful for integration of carbon nanotube arrays into electronic devices.

The impact of embedded support for underprepared students in a college chemistry course

NASA Astrophysics Data System (ADS)

Hesser, Tiffany L.

This quasi-experimental study examined the impact of embedded support on academic success for students requiring remediation in college chemistry. Additional support for underprepared students incorporated within a course is recommended by Connecticut's Public Act 12-40, An Act Concerning College Readiness and Completion. For this study, embedded support consisted of weekly instructional support sessions and introduced the concepts of metacognitive awareness and motivation in learning. Students' progression through the course was measured using a series of standardized questions. Metacognitive awareness and motivation levels were measure at the start and completion of the semester using the Metacognitive Awareness Inventory (MAI) and Motivated Student Learning Questionnaire (MSLQ). It was found that with embedded support, underprepared students performed academically at a level equivalent to that of their college-ready peers. Based on these results, this embedded support model as an evidence-based practice should be considered in class development or policies surrounding students identified as underprepared.

High performance flight computer developed for deep space applications

NASA Technical Reports Server (NTRS)

Bunker, Robert L.

1993-01-01

The development of an advanced space flight computer for real time embedded deep space applications which embodies the lessons learned on Galileo and modern computer technology is described. The requirements are listed and the design implementation that meets those requirements is described. The development of SPACE-16 (Spaceborne Advanced Computing Engine) (where 16 designates the databus width) was initiated to support the MM2 (Marine Mark 2) project. The computer is based on a radiation hardened emulation of a modern 32 bit microprocessor and its family of support devices including a high performance floating point accelerator. Additional custom devices which include a coprocessor to improve input/output capabilities, a memory interface chip, and an additional support chip that provide management of all fault tolerant features, are described. Detailed supporting analyses and rationale which justifies specific design and architectural decisions are provided. The six chip types were designed and fabricated. Testing and evaluation of a brass/board was initiated.

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

PubMed Central

Schmitt, Laetitia Helene Marie; Brugere, Cecile

2013-01-01

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

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

NASA Astrophysics Data System (ADS)

Huggins, D. R.

2015-12-01

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

Evidence synthesis for decision making 7: a reviewer's checklist.

PubMed

Ades, A E; Caldwell, Deborah M; Reken, Stefanie; Welton, Nicky J; Sutton, Alex J; Dias, Sofia

2013-07-01

This checklist is for the review of evidence syntheses for treatment efficacy used in decision making based on either efficacy or cost-effectiveness. It is intended to be used for pairwise meta-analysis, indirect comparisons, and network meta-analysis, without distinction. It does not generate a quality rating and is not prescriptive. Instead, it focuses on a series of questions aimed at revealing the assumptions that the authors of the synthesis are expecting readers to accept, the adequacy of the arguments authors advance in support of their position, and the need for further analyses or sensitivity analyses. The checklist is intended primarily for those who review evidence syntheses, including indirect comparisons and network meta-analyses, in the context of decision making but will also be of value to those submitting syntheses for review, whether to decision-making bodies or journals. The checklist has 4 main headings: A) definition of the decision problem, B) methods of analysis and presentation of results, C) issues specific to network synthesis, and D) embedding the synthesis in a probabilistic cost-effectiveness model. The headings and implicit advice follow directly from the other tutorials in this series. A simple table is provided that could serve as a pro forma checklist.

Enriching the national map database for multi-scale use: Introducing the visibilityfilter attribution

USGS Publications Warehouse

Stauffer, Andrew J.; Webinger, Seth; Roche, Brittany

2016-01-01

The US Geological Survey’s (USGS) National Geospatial Technical Operations Center is prototyping and evaluating the ability to filter data through a range of scales using 1:24,000-scale The National Map (TNM) datasets as the source. A “VisibilityFilter” attribute is under evaluation that can be added to all TNM vector data themes and will permit filtering of data to eight target scales between 1:24,000 and 1:5,000,000, thus defining each feature’s smallest applicable scale-of-use. For a prototype implementation, map specifications for 1:100,000- and 1:250,000-scale USGS Topographic Map Series are being utilized to define feature content appropriate at fixed mapping scales to guide generalization decisions that are documented in a ScaleMaster diagram. This paper defines the VisibilityFilter attribute, the generalization decisions made for each TNM data theme, and how these decisions are embedded into the data to support efficient data filtering.

How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study.

PubMed

van der Weijden, Trudy; Pieterse, Arwen H; Koelewijn-van Loon, Marije S; Knaapen, Loes; Légaré, France; Boivin, Antoine; Burgers, Jako S; Stiggelbout, Anne M; Faber, Marjan; Elwyn, Glyn

2013-10-01

To explore how clinical practice guidelines can be adapted to facilitate shared decision making. This was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in group discussions at two international conferences. Next, health professionals known as experts in depression or breast cancer, experts on clinical practice guidelines and/or shared decision making, and patient representatives were interviewed (N=20). Using illustrative treatment decisions on depression or breast cancer, we asked the interviewees to indicate as specifically as they could how guidelines could be used to facilitate shared decision making. Interviewees suggested some generic strategies, namely to include a separate chapter on the importance of shared decision making, to use language that encourages patient involvement, and to develop patient versions of guidelines. Recommendation-specific strategies, related to specific decision points in the guideline, were also suggested: These include structuring the presentation of healthcare options to increase professionals' option awareness; structuring the deliberation process between professionals and patients; and providing relevant patient support tools embedded at important decision points in the guideline. This study resulted in an overview of strategies to adapt clinical practice guidelines to facilitate shared decision making. Some strategies seemed more contentious than others. Future research should assess the feasibility and impact of these strategies to make clinical practice guidelines more conducive to facilitate shared decision making.

Knowledge mobilisation for policy development: implementing systems approaches through participatory dynamic simulation modelling.

PubMed

Freebairn, Louise; Rychetnik, Lucie; Atkinson, Jo-An; Kelly, Paul; McDonnell, Geoff; Roberts, Nick; Whittall, Christine; Redman, Sally

2017-10-02

Evidence-based decision-making is an important foundation for health policy and service planning decisions, yet there remain challenges in ensuring that the many forms of available evidence are considered when decisions are being made. Mobilising knowledge for policy and practice is an emergent process, and one that is highly relational, often messy and profoundly context dependent. Systems approaches, such as dynamic simulation modelling can be used to examine both complex health issues and the context in which they are embedded, and to develop decision support tools. This paper reports on the novel use of participatory simulation modelling as a knowledge mobilisation tool in Australian real-world policy settings. We describe how this approach combined systems science methodology and some of the core elements of knowledge mobilisation best practice. We describe the strategies adopted in three case studies to address both technical and socio-political issues, and compile the experiential lessons derived. Finally, we consider the implications of these knowledge mobilisation case studies and provide evidence for the feasibility of this approach in policy development settings. Participatory dynamic simulation modelling builds on contemporary knowledge mobilisation approaches for health stakeholders to collaborate and explore policy and health service scenarios for priority public health topics. The participatory methods place the decision-maker at the centre of the process and embed deliberative methods and co-production of knowledge. The simulation models function as health policy and programme dynamic decision support tools that integrate diverse forms of evidence, including research evidence, expert knowledge and localised contextual information. Further research is underway to determine the impact of these methods on health service decision-making.

A Reinforcement Sensor Embedded Vertical Handoff Controller for Vehicular Heterogeneous Wireless Networks

PubMed Central

Li, Limin; Xu, Yubin; Soong, Boon-Hee; Ma, Lin

2013-01-01

Vehicular communication platforms that provide real-time access to wireless networks have drawn more and more attention in recent years. IEEE 802.11p is the main radio access technology that supports communication for high mobility terminals, however, due to its limited coverage, IEEE 802.11p is usually deployed by coupling with cellular networks to achieve seamless mobility. In a heterogeneous cellular/802.11p network, vehicular communication is characterized by its short time span in association with a wireless local area network (WLAN). Moreover, for the media access control (MAC) scheme used for WLAN, the network throughput dramatically decreases with increasing user quantity. In response to these compelling problems, we propose a reinforcement sensor (RFS) embedded vertical handoff control strategy to support mobility management. The RFS has online learning capability and can provide optimal handoff decisions in an adaptive fashion without prior knowledge. The algorithm integrates considerations including vehicular mobility, traffic load, handoff latency, and network status. Simulation results verify that the proposed algorithm can adaptively adjust the handoff strategy, allowing users to stay connected to the best network. Furthermore, the algorithm can ensure that RSUs are adequate, thereby guaranteeing a high quality user experience. PMID:24193101

Dynamic Evaluation of Two Decades of CMAQ Simulations ...

EPA Pesticide Factsheets

This presentation focuses on the dynamic evaluation of the CMAQ model over the continental United States using multi-decadal simulations for the period from 1990 to 2010 to examine how well the changes in observed ozone air quality induced by variations in meteorology and/or emissions are simulated by the model. We applied spectral decomposition of the ozone time-series using the KZ filter to assess the variations in the strengths of synoptic (weather-induced variations) and baseline (long-term variation) forcings, embedded in the simulated and observed concentrations. The results reveal that CMAQ captured the year-to-year variability (more so in the later years than the earlier years) and the synoptic forcing in accordance with what the observations are showing. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

Acute asthma severity identification of expert system flow in emergency department

NASA Astrophysics Data System (ADS)

Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

2017-11-01

Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

Adapting Cooperative Learning and Embedding It into Holistic Language Usage.

ERIC Educational Resources Information Center

Bailey, Dora L.; Ginnetti, Philip

Class collaboration and small group composition illustrate the embedding of cooperative learning theory in whole language classroom events. Through this experience all students participate in active learning. The teacher has a weighty role in decision making, setting of the lesson, assigning roles, and monitoring segments of cooperative learning…

Portable parallel portfolio optimization in the Aurora Financial Management System

NASA Astrophysics Data System (ADS)

Laure, Erwin; Moritsch, Hans

2001-07-01

Financial planning problems are formulated as large scale, stochastic, multiperiod, tree structured optimization problems. An efficient technique for solving this kind of problems is the nested Benders decomposition method. In this paper we present a parallel, portable, asynchronous implementation of this technique. To achieve our portability goals we elected the programming language Java for our implementation and used a high level Java based framework, called OpusJava, for expressing the parallelism potential as well as synchronization constraints. Our implementation is embedded within a modular decision support tool for portfolio and asset liability management, the Aurora Financial Management System.

A Socioecological Model of Rape Survivors' Decisions to Aid in Case Prosecution

ERIC Educational Resources Information Center

Anders, Mary C.; Christopher, F. Scott

2011-01-01

The purpose of our study was to identify factors underlying rape survivors' post-assault prosecution decisions by testing a decision model that included the complex relations between the multiple social ecological systems within which rape survivors are embedded. We coded 440 police rape cases for characteristics of the assault and characteristics…

Interactive Resource Planning—An Anticipative Concept in the Simulation-Based Decision Support System EXPOSIM

NASA Astrophysics Data System (ADS)

Leopold-Wildburger, Ulrike; Pickl, Stefan

2008-10-01

In our research we intend to use experiments to study human behavior in a simulation environment based on a simple Lotka-Volterra predator-prey ecology. The aim is to study the influence of participants' harvesting strategies and certain personality traits derived from [1] on the outcome in terms of sustainability and economic performance. Such an approach is embedded in a research program which intends to develop and understand interactive resource planning processes. We present the general framework as well as the new decision support system EXPOSIM. The key element is the combination of experimental design, analytical understanding of time-discrete systems (especially Lotka-Volterra systems) and economic performance. In the first part, the general role of laboratory experiments is discussed. The second part summarizes the concept of sustainable development. It is taken from [18]. As we use Lotka-Volterra systems as the basis for our simulations a theoretical framework is described afterwards. It is possible to determine optimal behavior for those systems. The empirical setting is based on the empirical approach that the subjects are put into the position of a decision-maker. They are able to model the environment in such a way that harvesting can be observed. We suggest an experimental setting which might lead to new insights in an anticipatory sense.

The Use of Clinical Decision Support in Reducing Diagnosis of and Treatment of Asymptomatic Bacteriuria.

PubMed

Keller, Sara C; Feldman, Leonard; Smith, Janessa; Pahwa, Amit; Cosgrove, Sara E; Chida, Natasha

2018-06-01

Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. The objective of this study was to design an intervention to reduce unnecessary urinalysis and urine culture (UC) orders as well as the treatment of ASB. We performed a quasiexperimental study among adult inpatients at a single academic institution. We implemented a bundled intervention, including information broadcast in newsletters, hospitalwide screensavers, and passive CDS messages in the EHR. We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy. © 2018 Society of Hospital Medicine.

Heterogeneous data fusion and intelligent techniques embedded in a mobile application for real-time chronic disease management.

PubMed

Bellos, Christos; Papadopoulos, Athanassios; Rosso, Roberto; Fotiadis, Dimitrios I

2011-01-01

CHRONIOUS system is an integrated platform aiming at the management of chronic disease patients. One of the most important components of the system is a Decision Support System (DSS) that has been developed in a Smart Device (SD). This component decides on patient's current health status by combining several data, which are acquired either by wearable sensors or manually inputted by the patient or retrieved from the specific database. In case no abnormal situation has been tracked, the DSS takes no action and remains deactivated until next abnormal situation pack of data are being acquired or next scheduled data being transmitted. The DSS that has been implemented is an integrated classification system with two parallel classifiers, combining an expert system (rule-based system) and a supervised classifier, such as Support Vector Machines (SVM), Random Forests, artificial Neural Networks (aNN like the Multi-Layer Perceptron), Decision Trees and Naïve Bayes. The above categorized system is useful for providing critical information about the health status of the patient.

Thinking back: becoming aware of the global and its impact on choice

NASA Astrophysics Data System (ADS)

Clarkson, Philip C.

2011-03-01

Teaching decisions made `in the moment' do not often allow for deliberate, well thought through actions by teachers. Sometimes we are conscious of the options that are available and we do make deliberate decisions. We may even be aware of the values impinging on our decision, but for many other aspects embedded in our teaching, deeper influences impact. They may never become conscious. Sometimes though, over time and with reflection, we do uncover the influences to which we are beholden. In this paper, I reflect on moments that for me were local, but in which were embedded the influences of the global although I was not always aware of this at the time. Through these moments, I comment and attempt to nuance ideas espoused by the authors in this issue.

A design proposal of a certain missile tactical command system based on Beidou satellite communication and GPS positioning techniques

NASA Astrophysics Data System (ADS)

Ma, Jian; Hao, Yongsheng; Miao, Jian; Zhang, Jianmao

2007-11-01

This paper introduced a design proposal of tactical command system that applied to a kind of anti-tank missile carriers. The tactical command system was made up of embedded computer system based on PC104 bus, Linux operating system, digital military map, Beidou satellite communication equipments and GPS positioning equipments. The geographic coordinates was measured by the GPS receiver, the positioning data, commands and information were transmitted real-time between tactical command systems, tactical command systems and command center, by the Beidou satellite communication systems. The Beidou satellite communication equipments and GPS positioning equipments were integrated to an independent module, exchanging data with embedded computer through RS232 serial ports and USB ports. The decision support system software based on information fusion, calculates positioning data, geography information and battle field information synthetically, shows the position of allies and the position of enemy on the military map, and assesses the various threats of different enemy objects, educes a situation assessment and threat assessment.

Beginning Readers Activate Semantics from Sub-Word Orthography

ERIC Educational Resources Information Center

Nation, Kate; Cocksey, Joanne

2009-01-01

Two experiments assessed whether 7-year-old children activate semantic information from sub-word orthography. Children made category decisions to visually-presented words, some of which contained an embedded word (e.g., "hip" in s"hip"). In Experiment 1 children were slower and less accurate to classify words if they contained an embedded word…

Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial.

PubMed

Volker, Daniëlle; Vlasveld, Moniek C; Anema, Johannes R; Beekman, Aartjan Tf; Roijen, Leona Hakkaart-van; Brouwers, Evelien Pm; van Lomwel, A Gijsbert C; van der Feltz-Cornelis, Christina M

2013-01-01

Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial. It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.

Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms.

PubMed

Drescher, Michael J; Fried, Jeremy; Brass, Ryan; Medoro, Amanda; Murphy, Timothy; Delgado, João

2017-10-01

Computerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered. We performed a historically controlled observational before-after study for one year pre- and post-implementation of a departmentally-endorsed protocol. We included patients > 18 in whom providers suspected PE and who did not have a contraindication to CTPA. Providers entered clinical information into a diagnostic pathway via computerized order entry. Prior to protocol implementation, we provided education to ordering providers. The primary outcome measure was the number of CTPA ordered per 1,000 visits one year before vs. after implementation. CTPA declined from 1,033 scans for 98,028 annual visits (10.53 per 1,000 patient visits (95% CI [9.9-11.2]) to 892 scans for 101,172 annual visits (8.81 per 1,000 patient visits (95% CI [8.3-9.4]) p<0.001. The absolute reduction in PACT ordered was 1.72 per 1,000 visits (a 16% reduction). Patient characteristics were similar for both periods. Knowledge translation clinical decision support using the PERC rule significantly reduced the number of CTPA ordered.

C3 generic workstation: Performance metrics and applications

NASA Technical Reports Server (NTRS)

Eddy, Douglas R.

1988-01-01

The large number of integrated dependent measures available on a command, control, and communications (C3) generic workstation under development are described. In this system, embedded communications tasks will manipulate workload to assess the effects of performance-enhancing drugs (sleep aids and decongestants), work/rest cycles, biocybernetics, and decision support systems on performance. Task performance accuracy and latency will be event coded for correlation with other measures of voice stress and physiological functioning. Sessions will be videotaped to score non-verbal communications. Physiological recordings include spectral analysis of EEG, ECG, vagal tone, and EOG. Subjective measurements include SWAT, fatigue, POMS and specialized self-report scales. The system will be used primarily to evaluate the effects on performance of drugs, work/rest cycles, and biocybernetic concepts. Performance assessment algorithms will also be developed, including those used with small teams. This system provides a tool for integrating and synchronizing behavioral and psychophysiological measures in a complex decision-making environment.

The Roles of Science in Local Resilience Policy Development: A Case Study of Three U.S. Cities

NASA Astrophysics Data System (ADS)

Clavin, C.; Gupta, N.

2015-12-01

The development and deployment of resilience policies within communities in the United States often respond to the place-based, hazard-specific nature of disasters. Prior to the onset of a disaster, municipal and regional decision makers establish long-term development policies, such as land use planning, infrastructure investment, and economic development policies. Despite the importance of incorporating disaster risk within community decision making, resilience and disaster risk are only one consideration community decision makers weigh when choosing how and whether to establish resilience policy. Using a case study approach, we examine the governance, organizational, management, and policy making processes and the involvement of scientific advice in designing and implementing resilience policy in three U.S. communities: Los Angeles, CA; Norfolk, VA; and Flagstaff, AZ. Disaster mitigation or resilience initiatives were developed and deployed in each community with differing levels and types of scientific engagement. Engagement spanned from providing technical support with traditional risk assessment to direct engagement with community decision makers and design of community resilience outreach. Best practices observed include embedding trusted, independent scientific advisors with strong community credibility within local government agencies, use of interdisciplinary and interdepartmental expert teams with management and technical skillsets, and establishing scientifically-informed disaster and hazard scenarios to enable community outreach. Case study evidence suggest science communication and engagement within and across municipal government agencies and scientifically-informed direct engagement with community stakeholders are effective approaches and roles that disaster risk scientists can fill to support resilience policy development.

Home care nurses' experience of job stress and considerations for the work environment.

PubMed

Samia, Linda W; Ellenbecker, Carol Hall; Friedman, Donna Haig; Dick, Karen

2012-01-01

Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

Towards a cyber-physical era: soft computing framework based multi-sensor array for water quality monitoring

NASA Astrophysics Data System (ADS)

Bhardwaj, Jyotirmoy; Gupta, Karunesh K.; Gupta, Rajiv

2018-02-01

New concepts and techniques are replacing traditional methods of water quality parameter measurement systems. This paper introduces a cyber-physical system (CPS) approach for water quality assessment in a distribution network. Cyber-physical systems with embedded sensors, processors and actuators can be designed to sense and interact with the water environment. The proposed CPS is comprised of sensing framework integrated with five different water quality parameter sensor nodes and soft computing framework for computational modelling. Soft computing framework utilizes the applications of Python for user interface and fuzzy sciences for decision making. Introduction of multiple sensors in a water distribution network generates a huge number of data matrices, which are sometimes highly complex, difficult to understand and convoluted for effective decision making. Therefore, the proposed system framework also intends to simplify the complexity of obtained sensor data matrices and to support decision making for water engineers through a soft computing framework. The target of this proposed research is to provide a simple and efficient method to identify and detect presence of contamination in a water distribution network using applications of CPS.

A Project-Based Laboratory for Learning Embedded System Design with Industry Support

ERIC Educational Resources Information Center

Lee, Chyi-Shyong; Su, Juing-Huei; Lin, Kuo-En; Chang, Jia-Hao; Lin, Gu-Hong

2010-01-01

A project-based laboratory for learning embedded system design with support from industry is presented in this paper. The aim of this laboratory is to motivate students to learn the building blocks of embedded systems and practical control algorithms by constructing a line-following robot using the quadratic interpolation technique to predict the…

Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence

PubMed Central

2013-01-01

Background Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. Methods We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. Results Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. Conclusions Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance. PMID:24624995

A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

PubMed Central

Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-01-01

Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope®; Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations. PMID:25347226

A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

PubMed

Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-03-01

Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.

Lunar Surface Systems Supportability Technology Development Roadmap

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Struk, Peter M.; Green, Jennifer L.; Chau, Savio N.; Curell, Philip C.; Dempsey, Cathy A.; Patterson, Linda P.; Robbins, William; Steele, Michael A.; DAnnunzio, Anthony;

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

ERIC Educational Resources Information Center

Perez-Brena, Norma J.; Updegraff, Kimberly A.; Umana-Taylor, Adriana J.

2012-01-01

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully comprehend how family processes are embedded within culture. The goals of this study were to describe mothers' and fathers' decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including…

With A Little Help From My Friends (And My Financial Planner)

ERIC Educational Resources Information Center

Chang, Mariko Lin

2005-01-01

Despite the tremendous implications that financial decisions have for socioeconomic well-being, the study of financial decision-making has been left largely to economists. This paper places this topic firmly within sociological terrain and demonstrates that the search for financial information is embedded within broader systems of social…

Determining the Applicability of Threshold of Toxicological Concern Approaches to Substances Found in Foods

PubMed Central

Canady, Richard; Lane, Richard; Paoli, Greg; Wilson, Margaret; Bialk, Heidi; Hermansky, Steven; Kobielush, Brent; Lee, Ji-Eun; Llewellyn, Craig; Scimeca, Joseph

2013-01-01

Threshold of Toxicological Concern (TTC) decision-support methods present a pragmatic approach to using data from well-characterized chemicals and protective estimates of exposure in a stepwise fashion to inform decisions regarding low-level exposures to chemicals for which few data exist. It is based on structural and functional categorizations of chemicals derived from decades of animal testing with a wide variety of chemicals. Expertise is required to use the TTC methods, and there are situations in which its use is clearly inappropriate or not currently supported. To facilitate proper use of the TTC, this paper describes issues to be considered by risk managers when faced with the situation of an unexpected substance in food. Case studies are provided to illustrate the implementation of these considerations, demonstrating the steps taken in deciding whether it would be appropriate to apply the TTC approach in each case. By appropriately applying the methods, employing the appropriate scientific expertise, and combining use with the conservative assumptions embedded within the derivation of the thresholds, the TTC can realize its potential to protect public health and to contribute to efficient use of resources in food safety risk management. PMID:24090142

Combining macula clinical signs and patient characteristics for age-related macular degeneration diagnosis: a machine learning approach.

PubMed

Fraccaro, Paolo; Nicolo, Massimo; Bonetto, Monica; Giacomini, Mauro; Weller, Peter; Traverso, Carlo Enrico; Prosperi, Mattia; OSullivan, Dympna

2015-01-27

To investigate machine learning methods, ranging from simpler interpretable techniques to complex (non-linear) "black-box" approaches, for automated diagnosis of Age-related Macular Degeneration (AMD). Data from healthy subjects and patients diagnosed with AMD or other retinal diseases were collected during routine visits via an Electronic Health Record (EHR) system. Patients' attributes included demographics and, for each eye, presence/absence of major AMD-related clinical signs (soft drusen, retinal pigment epitelium, defects/pigment mottling, depigmentation area, subretinal haemorrhage, subretinal fluid, macula thickness, macular scar, subretinal fibrosis). Interpretable techniques known as white box methods including logistic regression and decision trees as well as less interpreitable techniques known as black box methods, such as support vector machines (SVM), random forests and AdaBoost, were used to develop models (trained and validated on unseen data) to diagnose AMD. The gold standard was confirmed diagnosis of AMD by physicians. Sensitivity, specificity and area under the receiver operating characteristic (AUC) were used to assess performance. Study population included 487 patients (912 eyes). In terms of AUC, random forests, logistic regression and adaboost showed a mean performance of (0.92), followed by SVM and decision trees (0.90). All machine learning models identified soft drusen and age as the most discriminating variables in clinicians' decision pathways to diagnose AMD. Both black-box and white box methods performed well in identifying diagnoses of AMD and their decision pathways. Machine learning models developed through the proposed approach, relying on clinical signs identified by retinal specialists, could be embedded into EHR to provide physicians with real time (interpretable) support.

University of Wolverhampton Case Study: Embedding Practical Work-Based Modules into a Traditionally, Theoretical Programme

ERIC Educational Resources Information Center

Nicholls, Emma; Walsh, Margaret

2007-01-01

Purpose: This case study aims to provide a critical evaluation of the decision by the University of Wolverhampton's School of Legal Studies to develop a number of work-based learning modules, offered as part of the undergraduate programme. It seeks to examine why the School has taken the approach of embedding work-based learning into what has…

The Activation of Embedded Words in Spoken Word Recognition

PubMed Central

Zhang, Xujin; Samuel, Arthur G.

2015-01-01

The current study investigated how listeners understand English words that have shorter words embedded in them. A series of auditory-auditory priming experiments assessed the activation of six types of embedded words (2 embedded positions × 3 embedded proportions) under different listening conditions. Facilitation of lexical decision responses to targets (e.g., pig) associated with words embedded in primes (e.g., hamster) indexed activation of the embedded words (e.g., ham). When the listening conditions were optimal, isolated embedded words (e.g., ham) primed their targets in all six conditions (Experiment 1a). Within carrier words (e.g., hamster), the same set of embedded words produced priming only when they were at the beginning or comprised a large proportion of the carrier word (Experiment 1b). When the listening conditions were made suboptimal by expanding or compressing the primes, significant priming was found for isolated embedded words (Experiment 2a), but no priming was produced when the carrier words were compressed/expanded (Experiment 2b). Similarly, priming was eliminated when the carrier words were presented with one segment replaced by noise (Experiment 3). When cognitive load was imposed, priming for embedded words was again found when they were presented in isolation (Experiment 4a), but not when they were embedded in the carrier words (Experiment 4b). The results suggest that both embedded position and proportion play important roles in the activation of embedded words, but that such activation only occurs under unusually good listening conditions. PMID:25593407

The Activation of Embedded Words in Spoken Word Recognition.

PubMed

Zhang, Xujin; Samuel, Arthur G

2015-01-01

The current study investigated how listeners understand English words that have shorter words embedded in them. A series of auditory-auditory priming experiments assessed the activation of six types of embedded words (2 embedded positions × 3 embedded proportions) under different listening conditions. Facilitation of lexical decision responses to targets (e.g., pig) associated with words embedded in primes (e.g., hamster ) indexed activation of the embedded words (e.g., ham ). When the listening conditions were optimal, isolated embedded words (e.g., ham ) primed their targets in all six conditions (Experiment 1a). Within carrier words (e.g., hamster ), the same set of embedded words produced priming only when they were at the beginning or comprised a large proportion of the carrier word (Experiment 1b). When the listening conditions were made suboptimal by expanding or compressing the primes, significant priming was found for isolated embedded words (Experiment 2a), but no priming was produced when the carrier words were compressed/expanded (Experiment 2b). Similarly, priming was eliminated when the carrier words were presented with one segment replaced by noise (Experiment 3). When cognitive load was imposed, priming for embedded words was again found when they were presented in isolation (Experiment 4a), but not when they were embedded in the carrier words (Experiment 4b). The results suggest that both embedded position and proportion play important roles in the activation of embedded words, but that such activation only occurs under unusually good listening conditions.

Consideration of reference points for the management of renewable resources under an adaptive management paradigm

USGS Publications Warehouse

Irwin, Brian J.; Conroy, Michael J.

2013-01-01

The success of natural resource management depends on monitoring, assessment and enforcement. In support of these efforts, reference points (RPs) are often viewed as critical values of management-relevant indicators. This paper considers RPs from the standpoint of objective-driven decision making in dynamic resource systems, guided by principles of structured decision making (SDM) and adaptive resource management (AM). During the development of natural resource policy, RPs have been variously treated as either ‘targets’ or ‘triggers’. Under a SDM/AM paradigm, target RPs correspond approximately to value-based objectives, which may in turn be either of fundamental interest to stakeholders or intermediaries to other central objectives. By contrast, trigger RPs correspond to decision rules that are presumed to lead to desirable outcomes (such as the programme targets). Casting RPs as triggers or targets within a SDM framework is helpful towards clarifying why (or whether) a particular metric is appropriate. Further, the benefits of a SDM/AM process include elucidation of underlying untested assumptions that may reveal alternative metrics for use as RPs. Likewise, a structured decision-analytic framework may also reveal that failure to achieve management goals is not because the metrics are wrong, but because the decision-making process in which they are embedded is insufficiently robust to uncertainty, is not efficiently directed at producing a resource objective, or is incapable of adaptation to new knowledge.

Use of a Data-Linked Weather Information Display and Effects on Pilot Navigation Decision Making in a Piloted Simulation Study

NASA Technical Reports Server (NTRS)

Yuchnovicz, Daniel E.; Novacek, Paul F.; Burgess, Malcolm A.; Heck, Michael L.; Stokes, Alan F.

2001-01-01

This study provides recommendations to the FAA and to prospective manufacturers based on an exploration of the effects of data link weather displays upon pilot decision performance. An experiment was conducted with twenty-four current instrument rated pilots who were divided into two equal groups and presented with a challenging but realistic flight scenario involving weather containing significant embedded convective activity. All flights were flown in a full-mission simulation facility within instrument meteorological conditions. The inflight weather display depicted NexRad images, graphical METARs and textual METARs. The objective was to investigate the potential for misuse of a weather display, and incorporate recommendations for the design and use of these displays. The primary conclusion of the study found that the inflight weather display did not improve weather avoidance decision making. Some of the reasons to support this finding include: the pilot's inability to easily perceive their proximity to the storms, increased workload and difficulty in deciphering METAR textual data. The compelling nature of a graphical weather display caused many pilots to reduce their reliance on corroborating weather information from other sources. Minor changes to the weather display could improve the ability of a pilot to make better decisions on hazard avoidance.

Deontic Reasoning with Emotional Content: Evolutionary Psychology or Decision Theory?

ERIC Educational Resources Information Center

Perham, Nick; Oaksford, Mike

2005-01-01

Three experiments investigated the contrasting predictions of the evolutionary and decision-theoretic approaches to deontic reasoning. Two experiments embedded a hazard management (HM) rule in a social contract scenario that should lead to competition between innate modules. A 3rd experiment used a pure HM task. Threatening material was also…

A Model to Assess the Behavioral Impacts of Consultative Knowledge Based Systems.

ERIC Educational Resources Information Center

Mak, Brenda; Lyytinen, Kalle

1997-01-01

This research model studies the behavioral impacts of consultative knowledge based systems (KBS). A study of graduate students explored to what extent their decisions were affected by user participation in updating the knowledge base; ambiguity of decision setting; routinization of usage; and source credibility of the expertise embedded in the…

Primary Grades Teachers' Instructional Decisions during Online Mathematics Professional Development Activities

ERIC Educational Resources Information Center

Polly, Drew; Martin, Christie S.; Wang, Chuang; Lambert, Richard G.; Pugalee, David K.

2016-01-01

This study examines primary grades teachers' instructional decisions in their mathematics classroom during their participation in a year-long professional development program on formative assessment. Teachers participated in 40 h of face-to-face workshops followed by 40 h of classroom-embedded activities that were facilitated in an asynchronous…

"Quality of prenatal and maternal care: bridging the know-do gap" (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa.

PubMed

Blank, Antje; Prytherch, Helen; Kaltschmidt, Jens; Krings, Andreas; Sukums, Felix; Mensah, Nathan; Zakane, Alphonse; Loukanova, Svetla; Gustafsson, Lars L; Sauerborn, Rainer; Haefeli, Walter E

2013-04-10

Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.

“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

PubMed Central

2013-01-01

Background Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”. Results The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration http://www.clinicaltrials.gov/NCT01409824. PMID:23574764

Embedded-monolith armor

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

McElfresh, Michael W.; Groves, Scott E; Moffet, Mitchell L.

2016-07-19

A lightweight armor system utilizing a face section having a multiplicity of monoliths embedded in a matrix supported on low density foam. The face section is supported with a strong stiff backing plate. The backing plate is mounted on a spall plate.

Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making.

PubMed

Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O

2016-10-07

Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs. Copyright © 2016 by the American Society of Nephrology.

Using Elearning techniques to support problem based learning within a clinical simulation laboratory.

PubMed

Docherty, Charles; Hoy, Derek; Topp, Helena; Trinder, Kathryn

2004-01-01

This paper details the results of the first phase of a project that used eLearning to support students' learning within a simulated environment. The locus was a purpose built Clinical Simulation Laboratory (CSL) where the School's newly adopted philosophy of Problem Based Learning (PBL) was challenged through lecturers reverting to traditional teaching methods. The solution, a student-centred, problem-based approach to the acquisition of clinical skills was developed using learning objects embedded within web pages that substituted for lecturers providing instruction and demonstration. This allowed lecturers to retain their facilitator role, and encouraged students to explore, analyse and make decisions within the safety of a clinical simulation. Learning was enhanced through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that an elearning approach can support PBL in delivering a student centred learning experience.

Functions, Use and Effects of Embedded Support Devices in Printed Distance Learning Materials.

ERIC Educational Resources Information Center

Martens, Rob; And Others

1996-01-01

To support distance learning, printed materials for the course are enriched with embedded support devices (ESD) such as schemes, illustrations, examples, questions, or margin texts. Results of 3 studies involving 900 Dutch university students indicated that students used and appreciated ESD, and that they led to better study results. (SLD)

HTA – Algorithm or Process?

PubMed Central

Culyer, Anthony J.

2016-01-01

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

Outcomes-focused knowledge translation: a framework for knowledge translation and patient outcomes improvement.

PubMed

Doran, Diane M; Sidani, Souraya

2007-01-01

Regularly accessing information that is current and reliable continues to be a challenge for front-line staff nurses. Reconceptualizing how nurses access information and designing appropriate decision support systems to facilitate timely access to information may be important for increasing research utilization. An outcomes-focused knowledge translation framework was developed to guide the continuous improvement of patient care through the uptake of research evidence and feedback data about patient outcomes. The framework operationalizes the three elements of the PARIHS framework at the point of care. Outcomes-focused knowledge translation involves four components: (a) patient outcomes measurement and real-time feedback about outcomes achievement; (b) best-practice guidelines, embedded in decision support tools that deliver key messages in response to patient assessment data; (c) clarification of patients' preferences for care; and (d) facilitation by advanced practice nurses and practice leaders. In this paper the framework is described and evidence is provided to support theorized relationships among the concepts in the framework. The framework guided the design of a knowledge translation intervention aimed at continuous improvement of patient care and evidence-based practice, which are fostered through real-time feedback data about patient outcomes, electronic access to evidence-based resources at the point of care, and facilitation by advanced practice nurses. The propositions in the framework need to be empirically tested through future research.

Evaluating business value of IT towards optimisation of the application portfolio

NASA Astrophysics Data System (ADS)

Sun, Lily; Liu, Kecheng; Indrayani Jambari, Dian; Michell, Vaughan

2016-05-01

Information technology has become heavily embedded in business operations. As business needs change over time, IT applications are expected to continue providing required support. Whether the existing IT applications are still fit for the business purpose they were intended or new IT applications should be introduced is a strategic decision for business, IT and business-aligned IT. In this article, we present a method that aims to analyse business functions and IT roles and to evaluate business-aligned IT from both social and technical perspectives. The method introduces a set of techniques that systematically supports the evaluation of the existing IT applications in relation to their technical capabilities for maximising business value. Furthermore, we discuss the evaluation process and results that are illustrated and validated through a real-life case study of a UK borough council and followed by discussion on implications for researchers and practitioners.

The Effect of NEXRAD Image Looping and National Convective Weather Forecast Product on Pilot Decision Making in the Use of a Cockpit Weather Information Display

NASA Technical Reports Server (NTRS)

Burgess, Malcolm A.; Thomas, Rickey P.

2004-01-01

This experiment investigated improvements to cockpit weather displays to better support the hazardous weather avoidance decision-making of general aviation pilots. Forty-eight general aviation pilots were divided into three equal groups and presented with a simulated flight scenario involving embedded convective activity. The control group had access to conventional sources of pre-flight and in-flight weather products. The two treatment groups were provided with a weather display that presented NEXRAD mosaic images, graphic depiction of METARs, and text METARs. One treatment group used a NEXRAD image looping feature and the second group used the National Convective Weather Forecast (NCWF) product overlaid on the NEXRAD display. Both of the treatment displays provided a significant increase in situation awareness but, they provided incomplete information required to deal with hazardous convective weather conditions, and would require substantial pilot training to permit their safe and effective use.

Pervasive Monitoring—An Intelligent Sensor Pod Approach for Standardised Measurement Infrastructures

PubMed Central

Resch, Bernd; Mittlboeck, Manfred; Lippautz, Michael

2010-01-01

Geo-sensor networks have traditionally been built up in closed monolithic systems, thus limiting trans-domain usage of real-time measurements. This paper presents the technical infrastructure of a standardised embedded sensing device, which has been developed in the course of the Live Geography approach. The sensor pod implements data provision standards of the Sensor Web Enablement initiative, including an event-based alerting mechanism and location-aware Complex Event Processing functionality for detection of threshold transgression and quality assurance. The goal of this research is that the resultant highly flexible sensing architecture will bring sensor network applications one step further towards the realisation of the vision of a “digital skin for planet earth”. The developed infrastructure can potentially have far-reaching impacts on sensor-based monitoring systems through the deployment of ubiquitous and fine-grained sensor networks. This in turn allows for the straight-forward use of live sensor data in existing spatial decision support systems to enable better-informed decision-making. PMID:22163537

Pervasive monitoring--an intelligent sensor pod approach for standardised measurement infrastructures.

PubMed

Resch, Bernd; Mittlboeck, Manfred; Lippautz, Michael

2010-01-01

Geo-sensor networks have traditionally been built up in closed monolithic systems, thus limiting trans-domain usage of real-time measurements. This paper presents the technical infrastructure of a standardised embedded sensing device, which has been developed in the course of the Live Geography approach. The sensor pod implements data provision standards of the Sensor Web Enablement initiative, including an event-based alerting mechanism and location-aware Complex Event Processing functionality for detection of threshold transgression and quality assurance. The goal of this research is that the resultant highly flexible sensing architecture will bring sensor network applications one step further towards the realisation of the vision of a "digital skin for planet earth". The developed infrastructure can potentially have far-reaching impacts on sensor-based monitoring systems through the deployment of ubiquitous and fine-grained sensor networks. This in turn allows for the straight-forward use of live sensor data in existing spatial decision support systems to enable better-informed decision-making.

Managers' experience of training the associate practitioner role.

PubMed

Thurgate, Claire; MacGregor, Janet; O'Keefe, Helen

2013-03-01

This paper documents findings from a service evaluation of clinical managers' (n = 5) perceptions of the assistant practitioner (AP) training programme in one National Health Service (NHS) Trust in South East England, UK. The AP has been identified in England as a means for supporting registered nurses and enhancing patient care. The development of the AP role requires managers to consider how the role will be embedded and how they work with education providers. This service evaluation interviewed five clinical managers who have supported APs in relation to their function for the specialist clinical role. The AP role should be defined by competence, boundaries and the skill mix needed for specific clinical team function. Careful recruitment is vital and mentors need clear outcomes for the AP role. Managers need to be involved in all levels of the programme, from liaison with the Higher Education Institute and Trust decisions on role job descriptions and employment. Recruitment is vital, individuals have to be flexible and responsive to change and should be used in relation to their clinical competence. A competency framework for all health-care workers was the managers' desire for job descriptions and assessment of practice so that every member of the health-care team was 'fit for purpose'. Nurse managers need to work with workforce leads when considering introduction of new roles so appropriate skill mix is achieved and the AP role is embedded. © 2012 Blackwell Publishing Ltd.

Application of a web-based Decision Support System in risk management

NASA Astrophysics Data System (ADS)

Aye, Zar Chi; Jaboyedoff, Michel; Derron, Marc-Henri

2013-04-01

Increasingly, risk information is widely available with the help of advanced technologies such as earth observation satellites, global positioning technologies, coupled with hazard modeling and analysis, and geographical information systems (GIS). Even though it exists, no effort will be put into action if it is not properly presented to the decision makers. These information need to be communicated clearly and show its usefulness so that people can make better informed decision. Therefore, communicating available risk information has become an important challenge and decision support systems have been one of the significant approaches which can help not only in presenting risk information to the decision makers but also in making efficient decisions while reducing human resources and time needed. In this study, the conceptual framework of an internet-based decision support system is presented to highlight its importance role in risk management framework and how it can be applied in case study areas chosen. The main purpose of the proposed system is to facilitate the available risk information in risk reduction by taking into account of the changes in climate, land use and socio-economic along with the risk scenarios. It allows the users to formulate, compare and select risk reduction scenarios (mainly for floods and landslides) through an enhanced participatory platform with diverse stakeholders' involvement in the decision making process. It is based on the three-tier (client-server) architecture which integrates web-GIS plus DSS functionalities together with cost benefit analysis and other supporting tools. Embedding web-GIS provides its end users to make better planning and informed decisions referenced to a geographical location, which is the one of the essential factors in disaster risk reduction programs. Different risk reduction measures of a specific area (local scale) will be evaluated using this web-GIS tool, available risk scenarios obtained from Probabilistic Risk Assessment (PRA) model and the knowledge collected from experts. The visualization of the risk reduction scenarios can also be shared among the users on the web to support the on-line participatory process. In addition, cost-benefit ratios of the different risk reduction scenarios can be prepared in order to serve as inputs for high-level decision makers. The most appropriate risk reduction scenarios will be chosen using Multi-Criteria Evaluation (MCE) method by weighting different parameters according to the preferences and criteria defined by the users. The role of public participation has been changing from one-way communication between authorities, experts, stakeholders and citizens towards more intensive two-way interaction. Involving the affected public and interest groups can enhance the level of legitimacy, transparency, and confidence in the decision making process. Due to its important part in decision making, online participatory tool is included in the DSS in order to allow the involved stakeholders interactively in risk reduction and be aware of the existing vulnerability conditions of the community. Moreover, it aims to achieve a more transparent and better informed decision-making process. The system is under in progress and the first tools implemented will be presented showing the wide possibilities of new web technologies which can have a great impact on the decision making process. It will be applied in four pilot areas in Europe: French Alps, North Eastern Italy, Romania and Poland. Nevertheless, the framework will be designed and implemented in a way to be applicable in any other regions.

Context recognition and situation assessment in autonomous mobile robots

NASA Astrophysics Data System (ADS)

Yavnai, Arie

1993-05-01

The capability to recognize the operating context and to assess the situation in real-time is needed, if a high functionality autonomous mobile robot has to react properly and effectively to continuously changing situations and events, either external or internal, while the robot is performing its assigned tasks. A new approach and architecture for context recognition and situation assessment module (CORSA) is presented in this paper. CORSA is a multi-level information processing module which consists of adaptive decision and classification algorithms. It performs dynamic mapping from the data space to the context space, and dynamically decides on the context class. Learning mechanism is employed to update the decision variables so as to minimize the probability of misclassification. CORSA is embedded within the Mission Manager module of the intelligent autonomous hyper-controller (IAHC) of the mobile robot. The information regarding operating context, events and situation is then communicated to other modules of the IAHC where it is used to: (a) select the appropriate action strategy; (b) support the processes to arbitration and conflict resolution between reflexive behaviors and reasoning-driven behaviors; (c) predict future events and situations; and (d) determine criteria and priorities for planning, replanning, and decision making.

Real-Time Analysis of a Sensor's Data for Automated Decision Making in an IoT-Based Smart Home.

PubMed

Khan, Nida Saddaf; Ghani, Sayeed; Haider, Sajjad

2018-05-25

IoT devices frequently generate large volumes of streaming data and in order to take advantage of this data, their temporal patterns must be learned and identified. Streaming data analysis has become popular after being successfully used in many applications including forecasting electricity load, stock market prices, weather conditions, etc. Artificial Neural Networks (ANNs) have been successfully utilized in understanding the embedded interesting patterns/behaviors in the data and forecasting the future values based on it. One such pattern is modelled and learned in the present study to identify the occurrence of a specific pattern in a Water Management System (WMS). This prediction aids in making an automatic decision support system, to switch OFF a hydraulic suction pump at the appropriate time. Three types of ANN, namely Multi-Input Multi-Output (MIMO), Multi-Input Single-Output (MISO), and Recurrent Neural Network (RNN) have been compared, for multi-step-ahead forecasting, on a sensor's streaming data. Experiments have shown that RNN has the best performance among three models and based on its prediction, a system can be implemented to make the best decision with 86% accuracy.

Teachers' Thoughts on Student Decision Making during Engineering Design Lessons

ERIC Educational Resources Information Center

Meyer, Helen

2018-01-01

In this paper, I share the results of a study of teachers' ideas about student decision-making at entry into a professional development program to integrate engineering into their instruction. The framework for the Engineering Design Process (EDP) was based on a Challenge-Based Learning (CBL) model. The EDP embedded within the CBL model suggests…

EOS: A project to investigate the design and construction of real-time distributed Embedded Operating Systems

NASA Technical Reports Server (NTRS)

Campbell, R. H.; Essick, Ray B.; Johnston, Gary; Kenny, Kevin; Russo, Vince

1987-01-01

Project EOS is studying the problems of building adaptable real-time embedded operating systems for the scientific missions of NASA. Choices (A Class Hierarchical Open Interface for Custom Embedded Systems) is an operating system designed and built by Project EOS to address the following specific issues: the software architecture for adaptable embedded parallel operating systems, the achievement of high-performance and real-time operation, the simplification of interprocess communications, the isolation of operating system mechanisms from one another, and the separation of mechanisms from policy decisions. Choices is written in C++ and runs on a ten processor Encore Multimax. The system is intended for use in constructing specialized computer applications and research on advanced operating system features including fault tolerance and parallelism.

Embedding climate change risk assessment within a governance context

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

Preston, Benjamin L

Climate change adaptation is increasingly being framed in the context of climate risk management. This has contributed to the proliferation of climate change vulnerability and/or risk assessments as means of supporting institutional decision-making regarding adaptation policies and measures. To date, however, little consideration has been given to how such assessment projects and programs interact with governance systems to facilitate or hinder the implementation of adaptive responses. An examination of recent case studies involving Australian local governments reveals two key linkages between risk assessment and the governance of adaptation. First, governance systems influence how risk assessment processes are conducted, by whommore » they are conducted, and whom they are meant to inform. Australia s governance system emphasizes evidence-based decision-making that reinforces a knowledge deficit model of decision support. Assessments are often carried out by external experts on behalf of local government, with limited participation by relevant stakeholders and/or civil society. Second, governance systems influence the extent to which the outputs from risk assessment activities are translated into adaptive responses and outcomes. Technical information regarding risk is often stranded by institutional barriers to adaptation including poor uptake of information, competition on the policy agenda, and lack of sufficient entitlements. Yet, risk assessments can assist in bringing such barriers to the surface, where they can be debated and resolved. In fact, well-designed risk assessments can contribute to multi-loop learning by institutions, and that reflexive problem orientation may be one of the more valuable benefits of assessment.« less

Seeking high reliability in primary care: Leadership, tools, and organization.

PubMed

Weaver, Robert R

2015-01-01

Leaders in health care increasingly recognize that improving health care quality and safety requires developing an organizational culture that fosters high reliability and continuous process improvement. For various reasons, a reliability-seeking culture is lacking in most health care settings. Developing a reliability-seeking culture requires leaders' sustained commitment to reliability principles using key mechanisms to embed those principles widely in the organization. The aim of this study was to examine how key mechanisms used by a primary care practice (PCP) might foster a reliability-seeking, system-oriented organizational culture. A case study approach was used to investigate the PCP's reliability culture. The study examined four cultural artifacts used to embed reliability-seeking principles across the organization: leadership statements, decision support tools, and two organizational processes. To decipher their effects on reliability, the study relied on observations of work patterns and the tools' use, interactions during morning huddles and process improvement meetings, interviews with clinical and office staff, and a "collective mindfulness" questionnaire. The five reliability principles framed the data analysis. Leadership statements articulated principles that oriented the PCP toward a reliability-seeking culture of care. Reliability principles became embedded in the everyday discourse and actions through the use of "problem knowledge coupler" decision support tools and daily "huddles." Practitioners and staff were encouraged to report unexpected events or close calls that arose and which often initiated a formal "process change" used to adjust routines and prevent adverse events from recurring. Activities that foster reliable patient care became part of the taken-for-granted routine at the PCP. The analysis illustrates the role leadership, tools, and organizational processes play in developing and embedding a reliable-seeking culture across an organization. Progress toward a reliability-seeking, system-oriented approach to care remains ongoing, and movement in that direction requires deliberate and sustained effort by committed leaders in health care.

A Pilot Study to Reduce Computed Tomography Utilization for Pediatric Mild Head Injury in the Emergency Department Using a Clinical Decision Support Tool and a Structured Parent Discussion Tool.

PubMed

Engineer, Rakesh S; Podolsky, Seth R; Fertel, Baruch S; Grover, Purva; Jimenez, Heather; Simon, Erin L; Smalley, Courtney M

2018-05-15

The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance. Patients prospectively were enrolled when providers at a pediatric and a freestanding ED entered data into the CDST for decision making. Rate of care path utilization and head CT reduction was determined for all patients with minor head injury based on International Classification of Diseases, Ninth Revision codes. Targets for care path utilization and head CT reduction were established a priori. Results were compared with baseline data collected from 2013. The CDST was used in 176 (77.5%) of 227 eligible patients. Twelve patients were excluded based on a priori criteria. Adherence to recommendations occurred in 162 (99%) of 164 patients. Head CT utilization was reduced from 62.7% to 22% (odds ratio, 0.17; 95% confidence interval, 0.12-0.24) where CDST was used by the provider. There were no missed traumatic brain injuries in our study group. A Pediatric Mild Head Injury Care Path can be implemented in a pediatric and freestanding ED, resulting in reduced head CT utilization and high levels of adherence to CDST recommendations.

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

PubMed

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

2015-01-01

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

Embedded performance validity testing in neuropsychological assessment: Potential clinical tools.

PubMed

Rickards, Tyler A; Cranston, Christopher C; Touradji, Pegah; Bechtold, Kathleen T

2018-01-01

The article aims to suggest clinically-useful tools in neuropsychological assessment for efficient use of embedded measures of performance validity. To accomplish this, we integrated available validity-related and statistical research from the literature, consensus statements, and survey-based data from practicing neuropsychologists. We provide recommendations for use of 1) Cutoffs for embedded performance validity tests including Reliable Digit Span, California Verbal Learning Test (Second Edition) Forced Choice Recognition, Rey-Osterrieth Complex Figure Test Combination Score, Wisconsin Card Sorting Test Failure to Maintain Set, and the Finger Tapping Test; 2) Selecting number of performance validity measures to administer in an assessment; and 3) Hypothetical clinical decision-making models for use of performance validity testing in a neuropsychological assessment collectively considering behavior, patient reporting, and data indicating invalid or noncredible performance. Performance validity testing helps inform the clinician about an individual's general approach to tasks: response to failure, task engagement and persistence, compliance with task demands. Data-driven clinical suggestions provide a resource to clinicians and to instigate conversation within the field to make more uniform, testable decisions to further the discussion, and guide future research in this area.

New technologies for supporting real-time on-board software development

NASA Astrophysics Data System (ADS)

Kerridge, D.

1995-03-01

The next generation of on-board data management systems will be significantly more complex than current designs, and will be required to perform more complex and demanding tasks in software. Improved hardware technology, in the form of the MA31750 radiation hard processor, is one key component in addressing the needs of future embedded systems. However, to complement these hardware advances, improved support for the design and implementation of real-time data management software is now needed. This will help to control the cost and risk assoicated with developing data management software development as it becomes an increasingly significant element within embedded systems. One particular problem with developing embedded software is managing the non-functional requirements in a systematic way. This paper identifies how Logica has exploited recent developments in hard real-time theory to address this problem through the use of new hard real-time analysis and design methods which can be supported by specialized tools. The first stage in transferring this technology from the research domain to industrial application has already been completed. The MA37150 Hard Real-Time Embedded Software Support Environment (HESSE) is a loosely integrated set of hardware and software tools which directly support the process of hard real-time analysis for software targeting the MA31750 processor. With further development, this HESSE promises to provide embedded system developers with software tools which can reduce the risks associated with developing complex hard real-time software. Supported in this way by more sophisticated software methods and tools, it is foreseen that MA31750 based embedded systems can meet the processing needs for the next generation of on-board data management systems.

Dynamic adaptive learning for decision-making supporting systems

NASA Astrophysics Data System (ADS)

He, Haibo; Cao, Yuan; Chen, Sheng; Desai, Sachi; Hohil, Myron E.

2008-03-01

This paper proposes a novel adaptive learning method for data mining in support of decision-making systems. Due to the inherent characteristics of information ambiguity/uncertainty, high dimensionality and noisy in many homeland security and defense applications, such as surveillances, monitoring, net-centric battlefield, and others, it is critical to develop autonomous learning methods to efficiently learn useful information from raw data to help the decision making process. The proposed method is based on a dynamic learning principle in the feature spaces. Generally speaking, conventional approaches of learning from high dimensional data sets include various feature extraction (principal component analysis, wavelet transform, and others) and feature selection (embedded approach, wrapper approach, filter approach, and others) methods. However, very limited understandings of adaptive learning from different feature spaces have been achieved. We propose an integrative approach that takes advantages of feature selection and hypothesis ensemble techniques to achieve our goal. Based on the training data distributions, a feature score function is used to provide a measurement of the importance of different features for learning purpose. Then multiple hypotheses are iteratively developed in different feature spaces according to their learning capabilities. Unlike the pre-set iteration steps in many of the existing ensemble learning approaches, such as adaptive boosting (AdaBoost) method, the iterative learning process will automatically stop when the intelligent system can not provide a better understanding than a random guess in that particular subset of feature spaces. Finally, a voting algorithm is used to combine all the decisions from different hypotheses to provide the final prediction results. Simulation analyses of the proposed method on classification of different US military aircraft databases show the effectiveness of this method.

From Forecasters to the General Public: A Communication Tool to Understand Decision-making Challenges in Weather-related Early Warning Systems

NASA Astrophysics Data System (ADS)

Terti, G.; Ruin, I.; Kalas, M.; Lorini, V.; Sabbatini, T.; i Alonso, A. C.

2017-12-01

New technologies are currently adopted worldwide to improve weather forecasts and communication of the corresponding warnings to the end-users. "EnhANcing emergency management and response to extreme WeatHER and climate Events" (ANYWHERE) project is an innovating action that aims at developing and implementing a European decision-support platform for weather-related risks integrating cutting-edge forecasting technology. The initiative is built in a collaborative manner where researchers, developers, potential users and other stakeholders meet frequently to define needs, capabilities and challenges. In this study, we propose a role-playing game to test the added value of the ANYWHERE platform on i) the decision-making process and the choice of warning levels under uncertainty, ii) the management of the official emergency response and iii) the crisis communication and triggering of protective actions at different levels of the warning system (from hazard detection to citizen response). The designed game serves as an interactive communication tool. Here, flood and flash flood focused simulations seek to enhance participant's understanding of the complexities and challenges embedded in various levels of the decision-making process under the threat of weather disasters (e.g., forecasting/warnings, official emergency actions, self-protection). Also, we facilitate collaboration and coordination between the participants who belong to different national or local agencies/authorities across Europe. The game is first applied and tested in ANYWHERE's workshop in Helsinki (September, 2017) where about 30-50 people, including researchers, forecasters, civil protection and representatives of related companies, are anticipated to play the simulation. The main idea is to provide to the players a virtual case study that well represents realistic uncertainties and dilemmas embedded in the real-time forecasting-warning processes. At the final debriefing step the participants are encouraged to exchange knowledge, thoughts and insights on their capability or difficulty to decide and communicate their action based on the available information and given constrains. Such feedback will be analyzed and presented and future potentialities for the application of the game will be discussed.

Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review

PubMed Central

2009-01-01

Background Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services. Methods A systematic literature search (1990 to December 2008) of the English literature indexed in the Medline database, Embase, the Cochrane Central Register of Controlled Trials, and CRD (DARE, HTA and NHS EED databases) was conducted to identify evaluation studies of electronic multi-step guideline implementation systems in ambulatory care settings. Important inclusion criterions were the multidimensionality of the guideline (the guideline needed to consist of several aspects or steps) and real-time interaction with the system during consultation. Clinical decision support systems such as one-time reminders for preventive care for which positive findings were shown in earlier reviews were excluded. Two comparisons were considered: electronic multidimensional guidelines versus usual care (comparison one) and electronic multidimensional guidelines versus other guideline implementation methods (comparison two). Results Twenty-seven publications were selected for analysis in this systematic review. Most designs were cluster randomized controlled trials investigating process outcomes more than patient outcomes. With success defined as at least 50% of the outcome variables being significant, none of the studies were successful in improving patient outcomes. Only seven of seventeen studies that investigated process outcomes showed improvements in process of care variables compared with the usual care group (comparison one). No incremental effect of the electronic implementation over the distribution of paper versions of the guideline was found, neither for the patient outcomes nor for the process outcomes (comparison two). Conclusions There is little evidence at the moment for the effectiveness of an increasingly used and commercialised instrument such as electronic multidimensional guidelines. After more than a decade of development of numerous electronic systems, research on the most effective implementation strategy for this kind of guideline-based decision support systems is still lacking. This conclusion implies a considerable risk towards inappropriate investments in ineffective implementation interventions and in suboptimal care. PMID:20042070

Supporting dynamic change detection: using the right tool for the task.

PubMed

Vallières, Benoît R; Hodgetts, Helen M; Vachon, François; Tremblay, Sébastien

2016-01-01

Detecting task-relevant changes in a visual scene is necessary for successfully monitoring and managing dynamic command and control situations. Change blindness-the failure to notice visual changes-is an important source of human error. Change History EXplicit (CHEX) is a tool developed to aid change detection and maintain situation awareness; and in the current study we test the generality of its ability to facilitate the detection of changes when this subtask is embedded within a broader dynamic decision-making task. A multitasking air-warfare simulation required participants to perform radar-based subtasks, for which change detection was a necessary aspect of the higher-order goal of protecting one's own ship. In this task, however, CHEX rendered the operator even more vulnerable to attentional failures in change detection and increased perceived workload. Such support was only effective when participants performed a change detection task without concurrent subtasks. Results are interpreted in terms of the NSEEV model of attention behavior (Steelman, McCarley, & Wickens, Hum. Factors 53:142-153, 2011; J. Exp. Psychol. Appl. 19:403-419, 2013), and suggest that decision aids for use in multitasking contexts must be designed to fit within the available workload capacity of the user so that they may truly augment cognition.

Health informatics 3.0.

PubMed

Kalra, Dipak

2011-01-01

Web 3.0 promises us smart computer services that will interact with each other and leverage knowledge about us and our immediate context to deliver prioritised and relevant information to support decisions and actions. Healthcare must take advantage of such new knowledge-integrating services, in particular to support better co-operation between professionals of different disciplines working in different locations, and to enable well-informed co-operation between clinicians and patients. To grasp the potential of Web 3.0 we will need well-harmonised semantic resources that can richly connect virtual teams and link their strategies to real-time and tailored evidence. Facts, decision logic, care pathway steps, alerts, education need to be embedded within components that can interact with multiple EHR systems and services consistently. Using Health Informatics 3.0 a patient's current situation could be compared with the outcomes of very similar patients (from across millions) to deliver personalised care recommendations. The integration of EHRs with biomedical sciences ('omics) research results and predictive models such as the Virtual Physiological Human could help speed up the translation of new knowledge into clinical practice. The mission, and challenge, for Health Informatics 3.0 is to enable healthy citizens, patients and professionals to collaborate within a knowledge-empowered social network in which patient specific information and personalised real-time evidence are seamlessly interwoven.

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

PubMed

Elwyn, Glyn; Rasmussen, Julie; Kinsey, Katharine; Firth, Jill; Marrin, Katy; Edwards, Adrian; Wood, Fiona

2018-02-01

Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. © 2016 John Wiley & Sons, Ltd.

Dynamics of career choice among students in undergraduate medical courses. A BEME systematic review: BEME Guide No. 33.

PubMed

Querido, Sophie J; Vergouw, David; Wigersma, Lode; Batenburg, Ronald S; De Rond, Marlies E J; Ten Cate, Olle T J

2016-01-01

Due to the lack of a theoretically embedded overview of the recent literature on medical career decision-making, this study provides an outline of these dynamics. Since differences in educational routes to the medical degree likely affect career choice dynamics, this study focuses on medical career decision-making in educational systems with a Western European curriculum structure. A systematic search of electronic databases (Medline, Embase) was conducted from January 2008 to November 2014. A panel of seven independent reviewers performed the data extraction, quality assessment and data synthesis using the Bland-Meurer model of medical specialty choice as a reference. Fifty-seven studies met the inclusion criteria for the review. Factors associated with specialty preference or career choice can be classified in five main categories: (1) medical school characteristics (e.g., curriculum structure), (2) student characteristics (e.g., age, personality), (3) student values (e.g., personal preference), (4) career needs to be satisfied (e.g., expected income, status, and work-life balance), and (5) perception of specialty characteristics (e.g., extracurricular or curricular experiences). Especially career needs and perceptions of specialty characteristics are often associated with medical career decision-making. Our results support that medical career decisions are formed by a matching of perceptions of specialty characteristics with personal needs. However, the process of medical career decision-making is not yet fully understood. Besides identifying possible predictors, future research should focus on detecting interrelations between hypothesized predictors and identify the determinants and interrelations at the various stages of the medical career decision-making process.

The Quality of the Embedding Potential Is Decisive for Minimal Quantum Region Size in Embedding Calculations: The Case of the Green Fluorescent Protein.

PubMed

Nåbo, Lina J; Olsen, Jógvan Magnus Haugaard; Martínez, Todd J; Kongsted, Jacob

2017-12-12

The calculation of spectral properties for photoactive proteins is challenging because of the large cost of electronic structure calculations on large systems. Mixed quantum mechanical (QM) and molecular mechanical (MM) methods are typically employed to make such calculations computationally tractable. This study addresses the connection between the minimal QM region size and the method used to model the MM region in the calculation of absorption properties-here exemplified for calculations on the green fluorescent protein. We find that polarizable embedding is necessary for a qualitatively correct description of the MM region, and that this enables the use of much smaller QM regions compared to fixed charge electrostatic embedding. Furthermore, absorption intensities converge very slowly with system size and inclusion of effective external field effects in the MM region through polarizabilities is therefore very important. Thus, this embedding scheme enables accurate prediction of intensities for systems that are too large to be treated fully quantum mechanically.

FingerScanner: Embedding a Fingerprint Scanner in a Raspberry Pi.

PubMed

Sapes, Jordi; Solsona, Francesc

2016-02-06

Nowadays, researchers are paying increasing attention to embedding systems. Cost reduction has lead to an increase in the number of platforms supporting the operating system Linux, jointly with the Raspberry Pi motherboard. Thus, embedding devices on Raspberry-Linux systems is a goal in order to make competitive commercial products. This paper presents a low-cost fingerprint recognition system embedded into a Raspberry Pi with Linux.

Physiological implications of pair-bond status in greylag geese.

PubMed

Wascher, Claudia A F; Weiß, Brigitte M; Arnold, Walter; Kotrschal, Kurt

2012-06-23

In group-living vertebrates, reliable social allies play a decisive role in dealing with stressors. For example, support by social allies is known to dampen glucocorticoid responses. It remains unknown, however, how social embedding affects the sympatho-adrenergic axis as indicated by heart rate (HR) in non-human animals. We studied the relationships between HR, pair-bond status and distance from the pair-partner in twenty-five free-ranging greylag geese (Anser anser) in a natural social environment. In three individuals, we investigated HR responses following partner loss. Overall, we found a context- and sex-dependent difference in HR between paired and unpaired individuals, paired males having a lower HR during agonistic encounters, and unpaired females having a lower HR during resting. Also, in paired females HR increased with increasing distance from the partner. Our data suggest that HR is modulated by pair-bond status in greylag geese in a context- and sex-dependent manner, which may be representative for social vertebrates in general. Despite the low sample size, the present study indicates that proper social embedding may optimize an individual's physiological investment in the social domain. This reduces individual energy expenditure and may benefit health and reproductive success.

Distributed digital signal processors for multi-body flexible structures

NASA Technical Reports Server (NTRS)

Lee, Gordon K. F.

1992-01-01

Multi-body flexible structures, such as those currently under investigation in spacecraft design, are large scale (high-order) dimensional systems. Controlling and filtering such structures is a computationally complex problem. This is particularly important when many sensors and actuators are located along the structure and need to be processed in real time. This report summarizes research activity focused on solving the signal processing (that is, information processing) issues of multi-body structures. A distributed architecture is developed in which single loop processors are employed for local filtering and control. By implementing such a philosophy with an embedded controller configuration, a supervising controller may be used to process global data and make global decisions as the local devices are processing local information. A hardware testbed, a position controller system for a servo motor, is employed to illustrate the capabilities of the embedded controller structure. Several filtering and control structures which can be modeled as rational functions can be implemented on the system developed in this research effort. Thus the results of the study provide a support tool for many Control/Structure Interaction (CSI) NASA testbeds such as the Evolutionary model and the nine-bay truss structure.

Using Curriculum-Embedded Assessment for Making Educational Decisions: An Empirical Study with Implications for Including Students with Disabilities in Accountability.

ERIC Educational Resources Information Center

Swisher, Judith D.; Green, Samuel B.; Tollefson, Nona

The focus of this research was to examine the perceived effectiveness of the Practical Assessment Exploration System (PAES) (J. Swisher, 1987) for making educational decisions at the instructional program level for students with disabilities across groups of teachers who have various levels of familiarity with the PAES. The PAES is a functional…

Balancing Materiel Readiness Risks and Concurrency in Weapon System Acquisition: A Handbook for Program Managers

DTIC Science & Technology

1984-07-15

ftViCCii UWNC COMMAND MIX CM AFT DCP OUTUNC moo ffEOUCST FOR PROGRAM DECISION DRAFT DCP AFSC REVIEW RECOWMEM CATIONS OHI*OC Arse wioc...CS.P3 F16. El*. P» MCA Exhibit 4-6b. EMBEDDED COMPUTER HARDWARE vs. SOFTWARE Exhibit 4-6c. DoD EMBEDDED COMPUTER MARKET 31.J1...the mix of stores carried by that vehicle 6. Anticipated combat tactics employed by the carrying or launching vehicle and its maneuvering

The Use and Effects of Embedded Support Devices in Independent Learning.

ERIC Educational Resources Information Center

Martens, Rob

This book examines embedded support in course material. The focus is on self-study and associated concepts such as independent learning, distance education, and open education, and the general context is adult and higher education. The seven chapters cover: (1) general introductory material, including a description of the future, distance…

Gender sensitive education in watershed management to support environmental friendly city

NASA Astrophysics Data System (ADS)

Asteria, D.; Budidarmono; Herdiansyah, H.; Ni’mah, N. L.

2018-03-01

This study is about gender-sensitive perspective in watershed management education program as one of capacity building for citizens in watershed management with community-based strategy to support environmental friendly cities and security for women from flood disasters. Involving women and increasing women’s active participation in sustainable watershed management is essential in urban area. In global warming and climate change situations, city management should be integrated between social aspect and environmental planning. This study used mix method (concurrent embedded type, with quantitative as primary method) with research type is descriptive-explanatory. The result of this study is education strategies with gender approaches and affirmative action through emancipation approach and local knowledge from women’s experiences can increase women’s participation. Women’s empowerment efforts need integrated intervention and collaboration from government, NGO, and other stakeholders to optimize women’s role in watershed management for support environmental friendly city. The implication of this study is an educational strategy on watershed conservation with gender perspective to offer social engineering alternatives for decision makers to policy of sustainable watershed management in urban area related to flood mitigation efforts.

Men and talk about legal abortion in South Africa: equality, support and rights discourses undermining reproductive 'choice'.

PubMed

Macleod, Catriona Ida; Hansjee, Jateen

2013-01-01

Discursive constructions of abortion are embedded in the social and gendered power relations of a particular socio-historical space. As part of research on public discourses concerning abortion in South Africa where there has been a radical liberalisation of abortion legislation, we collected data from male group discussions about a vignette concerning abortion, and newspaper articles written by men about abortion. Our analysis revealed how discourses of equality, support and rights may be used by men to subtly undermine women's reproductive right to 'choose' an abortion. Within an Equal Partnership discourse, abortion, paired with the assumption of foetal personhood, was equated with violating an equal heterosexual partnership and a man's patriarchal duty to protect a child. A New Man discourse, which positions men as supportive of women, was paired with the assumption of men as rational and women as irrational in decision-making, to allow for the possibility of men dissuading women from terminating a pregnancy. A Rights discourse was invoked to suggest that abortion violates men's paternal rights.

FingerScanner: Embedding a Fingerprint Scanner in a Raspberry Pi

PubMed Central

Sapes, Jordi; Solsona, Francesc

2016-01-01

Nowadays, researchers are paying increasing attention to embedding systems. Cost reduction has lead to an increase in the number of platforms supporting the operating system Linux, jointly with the Raspberry Pi motherboard. Thus, embedding devices on Raspberry-Linux systems is a goal in order to make competitive commercial products. This paper presents a low-cost fingerprint recognition system embedded into a Raspberry Pi with Linux. PMID:26861340

Internet embeddedness: links with online health information seeking, expectancy value/quality of health information websites, and Internet usage patterns.

PubMed

Leung, Louis

2008-10-01

To see how the Internet is actually embedded in our lives, this exploratory study examines how Internet users search the Web for important information, especially health or medical information, to make critical decisions, and the perception of how intimately our lives are embedded in the Internet intersects with patterns of health information seeking online and the expected quality of health information websites. Data from a probability sample of 569 Internet users found four types of commonly sought health information clusters online which included information on (a) health improvement, (b) medical treatment, (c) family health, and (d) health issues that are difficult to talk about. Results also show that behavior or behavioral intentions in health information seeking are in fact either a function of value expectancy or the evaluation of health information websites. More importantly, people who often go to the Internet for health information and have high expectations of the value and quality of health information websites (especially in terms of reliability, relevance/context, and interaction) tend to be those who are more likely to perceive the Internet as playing an important role in life decisions or rate the Internet as more embedded in their lives.

How can sensitivity analysis improve the robustness of mathematical models utilized by the re/insurance industry?

NASA Astrophysics Data System (ADS)

Noacco, V.; Wagener, T.; Pianosi, F.; Philp, T.

2017-12-01

Insurance companies provide insurance against a wide range of threats, such as natural catastrophes, nuclear incidents and terrorism. To quantify risk and support investment decisions, mathematical models are used, for example to set the premiums charged to clients that protect from financial loss, should deleterious events occur. While these models are essential tools for adequately assessing the risk attached to an insurer's portfolio, their development is costly and their value for decision-making may be limited by an incomplete understanding of uncertainty and sensitivity. Aside from the business need to understand risk and uncertainty, the insurance sector also faces regulation which requires them to test their models in such a way that uncertainties are appropriately captured and that plans are in place to assess the risks and their mitigation. The building and testing of models constitutes a high cost for insurance companies, and it is a time intensive activity. This study uses an established global sensitivity analysis toolbox (SAFE) to more efficiently capture the uncertainties and sensitivities embedded in models used by a leading re/insurance firm, with structured approaches to validate these models and test the impact of assumptions on the model predictions. It is hoped that this in turn will lead to better-informed and more robust business decisions.

Indigenous knowledge management to enhance community resilience to tsunami risk: lessons learned from Smong traditions in Simeulue island, Indonesia

NASA Astrophysics Data System (ADS)

Rahman, A.; Sakurai, A.; Munadi, K.

2017-02-01

Knowledge accumulation and production embedded in communities through social interactions meant that the Smong tradition of indigenous knowledge of tsunami risk successfully alerted people to the 2004 tsunami, on the island of Simeulue, in Aceh, Indonesia. Based on this practical example, an indigenous management model was developed for Smong information. This knowledge management method involves the transformation of indigenous knowledge into applicable ways to increase community resilience, including making appropriate decisions and taking action in three disaster phases. First, in the pre-disaster stage, the community needs to be willing to mainstream and integrate indigenous knowledge of disaster risk reduction issues into related activities. Second, during disasters, the Smong tradition should make the community able to think clearly, act based on informed decisions, and protect themselves and others by using their indigenous knowledge. Last, in the post-disaster phase, the community needs to be strong enough to face challenges and support each other and “building back better” efforts, using local resources. The findings for the Smong tradition provide valuable knowledge about community resilience. Primary community resilience to disasters is strongly related to existing knowledge that triggers appropriate decisions and actions during pre-disaster, disaster, and post-disaster phases.

Testing Video and Social Media for Engaging Users of the U.S. Climate Resilience Toolkit

NASA Astrophysics Data System (ADS)

Green, C. J.; Gardiner, N.; Niepold, F., III; Esposito, C.

2015-12-01

We developed a custom video production stye and a method for analyzing social media behavior so that we may deliberately build and track audience growth for decision-support tools and case studies within the U.S. Climate Resilience Toolkit. The new style of video focuses quickly on decision processes; its 30s format is well-suited for deployment through social media. We measured both traffic and engagement with video using Google Analytics. Each video included an embedded tag, allowing us to measure viewers' behavior: whether or not they entered the toolkit website; the duration of their session on the website; and the number pages they visited in that session. Results showed that video promotion was more effective on Facebook than Twitter. Facebook links generated twice the number of visits to the toolkit. Videos also increased Facebook interaction overall. Because most Facebook users are return visitors, this campaign did not substantially draw new site visitors. We continue to research and apply these methods in a targeted engagement and outreach campaign that utilizes the theory of social diffusion and social influence strategies to grow our audience of "influential" decision-makers and people within their social networks. Our goal is to increase access and use of the U.S. Climate Resilience Toolkit.

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

PubMed Central

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

2009-01-01

Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data. Discussion The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical. PMID:19210787

Shared decision-making.

PubMed

Godolphin, William

2009-01-01

Shared decision-making has been called the crux of patient-centred care and identified as a key part of change for improved quality and safety in healthcare. However, it rarely happens, is hard to do and is not taught - for many reasons. Talking with patients about options is not embedded in the attitudes or communication skills training of most healthcare professionals. Information tools such as patient decision aids, personal health records and the Internet will help to shift this state, as will policy that drives patient and public involvement in healthcare delivery and training.

Fast decision algorithms in low-power embedded processors for quality-of-service based connectivity of mobile sensors in heterogeneous wireless sensor networks.

PubMed

Jaraíz-Simón, María D; Gómez-Pulido, Juan A; Vega-Rodríguez, Miguel A; Sánchez-Pérez, Juan M

2012-01-01

When a mobile wireless sensor is moving along heterogeneous wireless sensor networks, it can be under the coverage of more than one network many times. In these situations, the Vertical Handoff process can happen, where the mobile sensor decides to change its connection from a network to the best network among the available ones according to their quality of service characteristics. A fitness function is used for the handoff decision, being desirable to minimize it. This is an optimization problem which consists of the adjustment of a set of weights for the quality of service. Solving this problem efficiently is relevant to heterogeneous wireless sensor networks in many advanced applications. Numerous works can be found in the literature dealing with the vertical handoff decision, although they all suffer from the same shortfall: a non-comparable efficiency. Therefore, the aim of this work is twofold: first, to develop a fast decision algorithm that explores the entire space of possible combinations of weights, searching that one that minimizes the fitness function; and second, to design and implement a system on chip architecture based on reconfigurable hardware and embedded processors to achieve several goals necessary for competitive mobile terminals: good performance, low power consumption, low economic cost, and small area integration.

The Embedded Librarian Online or Face-to-Face: American University's Experiences

ERIC Educational Resources Information Center

Matos, Michael A.; Matsuoka-Motley, Nobue; Mayer, William

2010-01-01

This article examines the role online communication and tools play in embedded librarianship at American University. Two embedded models of user engagement, traditional and hybrid, are discussed. The librarians operating in each mode share their experiences providing tailored support to the departments of music/performing arts and business. The…

Assessing the value of post-processed state-of-the-art long-term weather forecast ensembles for agricultural water management mediated by farmers' behaviours

NASA Astrophysics Data System (ADS)

Li, Yu; Giuliani, Matteo; Castelletti, Andrea

2016-04-01

Recent advances in modelling of coupled ocean-atmosphere dynamics significantly improved skills of long-term climate forecast from global circulation models (GCMs). These more accurate weather predictions are supposed to be a valuable support to farmers in optimizing farming operations (e.g. crop choice, cropping and watering time) and for more effectively coping with the adverse impacts of climate variability. Yet, assessing how actually valuable this information can be to a farmer is not straightforward and farmers' response must be taken into consideration. Indeed, in the context of agricultural systems potentially useful forecast information should alter stakeholders' expectation, modify their decisions, and ultimately produce an impact on their performance. Nevertheless, long-term forecast are mostly evaluated in terms of accuracy (i.e., forecast quality) by comparing hindcast and observed values and only few studies investigated the operational value of forecast looking at the gain of utility within the decision-making context, e.g. by considering the derivative of forecast information, such as simulated crop yields or simulated soil moisture, which are essential to farmers' decision-making process. In this study, we contribute a step further in the assessment of the operational value of long-term weather forecasts products by embedding these latter into farmers' behavioral models. This allows a more critical assessment of the forecast value mediated by the end-users' perspective, including farmers' risk attitudes and behavioral patterns. Specifically, we evaluate the operational value of thirteen state-of-the-art long-range forecast products against climatology forecast and empirical prediction (i.e. past year climate and historical average) within an integrated agronomic modeling framework embedding an implicit model of the farmers' decision-making process. Raw ensemble datasets are bias-corrected and downscaled using a stochastic weather generator, in order to address the mismatch of the spatio-temporal scale between forecast data from GCMs and our model. For each product, the experiment is composed by two cascade simulations: 1) an ex-ante simulation using forecast data, and 2) an ex-post simulation with observations. Multi-year simulations are performed to account for climate variability, and the operational value of the different forecast products is evaluated against the perfect foresight on the basis of expected crop productivity as well as the final decisions under different decision-making criterions. Our results show that not all products generate beneficial effects to farmers' performance, and the forecast errors might be amplified due to farmers' decision-making process and risk attitudes, yielding little or even worse performance compared with the empirical approaches.

eLearning techniques supporting problem based learning in clinical simulation.

PubMed

Docherty, Charles; Hoy, Derek; Topp, Helena; Trinder, Kathryn

2005-08-01

This paper details the results of the first phase of a project using eLearning to support students' learning within a simulated environment. The locus was a purpose built clinical simulation laboratory (CSL) where the School's philosophy of problem based learning (PBL) was challenged through lecturers using traditional teaching methods. a student-centred, problem based approach to the acquisition of clinical skills that used high quality learning objects embedded within web pages, substituting for lecturers providing instruction and demonstration. This encouraged student nurses to explore, analyse and make decisions within the safety of a clinical simulation. Learning was facilitated through network communications and reflection on video performances of self and others. Evaluations were positive, students demonstrating increased satisfaction with PBL, improved performance in exams, and increased self-efficacy in the performance of nursing activities. These results indicate that eLearning techniques can help students acquire clinical skills in the safety of a simulated environment within the context of a problem based learning curriculum.

How can GPs drive software changes to improve healthcare for Aboriginal and Torres Strait Islanders peoples?

PubMed

Kehoe, Helen

2017-01-01

Changes to the software used in general practice could improve the collection of the Aboriginal and Torres Strait Islander status of all patients, and boost access to healthcare measures specifically for Aboriginal and Torres Strait Islander peoples provided directly or indirectly by general practitioners (GPs). Despite longstanding calls for improvements to general practice software to better support Aboriginal and Torres Strait Islander health, little change has been made. The aim of this article is to promote software improvements by identifying desirable software attributes and encouraging GPs to promote their adoption. Establishing strong links between collecting Aboriginal and Torres Strait Islander status, clinical decision supports, and uptake of GP-mediated health measures specifically for Aboriginal and Torres Strait Islander peoples - and embedding these links in GP software - is a long overdue reform. In the absence of government initiatives in this area, GPs are best placed to advocate for software changes, using the model described here as a starting point for action.

Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology

PubMed Central

Foran, David J; Chen, Wenjin; Chu, Huiqi; Sadimin, Evita; Loh, Doreen; Riedlinger, Gregory; Goodell, Lauri A; Ganesan, Shridar; Hirshfield, Kim; Rodriguez, Lorna; DiPaola, Robert S

2017-01-01

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes. PMID:28469389

Embedding a Palliative Approach in Nursing Care Delivery

PubMed Central

Porterfield, Pat; Roberts, Della; Lee, Joyce; Liang, Leah; Reimer-Kirkham, Sheryl; Pesut, Barb; Schalkwyk, Tilly; Stajduhar, Kelli; Tayler, Carolyn; Baumbusch, Jennifer; Thorne, Sally

2017-01-01

A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration. PMID:27930401

Gendered negotiations for research participation in community-based studies: implications for health research policy and practice

PubMed Central

Kamuya, Dorcas M; Molyneux, Catherine, S; Theobald, Sally

2017-01-01

There is a growing literature documenting the complex realities of consent processes in the field, and the negotiations and ethical dilemmas involved. Much has also been written about how gender and power shape household decision-making processes. However, these bodies of literature have rarely been brought together to inform research theory and practice in low-income settings. In this paper, qualitative research (observation, focus group discussions and interviews) were used alongside large clinical community-based studies conducted on the Kenyan Coast to explore how gender and power relations within households and communities and between fieldworkers and communities shape consent processes and interactions. This exploration is embedded in relevant literature and the implications for community-based health research policy and practice are considered. Across diverse forms of households, we observed significant consultation on whether or not to participate in research. Although men are typically described as household decision-makers, in practice, decision-making processes are often far more nuanced, with many women using their agency to control, sometimes subtly, the decisions made. Where decisions are made without adequately consulting women, many find strategies to exercise their choice, in ways that safeguard important relationships within households in the longer term. We also found that the gender of field staff who typically conduct research activities in the field, including consent processes, can influence household dynamics and decision-making processes with important implications for the science and ethics of research. It is essential that frontline field staff and their supervisors are aware of the complex and gendered realities of consent processes at household level, and their implications, and that they develop appropriate context-informed approaches that support ethical practice. PMID:29225935

Investigating the effect of freeway congestion thresholds on decision-making inputs.

DOT National Transportation Integrated Search

2010-05-01

Congestion threshold is embedded in the congestion definition. Two basic approaches exist in : current practice for setting the congestion threshold. One common approach uses the free-flow or : unimpeded conditions as the congestion threshold. ...

Job-Embedded Professional Development: How School Leaders Create and Support the Structures for Improved Teacher Effectiveness

ERIC Educational Resources Information Center

Hussey, Maureen P.

2013-01-01

This study was an exploration of the steps school leaders take when creating site-based professional support for school-based staff. The objective was to learn the steps taken by school leaders to implement job-embedded professional development practices and to identify the impact those steps had on the teachers, the students, and the school…

Course-Embedded Mentoring for First-Year Students: Melding Academic Subject Support with Role Modeling, Psycho-Social Support, and Goal Setting

ERIC Educational Resources Information Center

Henry, Jim; Bruland, Holly Huff; Sano-Franchini, Jennifer

2011-01-01

This article examines a mentoring initiative that embedded advanced students in first-year composition courses to mentor students to excel to the best of their abilities. Mentors attended all classes along with students and conducted many out-of-class individual conferences, documenting each of them using programimplemented work logs. Four hundred…

Geometric subspace methods and time-delay embedding for EEG artifact removal and classification.

PubMed

Anderson, Charles W; Knight, James N; O'Connor, Tim; Kirby, Michael J; Sokolov, Artem

2006-06-01

Generalized singular-value decomposition is used to separate multichannel electroencephalogram (EEG) into components found by optimizing a signal-to-noise quotient. These components are used to filter out artifacts. Short-time principal components analysis of time-delay embedded EEG is used to represent windowed EEG data to classify EEG according to which mental task is being performed. Examples are presented of the filtering of various artifacts and results are shown of classification of EEG from five mental tasks using committees of decision trees.

Dynamic simulation modelling of policy responses to reduce alcohol-related harms: rationale and procedure for a participatory approach.

PubMed

Atkinson, Jo-An; O'Donnell, Eloise; Wiggers, John; McDonnell, Geoff; Mitchell, Jo; Freebairn, Louise; Indig, Devon; Rychetnik, Lucie

2017-02-15

Development of effective policy responses to address complex public health problems can be challenged by a lack of clarity about the interaction of risk factors driving the problem, differing views of stakeholders on the most appropriate and effective intervention approaches, a lack of evidence to support commonly implemented and acceptable intervention approaches, and a lack of acceptance of effective interventions. Consequently, political considerations, community advocacy and industry lobbying can contribute to a hotly contested debate about the most appropriate course of action; this can hinder consensus and give rise to policy resistance. The problem of alcohol misuse and its associated harms in New South Wales (NSW), Australia, provides a relevant example of such challenges. Dynamic simulation modelling is increasingly being valued by the health sector as a robust tool to support decision making to address complex problems. It allows policy makers to ask 'what-if' questions and test the potential impacts of different policy scenarios over time, before solutions are implemented in the real world. Participatory approaches to modelling enable researchers, policy makers, program planners, practitioners and consumer representatives to collaborate with expert modellers to ensure that models are transparent, incorporate diverse evidence and perspectives, are better aligned to the decision-support needs of policy makers, and can facilitate consensus building for action. This paper outlines a procedure for embedding stakeholder engagement and consensus building in the development of dynamic simulation models that can guide the development of effective, coordinated and acceptable policy responses to complex public health problems, such as alcohol-related harms in NSW.

Supporting Students' Learning and Socioscientific Reasoning About Climate Change—the Effect of Computer-Based Concept Mapping Scaffolds

NASA Astrophysics Data System (ADS)

Eggert, Sabina; Nitsch, Anne; Boone, William J.; Nückles, Matthias; Bögeholz, Susanne

2017-02-01

Climate change is one of the most challenging problems facing today's global society (e.g., IPCC 2013). While climate change is a widely covered topic in the media, and abundant information is made available through the internet, the causes and consequences of climate change in its full complexity are difficult for individuals, especially non-scientists, to grasp. Science education is a field which can play a crucial role in fostering meaningful education of students to become climate literate citizens (e.g., NOAA 2009; Schreiner et al., 41, 3-50, 2005). If students are, at some point, to participate in societal discussions about the sustainable development of our planet, their learning with respect to such issues needs to be supported. This includes the ability to think critically, to cope with complex scientific evidence, which is often subject to ongoing inquiry, and to reach informed decisions on the basis of factual information as well as values-based considerations. The study presented in this paper focused on efforts to advance students in (1) their conceptual understanding about climate change and (2) their socioscientific reasoning and decision making regarding socioscientific issues in general. Although there is evidence that "knowledge" does not guarantee pro-environmental behavior (e.g. Schreiner et al., 41, 3-50, 2005; Skamp et al., 97(2), 191-217, 2013), conceptual, interdisciplinary understanding of climate change is an important prerequisite to change individuals' attitudes towards climate change and thus to eventually foster climate literate citizens (e.g., Clark et al. 2013). In order to foster conceptual understanding and socioscientific reasoning, a computer-based learning environment with an embedded concept mapping tool was utilized to support senior high school students' learning about climate change and possible solution strategies. The evaluation of the effect of different concept mapping scaffolds focused on the quality of student-generated concept maps, as well as on students' test performance with respect to conceptual knowledge as well as socioscientific reasoning and socioscientific decision making.

Making pharmacogenomic-based prescribing alerts more effective: A scenario-based pilot study with physicians.

PubMed

Overby, Casey Lynnette; Devine, Emily Beth; Abernethy, Neil; McCune, Jeannine S; Tarczy-Hornoch, Peter

2015-06-01

To facilitate personalized drug dosing (PDD), this pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. We employed a conceptual framework and measurement model to access the impact of physician characteristics (previous experience, awareness, relative advantage, perceived usefulness), technology characteristics (methods of implementation-semi-active/active, actionability-low/high) and a task characteristic (drug prescribed) on communication effectiveness (usefulness, confidence in prescribing decision), and clinical impact (uptake, prescribing intent, change in drug dosing). Physicians performed prescribing tasks using five simulated clinical case scenarios, presented in random order within the prototype PGx-CDS system. Twenty-two physicians completed the study. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83% at the start and 94% at the conclusion of our study. Physicians used semi-active alerts 74-88% of the time. There was no association between previous experience with, awareness of, and belief in a relative advantage of using PGx-CDS and improved uptake. The proportion of physicians reporting confidence in their prescribing decisions decreased significantly after using the prototype PGx-CDS system (p=0.02). Despite decreases in confidence, physicians perceived a relative advantage to using PGx-CDS, viewed semi-active alerts on most occasions, and more frequently changed doses toward doses supported by published evidence. Specifically, sixty-five percent of physicians reduced their dosing, significantly for capecitabine (p=0.002) and mercaptopurine/thioguanine (p=0.03). These findings suggest a need to improve our prototype such that PGx CDS content is more useful and delivered in a way that improves physician's confidence in their prescribing decisions. The greatest increases in communication effectiveness and clinical impact of PGx-CDS are likely to be realized through continued focus on content, content delivery, and tailoring to physician characteristics. Copyright © 2015 Elsevier Inc. All rights reserved.

Added Value of Selected Images Embedded Into Radiology Reports to Referring Clinicians

PubMed Central

Iyer, Veena R.; Hahn, Peter F.; Blaszkowsky, Lawrence S.; Thayer, Sarah P.; Halpern, Elkan F.; Harisinghani, Mukesh G.

2011-01-01

Purpose The aim of this study was to evaluate the added utility of embedding images for findings described in radiology text reports to referring clinicians. Methods Thirty-five cases referred for abdominal CT scans in 2007 and 2008 were included. Referring physicians were asked to view text-only reports, followed by the same reports with pertinent images embedded. For each pair of reports, a questionnaire was administered. A 5-point, Likert-type scale was used to assess if the clinical query was satisfactorily answered by the text-only report. A “yes-or-no” question was used to assess whether the report with images answered the clinical query better; a positive answer to this question generated “yes-or-no” queries to examine whether the report with images helped in making a more confident decision on management, whether it reduced time spent in forming the plan, and whether it altered management. The questionnaire asked whether a radiologist would be contacted with queries on reading the text-only report and the report with images. Results In 32 of 35 cases, the text-only reports satisfactorily answered the clinical queries. In these 32 cases, the reports with attached images helped in making more confident management decisions and reduced time in planning management. Attached images altered management in 2 cases. Radiologists would have been consulted for clarifications in 21 and 10 cases on reading the text-only reports and the reports with embedded images, respectively. Conclusions Providing relevant images with reports saves time, increases physicians' confidence in deciding treatment plans, and can alter management. PMID:20193926

Semantic Metadata for Heterogeneous Spatial Planning Documents

NASA Astrophysics Data System (ADS)

Iwaniak, A.; Kaczmarek, I.; Łukowicz, J.; Strzelecki, M.; Coetzee, S.; Paluszyński, W.

2016-09-01

Spatial planning documents contain information about the principles and rights of land use in different zones of a local authority. They are the basis for administrative decision making in support of sustainable development. In Poland these documents are published on the Web according to a prescribed non-extendable XML schema, designed for optimum presentation to humans in HTML web pages. There is no document standard, and limited functionality exists for adding references to external resources. The text in these documents is discoverable and searchable by general-purpose web search engines, but the semantics of the content cannot be discovered or queried. The spatial information in these documents is geographically referenced but not machine-readable. Major manual efforts are required to integrate such heterogeneous spatial planning documents from various local authorities for analysis, scenario planning and decision support. This article presents results of an implementation using machine-readable semantic metadata to identify relationships among regulations in the text, spatial objects in the drawings and links to external resources. A spatial planning ontology was used to annotate different sections of spatial planning documents with semantic metadata in the Resource Description Framework in Attributes (RDFa). The semantic interpretation of the content, links between document elements and links to external resources were embedded in XHTML pages. An example and use case from the spatial planning domain in Poland is presented to evaluate its efficiency and applicability. The solution enables the automated integration of spatial planning documents from multiple local authorities to assist decision makers with understanding and interpreting spatial planning information. The approach is equally applicable to legal documents from other countries and domains, such as cultural heritage and environmental management.

Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study.

PubMed

Hazemba, Alice N; Ncama, Busisiwe P; Sithole, Sello L

2016-01-01

Exclusive breastfeeding has the potential to reduce infant and under-five mortality, but research shows the practice is not widespread in resource-poor settings of sub-Saharan Africa. We explored factors influencing the decision to exclusively breastfeed among HIV-positive mothers accessing interventions for prevention of mother-to-child transmission of HIV in selected sites of Zambia. This exploratory qualitative study was embedded in research conducted on: HIV and infant feeding; choices and decision-outcomes in the context of prevention of mother-to-child transmission among HIV-positive mothers in Zambia. Thirty HIV-positive mothers and six key informants were recruited from two health facilities providing mother-to-child HIV transmission prevention services. A semi-structured guide was used to conduct interviews, which were digitally recorded and simultaneously transcribed. Data coding and analysis was done with the support of QRS Nvivo 10 version software. Despite the known benefits of exclusive breastfeeding, gaps in understanding and potential for behaviour change remained. We found that information promoting exclusive breastfeeding may have been understood by mothers as instructions from the health care workers indicating how to feed their HIV-exposed babies rather than as an option for the mothers' own informed-decision. This understanding influenced a mother's perceptions of breast milk safety while on antiretroviral medicine, of the formula feeding option, and of the baby crying after breastfeeding. The meanings mothers attached to exclusive breastfeeding thus influenced their understanding of breast milk insufficiency, abrupt weaning and mixed feeding in the context of preventing mother-to-child transmission of HIV. In order to enhance feeding practices for HIV-exposed infants, our study suggests a broader health campaign supporting all mothers to exclusively breastfeed.

Comparison as a Universal Learning Action

ERIC Educational Resources Information Center

Merkulova, T. V.

2016-01-01

This article explores "comparison" as a universal metasubject learning action, a key curricular element envisaged by the Russian Federal State Educational Standards. Representing the modern learner's fundamental pragmatic skill embedding such core capacities as information processing, critical thinking, robust decision-making, and…

Embedded academic writing support for nursing students with English as a second language.

PubMed

Salamonson, Yenna; Koch, Jane; Weaver, Roslyn; Everett, Bronwyn; Jackson, Debra

2010-02-01

This paper reports a study which evaluated a brief, embedded academic support workshop as a strategy for improving academic writing skills in first-year nursing students with low-to-medium English language proficiency. Nursing students who speak English as a second language have lower academic success compared with their native English-speaking counterparts. The development of academic writing skills is known to be most effective when embedded into discipline-specific curricula. Using a randomized controlled design, in 2008 106 students pre-enrolled in an introductory bioscience subject were randomized to receive either the intervention, a 4-day embedded academic learning support workshop facilitated by two bioscience (content) nursing academics and a writing and editing professional, or to act as the control group. The primary focus of the workshop was to support students to work through a mock assignment by providing progressive feedback and written suggestions on how to improve their answers. Of the 59 students randomized to the intervention, only 28 attended the workshop. Bioscience assignment results were analysed for those who attended (attendees), those randomized to the intervention but who did not attend (non-attendees), and the control group. Using anova, the results indicated that attendees achieved statistically significantly higher mean scores (70.8, sd: 6.1) compared to both control group (58.4, sd: 3.4, P = 0.002) and non-attendees (48.5, sd: 5.5, P = 0.001). A brief, intensive, embedded academic support workshop was effective in improving the academic writing ability of nursing students with low-to-medium English language proficiency, although reaching all students who are likely to benefit from this intervention remains a challenge.

Practicing governance towards equity in health systems: LMIC perspectives and experience.

PubMed

Gilson, Lucy; Lehmann, Uta; Schneider, Helen

2017-09-15

The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity.The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in this series is thus to provide an empirical and embedded research perspective on governance and equity in health systems.

Static Schedulers for Embedded Real-Time Systems

DTIC Science & Technology

1989-12-01

Because of the need for having efficient scheduling algorithms in large scale real time systems , software engineers put a lot of effort on developing...provide static schedulers for he Embedded Real Time Systems with single processor using Ada programming language. The independent nonpreemptable...support the Computer Aided Rapid Prototyping for Embedded Real Time Systems so that we determine whether the system, as designed, meets the required

Fish Passage in Large Culverts with Low Flows

DOT National Transportation Integrated Search

2014-08-01

A series of physical and numerical modeling runs were completed to support the development of a design procedure for characterizing the variation in velocity within non-embedded and embedded culverts. Physical modeling of symmetrical half-section cir...

Social Influences in Sequential Decision Making

PubMed Central

Schöbel, Markus; Rieskamp, Jörg; Huber, Rafael

2016-01-01

People often make decisions in a social environment. The present work examines social influence on people’s decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others’ authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions. PMID:26784448

Social Influences in Sequential Decision Making.

PubMed

Schöbel, Markus; Rieskamp, Jörg; Huber, Rafael

2016-01-01

People often make decisions in a social environment. The present work examines social influence on people's decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others' authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions.

The Practical Guide to Classroom Literacy Assessment

ERIC Educational Resources Information Center

Barone, Diane M.; Taylor, Joan M.

2006-01-01

Whether it is standardized test data, student journals, or informal classroom question and answer, assessments provide invaluable, ongoing diagnostic information for making key instructional decisions. In this engaging and comprehensive resource, the authors demonstrate practical ways for embedding test preparation into teaching by integrating…

Developing a multimodal biometric authentication system using soft computing methods.

PubMed

Malcangi, Mario

2015-01-01

Robust personal authentication is becoming ever more important in computer-based applications. Among a variety of methods, biometric offers several advantages, mainly in embedded system applications. Hard and soft multi-biometric, combined with hard and soft computing methods, can be applied to improve the personal authentication process and to generalize the applicability. This chapter describes the embedded implementation of a multi-biometric (voiceprint and fingerprint) multimodal identification system based on hard computing methods (DSP) for feature extraction and matching, an artificial neural network (ANN) for soft feature pattern matching, and a fuzzy logic engine (FLE) for data fusion and decision.

Deontic reasoning with emotional content: evolutionary psychology or decision theory?

PubMed

Perham, Nick; Oaksford, Mike

2005-09-10

Three experiments investigated the contrasting predictions of the evolutionary and decision-theoretic approaches to deontic reasoning. Two experiments embedded a hazard management (HM) rule in a social contract scenario that should lead to competition between innate modules. A 3rd experiment used a pure HM task. Threatening material was also introduced into the antecedent, p, of a deontic rule, if p then must q. According to the evolutionary approach, more HM responses (Cosmides & Tooby, 2000) are predicted when p is threatening, whereas decision theory predicts fewer. All 3 experiments were consistent with decision theory. Other theories are discussed, and it is concluded that they cannot account for the behavior observed in these experiments. 2005 Lawrence Erlbaum Associates, Inc.

Self-Similar Subsets of Symmetric Cantor Sets

NASA Astrophysics Data System (ADS)

Zeng, Ying

This paper concerns the affine embeddings of general symmetric Cantor sets. Under certain condition, we show that if a self-similar set F can be affinely embedded into a symmetric Cantor set E, then their contractions are rationally commensurable. Our result supports Conjecture 1.2 in [D. J. Feng, W. Huang and H. Rao, Affine embeddings and intersections of Cantor sets, J. Math. Pures Appl. 102 (2014) 1062-1079].

Wireless structural monitoring for homeland security applications

NASA Astrophysics Data System (ADS)

Kiremidjian, Garo K.; Kiremidjian, Anne S.; Lynch, Jerome P.

2004-07-01

This paper addresses the development of a robust, low-cost, low power, and high performance autonomous wireless monitoring system for civil assets such as large facilities, new construction, bridges, dams, commercial buildings, etc. The role of the system is to identify the onset, development, location and severity of structural vulnerability and damage. The proposed system represents an enabling infrastructure for addressing structural vulnerabilities specifically associated with homeland security. The system concept is based on dense networks of "intelligent" wireless sensing units. The fundamental properties of a wireless sensing unit include: (a) interfaces to multiple sensors for measuring structural and environmental data (such as acceleration, displacements, pressure, strain, material degradation, temperature, gas agents, biological agents, humidity, corrosion, etc.); (b) processing of sensor data with embedded algorithms for assessing damage and environmental conditions; (c) peer-to-peer wireless communications for information exchange among units(thus enabling joint "intelligent" processing coordination) and storage of data and processed information in servers for information fusion; (d) ultra low power operation; (e) cost-effectiveness and compact size through the use of low-cost small-size off-the-shelf components. An integral component of the overall system concept is a decision support environment for interpretation and dissemination of information to various decision makers.

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

PubMed

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

2008-11-01

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

Informed use of patients' records on trusted health care services.

PubMed

Sahama, Tony; Miller, Evonne

2011-01-01

Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF.

Prompting students to make socioscientific decisions: embedding metacognitive guidance in an e-learning environment

NASA Astrophysics Data System (ADS)

Hsu, Ying-Shao; Lin, Shu-Sheng

2017-05-01

This study aimed at improving the decision-making (DM) skills of 11th graders by incorporating a DM framework, visualisation tools, collaboration, and metacognitive guidance into a socioscientific issue context. Two classes, the experimental group (embedded metacognitive guidance, N = 42) and the comparison group (no metacognitive guidance, N = 32), were involved in the implementation of the experimental methodology. An open-ended test and worksheets were developed to assess the students' DM skills. The results indicated that the two versions of the DM learning modules had similar effects on the improvement in the students' DM skills, but there were significant differences in their overall skills in DM (Z = -6.410, p < .001), generating criteria (Z = -6.956, p < .001), and evaluating DM results (Z = -2.533, p < .011) based on the student responses on the worksheets. These findings indicate that further studies need to explore the mechanism of metacognitive guidance for students with different socioscientific issue DM skills in e-learning environments.

A dynamic modelling framework towards the solution of reduction in smoking prevalence

NASA Astrophysics Data System (ADS)

Halim, Tisya Farida Abdul; Sapiri, Hasimah; Abidin, Norhaslinda Zainal

2016-10-01

This paper presents a hypothetical framework towards the solution for reduction in smoking prevalence in Malaysia. The framework is design to assist in decision making process related to reduction in smoking prevalence using SD and OCT. In general, this framework is developed using SD approach where OCT is embedded in the policy evaluation process. Smoking prevalence is one of the determinant which plays an important role in measuring a successful implementation of anti-smoking strategies. Therefore, it is critical to determine the optimal value of smoking prevalence in order to trim down the hazardous effects of smoking to society. Conversely, smoking problem becomes increasingly complex since many issues that ranged from behavioral to economical need to be considered simultaneously. Thus, a hypothetical framework of the control model embedded in the SD methodology is expected to obtain the minimum value of smoking prevalence which the output in turn will provide a guideline for tobacco researchers as well as decision makers for policy design and evaluation.

Developing decision-relevant data and information systems for California water through listening and collaboration

NASA Astrophysics Data System (ADS)

Bales, R. C.; Bernacchi, L.; Conklin, M. H.; Viers, J. H.; Fogg, G. E.; Fisher, A. T.; Kiparsky, M.

2017-12-01

California's historic drought of 2011-2015 provided excellent conditions for researchers to listen to water-management challenges from decision makers, particularly with regard to data and information needs for improved decision making. Through the UC Water Security and Sustainability Research Initiative (http://ucwater.org/) we began a multi-year dialog with water-resources decision makers and state agencies that provide data and technical support for water management. Near-term products of that collaboration will be both a vision for a 21st-century water data and information system, and near-term steps to meet immediate legislative deadlines in a way that is consistent with the longer-term vision. While many university-based water researchers engage with state and local agencies on both science and policy challenges, UC Water's focus was on: i) integrated system management, from headwaters through groundwater and agriculture, and on ii) improved decision making through better water information systems. This focus aligned with the recognition by water leaders that fundamental changes in the way the state manages water were overdue. UC Water is focused on three "I"s: improved water information, empowering Institutions to use and to create new information, and enabling decision makers to make smart investments in both green and grey Infrastructure. Effective communication with water decision makers has led to engagement on high-priority programs where large knowledge gaps remain, including more-widespread groundwater recharge of storm flows, restoration of mountain forests in important source-water areas, governance structures for groundwater sustainability, and filling information gaps by bringing new technology to bear on measurement and data programs. Continuing engagement of UC Water researchers in public dialog around water resources, through opinion pieces, feature articles, blogs, white papers, social media, video clips and a feature documentary film have also been key to our continuing engagement. These novel partnerships are leading to decision-relevant tools and an improved integrated praxis in on-the-ground water-resources management. Our research is becoming more embedded in policies and our network remains interconnected with decision makers at multiple levels.

Knowledge discovery in cardiology: A systematic literature review.

PubMed

Kadi, I; Idri, A; Fernandez-Aleman, J L

2017-01-01

Data mining (DM) provides the methodology and technology needed to transform huge amounts of data into useful information for decision making. It is a powerful process employed to extract knowledge and discover new patterns embedded in large data sets. Data mining has been increasingly used in medicine, particularly in cardiology. In fact, DM applications can greatly benefit all those involved in cardiology, such as patients, cardiologists and nurses. The purpose of this paper is to review papers concerning the application of DM techniques in cardiology so as to summarize and analyze evidence regarding: (1) the DM techniques most frequently used in cardiology; (2) the performance of DM models in cardiology; (3) comparisons of the performance of different DM models in cardiology. We performed a systematic literature review of empirical studies on the application of DM techniques in cardiology published in the period between 1 January 2000 and 31 December 2015. A total of 149 articles published between 2000 and 2015 were selected, studied and analyzed according to the following criteria: DM techniques and performance of the approaches developed. The results obtained showed that a significant number of the studies selected used classification and prediction techniques when developing DM models. Neural networks, decision trees and support vector machines were identified as being the techniques most frequently employed when developing DM models in cardiology. Moreover, neural networks and support vector machines achieved the highest accuracy rates and were proved to be more efficient than other techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A discussion for integrating INSPIRE with volunteered geographic information (VGI) and the vision for a global spatial-based platform

NASA Astrophysics Data System (ADS)

Demetriou, Demetris; Campagna, Michele; Racetin, Ivana; Konecny, Milan

2017-09-01

INSPIRE is the EU's authoritative Spatial Data Infrastructure (SDI) in which each Member State provides access to their spatial data across a wide spectrum of data themes to support policy making. In contrast, Volunteered Geographic Information (VGI) is one type of user-generated geographic information where volunteers use the web and mobile devices to create, assemble and disseminate spatial information. There are similarities and differences between SDIs and VGI initiatives, as well as advantages and disadvantages. Thus, the integration of these two data sources will enhance what is offered to end users to facilitate decision makers and the wider community regarding solving complex spatial problems, managing emergency situations and getting useful information for peoples' daily activities. Although some efforts towards this direction have been arisen, several key issues need to be considered and resolved. Further to this integration, the vision is the development of a global integrated GIS platform, which extends the capabilities of a typical data-hub by embedding on-line spatial and non-spatial applications, to deliver both static and dynamic outputs to support planning and decision making. In this context, this paper discusses the challenges of integrating INSPIRE with VGI and outlines a generic framework towards creating a global integrated web-based GIS platform. The tremendous high speed evolution of the Web and Geospatial technologies suggest that this "super" global Geo-system is not far away.

An ontology-driven, diagnostic modeling system.

PubMed

Haug, Peter J; Ferraro, Jeffrey P; Holmen, John; Wu, Xinzi; Mynam, Kumar; Ebert, Matthew; Dean, Nathan; Jones, Jason

2013-06-01

To present a system that uses knowledge stored in a medical ontology to automate the development of diagnostic decision support systems. To illustrate its function through an example focused on the development of a tool for diagnosing pneumonia. We developed a system that automates the creation of diagnostic decision-support applications. It relies on a medical ontology to direct the acquisition of clinic data from a clinical data warehouse and uses an automated analytic system to apply a sequence of machine learning algorithms that create applications for diagnostic screening. We refer to this system as the ontology-driven diagnostic modeling system (ODMS). We tested this system using samples of patient data collected in Salt Lake City emergency rooms and stored in Intermountain Healthcare's enterprise data warehouse. The system was used in the preliminary development steps of a tool to identify patients with pneumonia in the emergency department. This tool was compared with a manually created diagnostic tool derived from a curated dataset. The manually created tool is currently in clinical use. The automatically created tool had an area under the receiver operating characteristic curve of 0.920 (95% CI 0.916 to 0.924), compared with 0.944 (95% CI 0.942 to 0.947) for the manually created tool. Initial testing of the ODMS demonstrates promising accuracy for the highly automated results and illustrates the route to model improvement. The use of medical knowledge, embedded in ontologies, to direct the initial development of diagnostic computing systems appears feasible.

Scientific Literacy and Student Attitudes: Perspectives from PISA 2006 science

NASA Astrophysics Data System (ADS)

Bybee, Rodger; McCrae, Barry

2011-01-01

International assessments provide important knowledge about science education and help inform decisions about policies, programmes, and practices in participating countries. In 2006, science was the primary domain for the Programme for International Student Assessment (PISA), supported by the Organisation for Economic Cooperation and Development (OECD) and conducted by the Australian Council for Educational Research (ACER). Compared to the school curriculum orientation of Trends in International Math and Science Study (TIMSS), PISA provides a perspective that emphasises the application of knowledge to science and technology-related life situations. The orientation of PISA includes both knowledge and attitudes as these contribute to students' competencies that are central to scientific literacy. In addition to students' knowledge and competencies, the 2006 PISA survey gathered data on students' interest in science, support for scientific enquiry, and responsibility towards resources and environments. The survey used both a non-contextualised student questionnaire and contextualised questions. The latter is an innovative approach which embedded attitudinal questions at the conclusion of about two-thirds of the test units. The results presented in this article make connections between students' attitudes and interests in science and scientific literacy.

Transplant Image Processing Technology under Windows into the Platform Based on MiniGUI

NASA Astrophysics Data System (ADS)

Gan, Lan; Zhang, Xu; Lv, Wenya; Yu, Jia

MFC has a large number of digital image processing-related API functions, object-oriented and class mechanisms which provides image processing technology strong support in Windows. But in embedded systems, image processing technology dues to the restrictions of hardware and software do not have the environment of MFC in Windows. Therefore, this paper draws on the experience of image processing technology of Windows and transplants it into MiniGUI embedded systems. The results show that MiniGUI/Embedded graphical user interface applications about image processing which used in embedded image processing system can be good results.

Implementing Curriculum-Embedded Formative Assessment in Primary School Science Classrooms

ERIC Educational Resources Information Center

Hondrich, Annika Lena; Hertel, Silke; Adl-Amini, Katja; Klieme, Eckhard

2016-01-01

The implementation of formative assessment strategies is challenging for teachers. We evaluated teachers' implementation fidelity of a curriculum-embedded formative assessment programme for primary school science education, investigating both material-supported, direct application and subsequent transfer. Furthermore, the relationship between…

Review of incursive, hyperincursive and anticipatory systems-foundation of anticipation in electromagnetism

NASA Astrophysics Data System (ADS)

Dubois, Daniel M.

2000-05-01

The main purpose of this paper is to show that anticipation is not only a property of biosystems but is also a fundamental property of physical systems. In electromagnetism, the anticipation is related to the Lorentz transform. In this framework the anticipation is a strong anticipation because it is not based on a prediction from a model of the physical system but is embedded in the fundamental system. So, Robert Rosen's anticipatory systems deal with weak anticipation. Contrary to Robert Rosen's affirmation, anticipation is thus not a characteristic of living systems. Finality is implicitly embedded in any system and thus the final cause of Aristotle is implicitly embedded in any physical and biological systems, contrary to what Robert Rosen argued. This paper will review some incursive and hyperincursive systems giving rise to strong anticipation. Space-time incursive parabolic systems show non-local properties. Hyperincursive crisp systems are related to catastrophe theory. Finally it will be shown that incursive and hyperincursive anticipatory systems could model properties of biosystems like free will, game strategy, theorem creation, etc. Anticipation is not only related to predictions but to decisions: hyperincursive systems create multiple choices and a decision process selects one choice. So, anticipation is not a final goal, like in cybernetics and system science, but is a fundamental property of physical and biological systems.

Planar Embedding of Planar Graphs,

DTIC Science & Technology

1983-02-01

Stanford University and supported by a Chaim Wcismann postdoctoral fellowship and DARPA contract MDAOO3-C-0102. Current address: Institute of ...rectilinear embeddings (both with and without cross - overs), using the bounding box area cost. He proved that a tree of vertices with maximum degree 4 can...be laid out without crossovers in an area that is linear in the number of edges (or vertices). He also showed how Ato get a such an embedding for any

Support for a Link between the Local Processing Bias and Social Deficits in Autism: An Investigation of Embedded Figures Test Performance in Non-Clinical Individuals

ERIC Educational Resources Information Center

Russell-Smith, Suzanna N.; Maybery, Murray T.; Bayliss, Donna M.; Sng, Adelln A. H.

2012-01-01

The aim of this investigation was to explore the degree to which specific subsets of autistic-like traits relate to performance on the Embedded Figures Test (Witkin et al. in A manual for the embedded figures test. Consulting Psychologists Press, Palo Alto, CA, 1971). In the first group-based investigation with this focus, students were selected…

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

PubMed

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

2007-01-01

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

The embedded operating system project

NASA Technical Reports Server (NTRS)

Campbell, R. H.

1984-01-01

This progress report describes research towards the design and construction of embedded operating systems for real-time advanced aerospace applications. The applications concerned require reliable operating system support that must accommodate networks of computers. The report addresses the problems of constructing such operating systems, the communications media, reconfiguration, consistency and recovery in a distributed system, and the issues of realtime processing. A discussion is included on suitable theoretical foundations for the use of atomic actions to support fault tolerance and data consistency in real-time object-based systems. In particular, this report addresses: atomic actions, fault tolerance, operating system structure, program development, reliability and availability, and networking issues. This document reports the status of various experiments designed and conducted to investigate embedded operating system design issues.

Miniature high speed compressor having embedded permanent magnet motor

NASA Technical Reports Server (NTRS)

Zhou, Lei (Inventor); Zheng, Liping (Inventor); Chow, Louis (Inventor); Kapat, Jayanta S. (Inventor); Wu, Thomas X. (Inventor); Kota, Krishna M. (Inventor); Li, Xiaoyi (Inventor); Acharya, Dipjyoti (Inventor)

2011-01-01

A high speed centrifugal compressor for compressing fluids includes a permanent magnet synchronous motor (PMSM) having a hollow shaft, the being supported on its ends by ball bearing supports. A permanent magnet core is embedded inside the shaft. A stator with a winding is located radially outward of the shaft. The PMSM includes a rotor including at least one impeller secured to the shaft or integrated with the shaft as a single piece. The rotor is a high rigidity rotor providing a bending mode speed of at least 100,000 RPM which advantageously permits implementation of relatively low-cost ball bearing supports.

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

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

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

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

Cardiac catheterization laboratory inpatient forecast tool: a prospective evaluation

PubMed Central

Flanagan, Eleni; Siddiqui, Sauleh; Appelbaum, Jeff; Kasper, Edward K; Levin, Scott

2016-01-01

Objective To develop and prospectively evaluate a web-based tool that forecasts the daily bed need for admissions from the cardiac catheterization laboratory using routinely available clinical data within electronic medical records (EMRs). Methods The forecast model was derived using a 13-month retrospective cohort of 6384 catheterization patients. Predictor variables such as demographics, scheduled procedures, and clinical indicators mined from free-text notes were input to a multivariable logistic regression model that predicted the probability of inpatient admission. The model was embedded into a web-based application connected to the local EMR system and used to support bed management decisions. After implementation, the tool was prospectively evaluated for accuracy on a 13-month test cohort of 7029 catheterization patients. Results The forecast model predicted admission with an area under the receiver operating characteristic curve of 0.722. Daily aggregate forecasts were accurate to within one bed for 70.3% of days and within three beds for 97.5% of days during the prospective evaluation period. The web-based application housing the forecast model was used by cardiology providers in practice to estimate daily admissions from the catheterization laboratory. Discussion The forecast model identified older age, male gender, invasive procedures, coronary artery bypass grafts, and a history of congestive heart failure as qualities indicating a patient was at increased risk for admission. Diagnostic procedures and less acute clinical indicators decreased patients’ risk of admission. Despite the site-specific limitations of the model, these findings were supported by the literature. Conclusion Data-driven predictive analytics may be used to accurately forecast daily demand for inpatient beds for cardiac catheterization patients. Connecting these analytics to EMR data sources has the potential to provide advanced operational decision support. PMID:26342217

A Lunar Surface System Supportability Technology Development Roadmap

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Struk, Peter M.; Taleghani, Barmac K.

2009-01-01

This paper discusses the establishment of a Supportability Technology Development Roadmap as a guide for developing capabilities intended to allow NASA's Constellation program to enable a supportable, sustainable and affordable exploration of the Moon and Mars. Presented is a discussion of "supportability", in terms of space facility maintenance, repair and related logistics and a comparison of how lunar outpost supportability differs from the International Space Station. Supportability lessons learned from NASA and Department of Defense experience and their impact on a future lunar outpost is discussed. A supportability concept for future missions to the Moon and Mars that involves a transition from a highly logistics dependent to a logistically independent operation is discussed. Lunar outpost supportability capability needs are summarized and a supportability technology development strategy is established. The resulting Lunar Surface Systems Supportability Strategy defines general criteria that will be used to select technologies that will enable future flight crews to act effectively to respond to problems and exploit opportunities in a environment of extreme resource scarcity and isolation. This strategy also introduces the concept of exploiting flight hardware as a supportability resource. The technology roadmap involves development of three mutually supporting technology categories, Diagnostics Test & Verification, Maintenance & Repair, and Scavenging & Recycling. The technology roadmap establishes two distinct technology types, "Embedded" and "Process" technologies, with different implementation and thus different criteria and development approaches. The supportability technology roadmap addresses the technology readiness level, and estimated development schedule for technology groups that includes down-selection decision gates that correlate with the lunar program milestones. The resulting supportability technology roadmap is intended to develop a set of technologies with widest possible capability and utility with a minimum impact on crew time and training and remain within the time and cost constraints of the Constellation program

A Lunar Surface System Supportability Technology Development Roadmap

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Struk, Peter M.; Taleghani, barmac K.

2011-01-01

This paper discusses the establishment of a Supportability Technology Development Roadmap as a guide for developing capabilities intended to allow NASA s Constellation program to enable a supportable, sustainable and affordable exploration of the Moon and Mars. Presented is a discussion of supportability, in terms of space facility maintenance, repair and related logistics and a comparison of how lunar outpost supportability differs from the International Space Station. Supportability lessons learned from NASA and Department of Defense experience and their impact on a future lunar outpost is discussed. A supportability concept for future missions to the Moon and Mars that involves a transition from a highly logistics dependent to a logistically independent operation is discussed. Lunar outpost supportability capability needs are summarized and a supportability technology development strategy is established. The resulting Lunar Surface Systems Supportability Strategy defines general criteria that will be used to select technologies that will enable future flight crews to act effectively to respond to problems and exploit opportunities in an environment of extreme resource scarcity and isolation. This strategy also introduces the concept of exploiting flight hardware as a supportability resource. The technology roadmap involves development of three mutually supporting technology categories, Diagnostics Test and Verification, Maintenance and Repair, and Scavenging and Recycling. The technology roadmap establishes two distinct technology types, "Embedded" and "Process" technologies, with different implementation and thus different criteria and development approaches. The supportability technology roadmap addresses the technology readiness level, and estimated development schedule for technology groups that includes down-selection decision gates that correlate with the lunar program milestones. The resulting supportability technology roadmap is intended to develop a set of technologies with widest possible capability and utility with a minimum impact on crew time and training and remain within the time and cost constraints of the Constellation program.

Embedding research to improve program implementation in Latin America and the Caribbean.

PubMed

Tran, Nhan; Langlois, Etienne V; Reveiz, Ludovic; Varallyay, Ilona; Elias, Vanessa; Mancuso, Arielle; Becerra-Posada, Francisco; Ghaffar, Abdul

2017-06-08

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

Decision Support | Solar Research | NREL

Science.gov Websites

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

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

PubMed

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-04-01

To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

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

PubMed

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

2014-01-01

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

The new millennium program: Fast-track procurements

NASA Astrophysics Data System (ADS)

Metzger, Robert M.

1996-11-01

The National Aeronautics and Space Administration's (NASA's) New Millennium Program (NMP) has embarked on a technology flight-validation demonstration program to enable the kinds of missions that NASA envisions for the 21st century. Embedded in this program is the concept of rapid mission development supported by a fast-track procurement process. This process begins with the decision to initiate a procurement very early in the program along with the formation of a technical acquisition team. A close working relationship among the team members is essential to avoiding delays and developing a clear acquisition plan. The request for proposal (RFP) that is subsequently issued seeks a company with proven capabilities, so that the time allotted for responses from proposers and the length of proposals they submit can be shortened. The fast-track procurement process has been demonstrated during selection of NMP's industrial partners and has been proven to work.

Public financing of IVF: a review of policy rationales.

PubMed

Mladovsky, Philipa; Sorenson, Corinna

2010-06-01

There is great diversity in in vitro fertilization (IVF) funding and reimbursement policies and practice throughout Europe and the rest of the world. While many existing reimbursement and regulatory frameworks address safety and legal concerns, economic factors also assume a central role. However, there are several problems with the evidence that is available on the economics of IVF. This suggests there is a need for more robust cost-effectiveness studies. It also indicates the need for alternative rationales to justify the reimbursement of IVF, which might more fully account for the social, political, ethical, and philosophical considerations embedded in notions of infertility and technology-driven reproductive treatments. The merits and limitations of five alternative rationales are discussed. The review suggests that while no existing single rationale provides a complete framework with which to support funding decisions, taken together they provide guideposts which signal important issues for consideration and highlight where further research, action, and debate are needed.

The Ongoing and Open-Ended Simulation

ERIC Educational Resources Information Center

Cohen, Alexander

2016-01-01

This case study explores a novel form of classroom simulation that differs from published examples in two important respects. First, it is ongoing. While most simulations represent a single learning episode embedded within a course, the ongoing simulation is a continuous set of interrelated events and decisions that accompany learning throughout…

Assumptions about Ecological Scale and Nature Knowing Best Hiding in Environmental Decisions

Treesearch

R. Bruce Hull; David P. Robertson; David Richert; Erin Seekamp; Gregory J. Buhyoff

2002-01-01

Assumptions about nature are embedded in people's preferences for environmental policy and management. The people we interviewed justified preservationist policies using four assumptions about nature knowing best: nature is balanced, evolution is progressive, technology is suspect, and the Creation is perfect. They justified interventionist policies using three...

Leadership in Multiplayer Online Gaming Environments

ERIC Educational Resources Information Center

Lisk, Timothy C.; Kaplancali, Ugur T.; Riggio, Ronald E.

2012-01-01

With their increased popularity, games open up possibilities for simultaneous learning on multiple levels; players may learn from contextual information embedded in the narrative of the game and through the risks, benefits, costs, outcomes, and rewards of the alternative strategies that result from fast-paced decision making. Such dynamics also…

Wireless and embedded carbon nanotube networks for damage detection in concrete structures

NASA Astrophysics Data System (ADS)

Saafi, Mohamed

2009-09-01

Concrete structures undergo an uncontrollable damage process manifesting in the form of cracks due to the coupling of fatigue loading and environmental effects. In order to achieve long-term durability and performance, continuous health monitoring systems are needed to make critical decisions regarding operation, maintenance and repairs. Recent advances in nanostructured materials such as carbon nanotubes have opened the door for new smart and advanced sensing materials that could effectively be used in health monitoring of structures where wireless and real time sensing could provide information on damage development. In this paper, carbon nanotube networks were embedded into a cement matrix to develop an in situ wireless and embedded sensor for damage detection in concrete structures. By wirelessly measuring the change in the electrical resistance of the carbon nanotube networks, the progress of damage can be detected and monitored. As a proof of concept, wireless cement-carbon nanotube sensors were embedded into concrete beams and subjected to monotonic and cyclic loading to evaluate the effect of damage on their response. Experimental results showed that the wireless response of the embedded nanotube sensors changes due to the formation of cracks during loading. In addition, the nanotube sensors were able to detect the initiation of damage at an early stage of loading.

Support from the Morphological Family When Unembedding the Stem

ERIC Educational Resources Information Center

Beyersmann, Elisabeth; Grainger, Jonathan

2018-01-01

Recent research investigating embedded stem priming effects with the masked priming paradigm and pseudoword primes (e.g., "quickify"--"quick") has shown that priming effects can be obtained even when the embedded target word is followed by a non-morphological ending (e.g., "quickald"--"quick"). Here we…

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

PubMed

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

2009-04-01

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

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

PubMed Central

Perez-Brena, Norma; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.

2013-01-01

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully understand how family processes are embedded within culture. The goals of this study were to describe mothers’ and fathers’ decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including parent-unilateral, joint, and youth-unilateral decision-making, and to examine the socio-cultural and family characteristics associated with these different types of decision-making in 246 Mexican-origin families. Mothers reported more joint and youth-unilateral decision-making and less parent-unilateral decision-making than did fathers. Fathers reported more youth-unilateral decision-making with sons than with daughters. Further, for mothers, more traditional gender role attitudes and higher levels of mother-adolescent conflict were associated with more parent-unilateral and less joint decision-making. In contrast, for fathers, lower levels of respect values were associated with more youth-unilateral decision-making with sons, and higher levels of parent-adolescent warmth was associated with more youth-unilateral decision-making with daughters. The importance of understanding the different correlates of mothers’ and fathers’ decision-making with sons versus daughters is discussed. PMID:21484288

Reliability Analysis and Optimal Release Problem Considering Maintenance Time of Software Components for an Embedded OSS Porting Phase

NASA Astrophysics Data System (ADS)

Tamura, Yoshinobu; Yamada, Shigeru

OSS (open source software) systems which serve as key components of critical infrastructures in our social life are still ever-expanding now. Especially, embedded OSS systems have been gaining a lot of attention in the embedded system area, i.e., Android, BusyBox, TRON, etc. However, the poor handling of quality problem and customer support prohibit the progress of embedded OSS. Also, it is difficult for developers to assess the reliability and portability of embedded OSS on a single-board computer. In this paper, we propose a method of software reliability assessment based on flexible hazard rates for the embedded OSS. Also, we analyze actual data of software failure-occurrence time-intervals to show numerical examples of software reliability assessment for the embedded OSS. Moreover, we compare the proposed hazard rate model for the embedded OSS with the typical conventional hazard rate models by using the comparison criteria of goodness-of-fit. Furthermore, we discuss the optimal software release problem for the porting-phase based on the total expected software maintenance cost.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study

PubMed Central

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-01-01

OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058

Expression-invariant representations of faces.

PubMed

Bronstein, Alexander M; Bronstein, Michael M; Kimmel, Ron

2007-01-01

Addressed here is the problem of constructing and analyzing expression-invariant representations of human faces. We demonstrate and justify experimentally a simple geometric model that allows to describe facial expressions as isometric deformations of the facial surface. The main step in the construction of expression-invariant representation of a face involves embedding of the facial intrinsic geometric structure into some low-dimensional space. We study the influence of the embedding space geometry and dimensionality choice on the representation accuracy and argue that compared to its Euclidean counterpart, spherical embedding leads to notably smaller metric distortions. We experimentally support our claim showing that a smaller embedding error leads to better recognition.

An Infrastructure for UML-Based Code Generation Tools

NASA Astrophysics Data System (ADS)

Wehrmeister, Marco A.; Freitas, Edison P.; Pereira, Carlos E.

The use of Model-Driven Engineering (MDE) techniques in the domain of distributed embedded real-time systems are gain importance in order to cope with the increasing design complexity of such systems. This paper discusses an infrastructure created to build GenERTiCA, a flexible tool that supports a MDE approach, which uses aspect-oriented concepts to handle non-functional requirements from embedded and real-time systems domain. GenERTiCA generates source code from UML models, and also performs weaving of aspects, which have been specified within the UML model. Additionally, this paper discusses the Distributed Embedded Real-Time Compact Specification (DERCS), a PIM created to support UML-based code generation tools. Some heuristics to transform UML models into DERCS, which have been implemented in GenERTiCA, are also discussed.

Arbitrary numbers counter fair decisions: trails of markedness in card distribution.

PubMed

Schroeder, Philipp A; Pfister, Roland

2015-01-01

Converging evidence from controlled experiments suggests that the mere processing of a number and its attributes such as value or parity might affect free choice decisions between different actions. For example the spatial numerical associations of response codes (SNARC) effect indicates the magnitude of a digit to be associated with a spatial representation and might therefore affect spatial response choices (i.e., decisions between a "left" and a "right" option). At the same time, other (linguistic) features of a number such as parity are embedded into space and might likewise prime left or right responses through feature words [odd or even, respectively; markedness association of response codes (MARC) effect]. In this experiment we aimed at documenting such influences in a natural setting. We therefore assessed number-space and parity-space association effects by exposing participants to a fair distribution task in a card playing scenario. Participants drew cards, read out loud their number values, and announced their response choice, i.e., dealing it to a left vs. right player, indicated by Playmobil characters. Not only did participants prefer to deal more cards to the right player, the card's digits also affected response choices and led to a slightly but systematically unfair distribution, supported by a regular SNARC effect and counteracted by a reversed MARC effect. The experiment demonstrates the impact of SNARC- and MARC-like biases in free choice behavior through verbal and visual numerical information processing even in a setting with high external validity.

Irrelevant events affect voters' evaluations of government performance.

PubMed

Healy, Andrew J; Malhotra, Neil; Mo, Cecilia Hyunjung

2010-07-20

Does information irrelevant to government performance affect voting behavior? If so, how does this help us understand the mechanisms underlying voters' retrospective assessments of candidates' performance in office? To precisely test for the effects of irrelevant information, we explore the electoral impact of local college football games just before an election, irrelevant events that government has nothing to do with and for which no government response would be expected. We find that a win in the 10 d before Election Day causes the incumbent to receive an additional 1.61 percentage points of the vote in Senate, gubernatorial, and presidential elections, with the effect being larger for teams with stronger fan support. In addition to conducting placebo tests based on postelection games, we demonstrate these effects by using the betting market's estimate of a team's probability of winning the game before it occurs to isolate the surprise component of game outcomes. We corroborate these aggregate-level results with a survey that we conducted during the 2009 NCAA men's college basketball tournament, where we find that surprising wins and losses affect presidential approval. An experiment embedded within the survey also indicates that personal well-being may influence voting decisions on a subconscious level. We find that making people more aware of the reasons for their current state of mind reduces the effect that irrelevant events have on their opinions. These findings underscore the subtle power of irrelevant events in shaping important real-world decisions and suggest ways in which decision making can be improved.

[Health targets for health promotion in an area of conflict between individual freedom, state paternalism and common welfare].

PubMed

Michelsen, K

2010-01-01

In Germany, a growing number of health targets has been adopted in the last years by various actors. While health targets are a useful instrument of governance, the priority setting and a respective redistribution of resources have to be legitimised in the cause of their advantages and disadvantages for population groups. The involved sciences including ethics can support decision-making, but not fully justify decisions. Therefore, decisions on health targets must be made in a transparent and participative process. In spite of a growing number of health targets, the lack of targets in health policies is to be criticised. Within the health targets, those measures assigned to curative medicine and prevention have a greater weight than health promotion. Health promotion should follow the WHO Ottawa-Charter and be embedded in the concept of "capabilities". Under these conditions, a stronger consideration of health promotion in the health target process would be desirable. However, the present actor constellations within health target processes make such a direction improbable. The struggle around capabilities and individual freedom occurs through, in and about institutions of the civil society as well as political and legal institutions. To restrict the discussion about public health and health promotions to an juxtaposition of individual freedom and state paternalism minimises societal and social restrictions of individual freedom as well as the possibility of a safeguard and enlargement of individual freedoms through political and legal institutions.

Irrelevant events affect voters' evaluations of government performance

PubMed Central

Healy, Andrew J.; Malhotra, Neil; Mo, Cecilia Hyunjung

2010-01-01

Does information irrelevant to government performance affect voting behavior? If so, how does this help us understand the mechanisms underlying voters’ retrospective assessments of candidates’ performance in office? To precisely test for the effects of irrelevant information, we explore the electoral impact of local college football games just before an election, irrelevant events that government has nothing to do with and for which no government response would be expected. We find that a win in the 10 d before Election Day causes the incumbent to receive an additional 1.61 percentage points of the vote in Senate, gubernatorial, and presidential elections, with the effect being larger for teams with stronger fan support. In addition to conducting placebo tests based on postelection games, we demonstrate these effects by using the betting market's estimate of a team's probability of winning the game before it occurs to isolate the surprise component of game outcomes. We corroborate these aggregate-level results with a survey that we conducted during the 2009 NCAA men's college basketball tournament, where we find that surprising wins and losses affect presidential approval. An experiment embedded within the survey also indicates that personal well-being may influence voting decisions on a subconscious level. We find that making people more aware of the reasons for their current state of mind reduces the effect that irrelevant events have on their opinions. These findings underscore the subtle power of irrelevant events in shaping important real-world decisions and suggest ways in which decision making can be improved. PMID:20615955

Using Embedded Visual Coding to Support Contextualization of Historical Texts

ERIC Educational Resources Information Center

Baron, Christine

2016-01-01

This mixed-method study examines the think-aloud protocols of 48 randomly assigned undergraduate students to understand what effect embedding a visual coding system, based on reliable visual cues for establishing historical time period, would have on novice history students' ability to contextualize historic documents. Results indicate that using…

Embedding Academic Literacy Skills: Towards a Best Practice Model

ERIC Educational Resources Information Center

McWilliams, Robyn; Allan, Quentin

2014-01-01

Learning advisors provide academic literacy development support in a variety of configurations, ranging from one-on-one consultations through to large-scale lectures. Such lectures can be generic, stand-alone modules or embedded within a discipline-specific course. Pragmatic and institutional considerations suggest that a generic model of delivery…

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

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

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

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

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

Embedding Human Expert Cognition Into Autonomous UAS Trajectory Planning.

PubMed

Narayan, Pritesh; Meyer, Patrick; Campbell, Duncan

2013-04-01

This paper presents a new approach for the inclusion of human expert cognition into autonomous trajectory planning for unmanned aerial systems (UASs) operating in low-altitude environments. During typical UAS operations, multiple objectives may exist; therefore, the use of multicriteria decision aid techniques can potentially allow for convergence to trajectory solutions which better reflect overall mission requirements. In that context, additive multiattribute value theory has been applied to optimize trajectories with respect to multiple objectives. A graphical user interface was developed to allow for knowledge capture from a human decision maker (HDM) through simulated decision scenarios. The expert decision data gathered are converted into value functions and corresponding criteria weightings using utility additive theory. The inclusion of preferences elicited from HDM data within an automated decision system allows for the generation of trajectories which more closely represent the candidate HDM decision preferences. This approach has been demonstrated in this paper through simulation using a fixed-wing UAS operating in low-altitude environments.

The Re-contextualization of the Patient: What Home Health Care Can Teach Us About Medical Decision-Making.

PubMed

Salter, Erica K

2015-06-01

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to "re-contextualize" patients, in order that they might be better equipped to make decisions that harmonize with their real lives.

An enhanced Ada run-time system for real-time embedded processors

NASA Technical Reports Server (NTRS)

Sims, J. T.

1991-01-01

An enhanced Ada run-time system has been developed to support real-time embedded processor applications. The primary focus of this development effort has been on the tasking system and the memory management facilities of the run-time system. The tasking system has been extended to support efficient and precise periodic task execution as required for control applications. Event-driven task execution providing a means of task-asynchronous control and communication among Ada tasks is supported in this system. Inter-task control is even provided among tasks distributed on separate physical processors. The memory management system has been enhanced to provide object allocation and protected access support for memory shared between disjoint processors, each of which is executing a distinct Ada program.

Initial implementation and evaluation of a Hepatitis C treatment clinical decision support system (CDSS)

PubMed Central

Fathauer, L; Meek, J.

2012-01-01

Background Clinician compliance with clinical guidelines in the treatment of patients with Hepatitis C (HCV) has been reported to be as low as 18.5%. Treatment is complex and patient compliance is often inconsistent thus, active clinician surveillance and support is essential to successful outcomes. A clinical decision support system (CDSS) embedded within an electronic health record can provide reminders, summarize key data, and facilitate coordination of care. To date, the literature is bereft of information describing the implementation and evaluation of a CDSS to support HCV treatment. Objective The purpose of this case report is to describe the design, implementation, and initial evaluation of an HCV-specific CDSS while piloting data collection metrics and methods to be used in a larger study across multiple practices. Methods The case report describes the design and implementation processes with preliminary reporting on impact of the CDSS on quality indicator completion by comparing the pre-CDSS group to the post-CDSS group. Results The CDSS was successfully designed and implemented using an iterative, collaborative process. Pilot testing of the clinical outcomes of the CDSS revealed high rates of quality indicator completion in both the pre- and post-CDSS; although the post-CDSS group received a higher frequency of reminders (4.25 per patient) than the pre-CDSS group (.25 per patient). Conclusions This case report documents the processes used to successfully design and implement an HCV CDSS. While the small sample size precludes generalizability of findings, results did positively demonstrate the feasibility of comparing quality indicator completion rates pre-CDSS and post-CDSS. It is recommended that future studies include a larger sample size across multiple providers with expanded outcomes measures related to patient outcomes, staff satisfaction with the CDSS, and time studies to evaluate efficiency and cost effectiveness of the CDSS. PMID:23646082

Beyond shared decision-making: Collaboration in the age of recovery from serious mental illness.

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement , whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Establishing Interpretive Consistency When Mixing Approaches: Role of Sampling Designs in Evaluations

ERIC Educational Resources Information Center

Collins, Kathleen M. T.; Onwuegbuzie, Anthony J.

2013-01-01

The goal of this chapter is to recommend quality criteria to guide evaluators' selections of sampling designs when mixing approaches. First, we contextualize our discussion of quality criteria and sampling designs by discussing the concept of interpretive consistency and how it impacts sampling decisions. Embedded in this discussion are…

Analysis of market penetration of renewable energy alternatives under uncertain and carbon constrained world

EPA Science Inventory

Future energy prices and supply, availability and costs can have a significant impact on how fast and cost effectively we could abate carbon emissions. Two-staged decision making methods embedded in U.S. EPA's MARKAL modeling system will be utilized to find the most robust mitig...

Manipulating Noise Frequencies Alters Hemispheric Contributions to Decision Making

ERIC Educational Resources Information Center

Gallagher, Patrick; Dagenbach, Dale

2007-01-01

Participants listened to the Asian disease problem framed in terms of either gains or losses and chose between two plans to combat the disease. All participants heard the problem embedded in other sounds; for some it was the relatively lower-frequency information, and for others it was the relatively higher-frequency information. The classic…

Embedding Play-Based Learning into Junior Primary (Year 1 and 2) Curriculum in WA

ERIC Educational Resources Information Center

Jay, Jenny A.; Knaus, Marianne

2018-01-01

Governments and their policy decisions inevitably influence the pedagogical practices of teachers. There have been considerable curriculum changes and national reforms in Australia with the implementation of two very different national curricula documents in the early childhood sector in the last decade. The political landscape in Western…

Embedded Managers in Informal Learning Spaces

ERIC Educational Resources Information Center

Raisin, Victoria; Fennewald, Joseph

2016-01-01

Many universities have decided to invest in updating their informal learning spaces. One decision to be made in planning the space is how to staff it. The researchers carried out a qualitative case study to better understand the perspective of learning space managers who work in offices within their assigned space. The research generated six…

Assessing the Decision Process towards Bring Your Own Device

ERIC Educational Resources Information Center

Koester, Richard F.

2017-01-01

Information technology continues to evolve to the point where mobile technologies--such as smart phones, tablets, and ultra-mobile computers have the embedded flexibility and power to be a ubiquitous platform to fulfill the entire user's computing needs. Mobile technology users view these platforms as adaptable enough to be the single solution for…

An ANN That Applies Pragmatic Decision on Texts.

ERIC Educational Resources Information Center

Aretoulaki, Maria; Tsujii, Jun-ichi

A computer-based artificial neural network (ANN) that learns to classify sentences in a text as important or unimportant is described. The program is designed to select the sentences that are important enough to be included in composition of an abstract of the text. The ANN is embedded in a conventional symbolic environment consisting of…

Luddites and the Demographic Transition. NBER Working Paper No. 14484

ERIC Educational Resources Information Center

O'Rourke, Kevin H.; Rahman, Ahmed S.; Taylor, Alan M.

2008-01-01

Technological change was unskilled-labor-biased during the early Industrial Revolution, but is skill-biased today. This is not embedded in extant unified growth models. We develop a model which can endogenously account for these facts, where factor bias reflects profit-maximizing decisions by innovators. Endowments dictate that the early…

Semantic Size and Contextual Congruency Effects during Reading: Evidence from Eye Movements

ERIC Educational Resources Information Center

Wei, Wei; Cook, Anne E.

2016-01-01

Recent lexical decision studies have produced conflicting evidence about whether an object's semantic size influences word recognition. The present study examined this variable in online reading. Target words representing small and large objects were embedded in sentence contexts that were either neutral, congruent, or incongruent with respect to…

A Seat at the Table: How the Work of Teaching Impacts Teachers as Policy Agents

ERIC Educational Resources Information Center

Good, Annalee G.; Fox Barocas, Sadie; Chávez-Moreno, Laura C.; Feldman, Rachel; Canela, Carlos

2017-01-01

Policy reflects and shapes society's beliefs about schools, teachers, children, learning, and society, as well as the power structures embedded in our communities and decision-making processes. Although teachers may be central to the "implementation" of education policy, they are marginal to the "design" of policy agendas and…

Explaining Scientists' Plans for International Mobility from a Life Course Perspective

ERIC Educational Resources Information Center

Netz, Nicolai; Jaksztat, Steffen

2017-01-01

We identify factors influencing young scientists' plans for research stays abroad by embedding theories of social inequality, educational decision making, and migration into a life course framework. We test the developed model of international academic mobility by calculating a structural equation model using data from an online survey of…

On Design and Implementation of Neural-Machine Interface for Artificial Legs

PubMed Central

Zhang, Xiaorong; Liu, Yuhong; Zhang, Fan; Ren, Jin; Sun, Yan (Lindsay); Yang, Qing

2011-01-01

The quality of life of leg amputees can be improved dramatically by using a cyber physical system (CPS) that controls artificial legs based on neural signals representing amputees’ intended movements. The key to the CPS is the neural-machine interface (NMI) that senses electromyographic (EMG) signals to make control decisions. This paper presents a design and implementation of a novel NMI using an embedded computer system to collect neural signals from a physical system - a leg amputee, provide adequate computational capability to interpret such signals, and make decisions to identify user’s intent for prostheses control in real time. A new deciphering algorithm, composed of an EMG pattern classifier and a post-processing scheme, was developed to identify the user’s intended lower limb movements. To deal with environmental uncertainty, a trust management mechanism was designed to handle unexpected sensor failures and signal disturbances. Integrating the neural deciphering algorithm with the trust management mechanism resulted in a highly accurate and reliable software system for neural control of artificial legs. The software was then embedded in a newly designed hardware platform based on an embedded microcontroller and a graphic processing unit (GPU) to form a complete NMI for real time testing. Real time experiments on a leg amputee subject and an able-bodied subject have been carried out to test the control accuracy of the new NMI. Our extensive experiments have shown promising results on both subjects, paving the way for clinical feasibility of neural controlled artificial legs. PMID:22389637

[Acupoint catgut-embedding therapy: superiorities and principles of application].

PubMed

Zhang, Xuan-Ping; Jia, Chun-Sheng; Wang, Jian-Ling; Shi, Jing; Zhang, Xin; Li, Xiao-Feng; Xu, Xiao-Kang; Qin, Liang; Zhang, Mei-Ling; Kang, Su-Gang; Duan, Xiao-Dong

2012-10-01

To analyze the superiorities of acupoint catgut-embedding therapy, discuss its law of clinical application and provide scientific decision-making for clinical treatment. Literatures on acupoint catgut-embedding therapy in the recent 40 years were selected, input, examined and verified, picked up and analyzed by establishing database with the modern computer technology. (1) One thousand and seventy-five literatures were input. It shows that the acupoint catgut-embedding therapy has an extensive application in all departments, especially in the internal department, accounting for 48.54% (50/103) of the total disease category. It has the most extensive application on treatment of epigastric pain, with the frequency of 102 times, and obesity of 74 times. The next is surgery, accounting for 14.56% (15/103). The major application is on low back pain and leg pain with the frequency of 79 times. Psoriasis, with the frequency of 30 times, holds the major application in dermatological department. And blepharoplasty, with the frequency of 30 times, gains the most application in department of ophthalmology and otorhinolaryngology. (2) In the included literatures, selection of adjacent acupoints and distal acupoints are held as the major method of acupoint selection. The adjusted lumbar puncture needle is taken as the major tool for the acupoint catgut-embedding therapy. And catguts of different sizes are adopted for the operation. (3) Analysis of the therapeutic effect shows that acupoint catgut-embedding therapy has obvious effect in all departments, especially in surgery and dermatology, with the total effective rate over 90%. Epigastric pain, obesity, epilepsy, asthma, abdominal pain, facial paralysis and constipation of the internal medicine, low back pain and leg pain of the surgical department, psoriasis of the dermatological department and blepharoplasty of the department of ophthalmology and otorhinolaryngology are considered as the dominant diseases for acupoint catgut-embedding therapy.

Development of the Supported Decision Making Inventory System.

PubMed

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

2017-12-01

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

Embedding the Teaching of Academic Writing into Anthropology Lectures

ERIC Educational Resources Information Center

Mostert, Linda Ann; Townsend, Rodwell

2018-01-01

This paper lends support to the argument that students require a variety of teaching strategies to help them improve their academic writing. The study described here took place in 2014 in the context of embedding the teaching of academic writing into anthropology modules. The strategies implemented were microthemes, peer feedback, annotated…

Embedded Formative Assessment and Classroom Process Quality: How Do They Interact in Promoting Science Understanding?

ERIC Educational Resources Information Center

Decristan, Jasmin; Klieme, Eckhard; Kunter, Mareike; Hochweber, Jan; Büttner, Gerhard; Fauth, Benjamin; Hondrich, A. Lena; Rieser, Svenja; Hertel, Silke; Hardy, Ilonca

2015-01-01

In this study we examine the interplay between curriculum-embedded formative assessment--a well-known teaching practice--and general features of classroom process quality (i.e., cognitive activation, supportive climate, classroom management) and their combined effect on elementary school students' understanding of the scientific concepts of…

Architecture of an E-Learning System with Embedded Authoring Support.

ERIC Educational Resources Information Center

Baudry, Andreas; Bungenstock, Michael; Mertsching, Barbel

This paper introduces an architecture for an e-learning system with an embedded authoring system. Based on the metaphor of a construction kit, this approach offers a general solution for specific content creation and publication. The learning resources are IMS "Content Packages" with a special structure to separate content and presentation. These…

Going home? An ethnographic study of assessment of capacity and best interests in people with dementia being discharged from hospital

PubMed Central

2014-01-01

Background A significant proportion of patients in an acute hospital is made up of older people, many of whom have cognitive impairment or dementia. Rightly or wrongly, if a degree of confusion is apparent, it is often questioned whether the person is able to return to the previous place of residence. We wished to understand how, on medical wards, judgements about capacity and best interests with respect to going home are made for people with dementia and how decision-making around hospital discharge for people with dementia and their families might be improved. Our research reflects the jurisdiction in which we work, but the importance of residence capacity rests on its implications for basic human rights. Methods The research employed a ward-based ethnography. Observational data were captured through detailed fieldnotes, in-depth interviews, medical-record review and focus groups. Themes and key issues were identified using constant comparative analysis of 29 cases. Theoretical sampling of key stakeholders was undertaken, including patients with dementia (with and without residence capacity), their relatives and a range of practitioners. The research was carried out in three hospital wards (acute and rehabilitation) in two hospitals within two National Health Service (NHS) healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Results Our analysis highlights the complexity of judgements about capacity and best interests in relation to decisions about place of residence for people with dementia facing discharge from hospital. Five key themes emerged from data: the complexity of borderline decisions; the requirement for better understanding of assessment approaches in relation to residence capacity; the need for better documentation; the importance of narrative; and the crucial relevance of time and timing in making these decisions. Conclusions We need: more support and training for practitioners, as well as support for patients and families; clarity about the information to be imparted to the person with dementia; more advocacy for people with dementia; appropriate assessments embedded in routine clinical practice; the patient with dementia to be centre-stage; and properly resourced step-down or rehabilitation units to facilitate timely and good decision-making about place of residence. PMID:24758694

Mirror system activity for action and language is embedded in the integration of dorsal and ventral pathways.

PubMed

Arbib, Michael A

2010-01-01

We develop the view that the involvement of mirror neurons in embodied experience grounds brain structures that underlie language, but that many other brain regions are involved. We stress the cooperation between the dorsal and ventral streams in praxis and language. Both have perceptual and motor schemas but the perceptual schemas in the dorsal path are affordances linked to specific motor schemas for detailed motor control, whereas the ventral path supports planning and decision making. This frames the hypothesis that the mirror system for words evolved from the mirror system for actions to support words-as-phonological-actions, with semantics provided by the linkage to neural systems supporting perceptual and motor schemas. We stress the importance of computational models which can be linked to the parametric analysis of data and conceptual analysis of these models to support new patterns of understanding of the data. In the domain of praxis, we assess the FARS model of the canonical system for grasping, the MNS models for the mirror system for grasping, and the Augmented Competitive Queuing model that extends the control of action to the opportunistic scheduling of action sequences and also offers a new hypothesis on the role of mirror neurons in self action. Turning to language, we use Construction Grammar as our linguistic framework to get beyond single words to phrases and sentences, and initiate analysis of what brain functions must complement mirror systems to support this functionality. 2009 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

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

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

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

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

Decision support for clinical laboratory capacity planning.

PubMed

van Merode, G G; Hasman, A; Derks, J; Goldschmidt, H M; Schoenmaker, B; Oosten, M

1995-01-01

The design of a decision support system for capacity planning in clinical laboratories is discussed. The DSS supports decisions concerning the following questions: how should the laboratory be divided into job shops (departments/sections), how should staff be assigned to workstations and how should samples be assigned to workstations for testing. The decision support system contains modules for supporting decisions at the overall laboratory level (concerning the division of the laboratory into job shops) and for supporting decisions at the job shop level (assignment of staff to workstations and sample scheduling). Experiments with these modules are described showing both the functionality and the validity.

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.

PubMed

Lee, Seonah

2013-10-01

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses' clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review.

Insights from life history theory for an explicit treatment of trade-offs in conservation biology.

PubMed

Charpentier, Anne

2015-06-01

As economic and social contexts become more embedded within biodiversity conservation, it becomes obvious that resources are a limiting factor in conservation. This recognition is leading conservation scientists and practitioners to increasingly frame conservation decisions as trade-offs between conflicting societal objectives. However, this framing is all too often done in an intuitive way, rather than by addressing trade-offs explicitly. In contrast, the concept of trade-off is a keystone in evolutionary biology, where it has been investigated extensively. I argue that insights from evolutionary theory can provide methodological and theoretical support to evaluating and quantifying trade-offs in biodiversity conservation. I reviewed the diverse ways in which trade-offs have emerged within the context of conservation and how advances from evolutionary theory can help avoid the main pitfalls of an implicit approach. When studying both evolutionary trade-offs (e.g., reproduction vs. survival) and conservation trade-offs (e.g., biodiversity conservation vs. agriculture), it is crucial to correctly identify the limiting resource, hold constant the amount of this resource when comparing different scenarios, and choose appropriate metrics to quantify the extent to which the objectives have been achieved. Insights from studies in evolutionary theory also reveal how an inadequate selection of conservation solutions may result from considering suboptimal rather than optional solutions when examining whether a trade-off exits between 2 objectives. Furthermore, the shape of a trade-off curve (i.e., whether the relationship between 2 objectives follows a concave, convex, or linear form) is known to affect crucially the definition of optimal solutions in evolutionary biology and very likely affects decisions in biodiversity conservation planning too. This interface between evolutionary biology and biodiversity conservation can therefore provide methodological guidance to support decision makers in the difficult task of choosing among conservation solutions. © 2015 Society for Conservation Biology.

Knowledge translation of the American College of Emergency Physicians' clinical policy on syncope using computerized clinical decision support.

PubMed

Melnick, Edward R; Genes, Nicholas G; Chawla, Neal K; Akerman, Meredith; Baumlin, Kevin M; Jagoda, Andy

2010-06-01

To influence physician practice behavior after implementation of a computerized clinical decision support system (CDSS) based upon the recommendations from the 2007 ACEP Clinical Policy on Syncope. This was a pre-post intervention with a prospective cohort and retrospective controls. We conducted a medical chart review of consecutive adult patients with syncope. A computerized CDSS prompting physicians to explain their decision-making regarding imaging and admission in syncope patients based upon ACEP Clinical Policy recommendations was embedded into the emergency department information system (EDIS). The medical records of 410 consecutive adult patients presenting with syncope were reviewed prior to implementation, and 301 records were reviewed after implementation. Primary outcomes were physician practice behavior demonstrated by admission rate and rate of head computed tomography (CT) imaging before and after implementation. There was a significant difference in admission rate pre- and post-intervention (68.1% vs. 60.5% respectively, p = 0.036). There was no significant difference in the head CT imaging rate pre- and post-intervention (39.8% vs. 43.2%, p = 0.358). There were seven physicians who saw ten or more patients during the pre- and post-intervention. Subset analysis of these seven physicians' practice behavior revealed a slight significant difference in the admission rate pre- and post-intervention (74.3% vs. 63.9%, p = 0.0495) and no significant difference in the head CT scan rate pre- and post-intervention (42.9% vs. 45.4%, p = 0.660). The introduction of an evidence-based CDSS based upon ACEP Clinical Policy recommendations on syncope correlated with a change in physician practice behavior in an urban academic emergency department. This change suggests emergency medicine clinical practice guideline recommendations can be incorporated into the physician workflow of an EDIS to enhance the quality of practice.

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Enhancing students' critical thinking in science: A two-year design based exploration in a large undergraduate science course

NASA Astrophysics Data System (ADS)

Yoo, Suhyun

The purpose of this study was to explore how to enhance students' critical thinking in an introductory undergraduate science course. As a design experiment, this study aimed to design, develop, implement, and refine learning activities, and investigate how the learning activities worked in fostering students' critical thinking in a large size classroom context. In this study, critical thinking in science was framed with six categories, 1) identifying decisions, 2) evaluating decisions, 3) providing own decision, 4) argument and justification for own decision, 5) presenting supporting data/evidence, and 6) integrating other perspectives, as the result of literature review. To enhance critical thinking, three design principles, 1) authentic task, 2) question prompts, and 3) peer interaction, were associated with the learning activities for two consecutive years. The research context was within a large general science course and the learning activities for a module were designed, implemented and refined for two years. Specially, changes in design strategies were made in the two design principles, question prompts and peer interaction, after the 1st implementation. With regard to the use of question prompts, the students of the 2nd year were provided with procedural and elaborative question prompts, while those of the 1st year only received procedural question prompts embedded in the Group and Community Discussion Charts. Second, instead of being engaged six times in two types of discussions, group and community discussions, the students of the 2nd year were required to take part in a community discussion twice and to prepare for the discussion by learning about and understanding important aspects of dealing with the hurricane situation. For individual preparation, elaborative question prompts were embedded in the Individual Worksheet. Quantitative and qualitative research methods were taken to investigate how the two different designs of the 1st and 2nd years worked for enhancing critical thinking in a large-size classroom. Data came from the students' written documents during and after the learning activities. The result from the descriptive and comparative analysis on the written documents for two years indicated that there were changes in patterns of reasoning between the two years. It was evident that the groups engaged in decision-making for communities of the 2nd year showed more concrete and shaped reasoning than those of the 1st year. The result of the t-test indicated that there was a significant difference in critical thinking demonstrated in individual reports between the students of the 1st and the 2nd years. The students of the 2nd year demonstrated better levels of critical thinking than those of the 1st year. Specially, among the six categories of critical thinking, the students of the 2nd year demonstrated better levels in three categories, 1) providing one's own decision, 2) argumentation and justification for one's own decision, and 3) integrating other perspectives, than those of the 1st year. By the multiple-case study method, four themes were found to explain what made students demonstrated higher levels of critical thinking: 1) understanding of one's assigned role, 2) linking roles to make decisions, 3) answers to the question prompts, and 4) use of data and source, were raised in explaining the different pattern between the students with higher and lower levels of critical thinking. Also, a trend was visible across artifacts for higher performing students in both years.

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

EPA Science Inventory

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

Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?

PubMed

Portocarrero, Maria Esther Leiva; Giguère, Anik M C; Lépine, Johanie; Garvelink, Mirjam M; Robitaille, Hubert; Delanoë, Agathe; Lévesque, Isabelle; Wilson, Brenda J; Rousseau, François; Légaré, France

2017-03-20

Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors influencing pregnant women's use of a patient decision aid for deciding about prenatal screening for Down syndrome (DS). This qualitative study was embedded in a sequential mixed-methods research program whose main aim is to implement shared decision-making (SDM) in the context of prenatal screening for DS in the province of Quebec, Canada. We planned to recruit a purposive sample of 45 pregnant women with low-risk pregnancy consulting for prenatal care at three clinical sites. Participating women watched a video depicting a prenatal care follow-up during which a pregnant woman, her partner and a health professional used a PtDA to decide about prenatal screening for DS. The women were then interviewed about factors that would influence the use of this PtDA using questions based on the Theoretical Domains Framework (TDF). We performed content analysis of transcribed verbatim interviews. Out of 216 eligible women, 100 agreed to participate (46% response rate) and 46 were interviewed. Regarding the type of health professional responsible for their prenatal care, 19 participants (41%) reported having made a decision about prenatal screening for DS with an obstetrician-gynecologist, 13 (28%) with a midwife, 12 (26%) with a family physician, and two (4%) decided on their own. We identified 54 factors that were mapped onto nine of the 12 TDF domains. The three most frequently-mentioned were: opinion of the pregnant woman's partner (n = 33, 72%), presentation of the PtDA by health professional and a discussion (n = 27, 72%), and not having encountered a PtDA (n = 26, 57%). This study allowed us to identify factors influencing pregnant women's use of a PtDA for prenatal screening for DS. Use of a PtDA by health professionals and patients is one step in providing the needed decision support and our study results will allow us to design an effective implementation strategy for PtDAs for prenatal screening for DS.

The macroeconomics of Dr. Strangelove

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

John, A.A.; Pecchenino, R.A.; Schreft, S.L.

1993-03-01

This paper examines the weapons-accumulation decisions of two adversarial countries in the context of a deterrence/conflict initiation game embedded in an overlapping-generations model. The demographic structure permits analysis of both within- and between-country intergenerational externalities caused by past weapons-accumulation decisions, as well as of intragenerational externalities from the adversary's current weapons accumulation. Zero accumulation is a possible equilibrium with both noncooperative and cooperative behavior. Countries may also accumulate weapons to the point where conflict initiation never occurs. Pareto-improving policies are generally available, but international cooperation need not be Pareto-improving. 15 refs., 12 figs.

Integration of Dynamic Models in Range Operations

NASA Technical Reports Server (NTRS)

Bardina, Jorge; Thirumalainambi, Rajkumar

2004-01-01

This work addresses the various model interactions in real-time to make an efficient internet based decision making tool for Shuttle launch. The decision making tool depends on the launch commit criteria coupled with physical models. Dynamic interaction between a wide variety of simulation applications and techniques, embedded algorithms, and data visualizations are needed to exploit the full potential of modeling and simulation. This paper also discusses in depth details of web based 3-D graphics and applications to range safety. The advantages of this dynamic model integration are secure accessibility and distribution of real time information to other NASA centers.

Compositional and enumerative designs for medical language representation.

PubMed Central

Rassinoux, A. M.; Miller, R. A.; Baud, R. H.; Scherrer, J. R.

1997-01-01

Medical language is in essence highly compositional, allowing complex information to be expressed from more elementary pieces. Embedding the expressive power of medical language into formal systems of representation is recognized in the medical informatics community as a key step towards sharing such information among medical record, decision support, and information retrieval systems. Accordingly, such representation requires managing both the expressiveness of the formalism and its computational tractability, while coping with the level of detail expected by clinical applications. These desiderata can be supported by enumerative as well as compositional approaches, as argued in this paper. These principles have been applied in recasting a frame-based system for general medical findings developed during the 1980s. The new system captures the precise meaning of a subset of over 1500 medical terms for general internal medicine identified from the Quick Medical Reference (QMR) lexicon. In order to evaluate the adequacy of this formal structure in reflecting the deep meaning of the QMR findings, a validation process was implemented. It consists of automatically rebuilding the semantic representation of the QMR findings by analyzing them through the RECIT natural language analyzer, whose semantic components have been adjusted to this frame-based model for the understanding task. PMID:9357700

Compositional and enumerative designs for medical language representation.

PubMed

Rassinoux, A M; Miller, R A; Baud, R H; Scherrer, J R

1997-01-01

Medical language is in essence highly compositional, allowing complex information to be expressed from more elementary pieces. Embedding the expressive power of medical language into formal systems of representation is recognized in the medical informatics community as a key step towards sharing such information among medical record, decision support, and information retrieval systems. Accordingly, such representation requires managing both the expressiveness of the formalism and its computational tractability, while coping with the level of detail expected by clinical applications. These desiderata can be supported by enumerative as well as compositional approaches, as argued in this paper. These principles have been applied in recasting a frame-based system for general medical findings developed during the 1980s. The new system captures the precise meaning of a subset of over 1500 medical terms for general internal medicine identified from the Quick Medical Reference (QMR) lexicon. In order to evaluate the adequacy of this formal structure in reflecting the deep meaning of the QMR findings, a validation process was implemented. It consists of automatically rebuilding the semantic representation of the QMR findings by analyzing them through the RECIT natural language analyzer, whose semantic components have been adjusted to this frame-based model for the understanding task.

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

PubMed

Lowe, Jeanne R; Raugi, Gregory J; Reiber, Gayle E; Whitney, Joanne D

2013-01-01

The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

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

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

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

Linking Action Research to Response to Intervention (RtI): The Strategy Implementation Project

ERIC Educational Resources Information Center

Hoppey, David

2013-01-01

This paper showcases how one teacher preparation program embedded action research within the Response to Intervention (RtI) model. This integration helped preservice teachers gain a deeper knowledge of RtI key concepts and pedagogical decision making for meeting diverse students' needs. Examples from a course assignment are provided to demonstrate…

"Does that Make Me a Woman?": Breast Cancer, Mastectomy, and Breast Reconstruction Decisions among Sexual Minority Women

ERIC Educational Resources Information Center

Rubin, Lisa R.; Tanenbaum, Molly

2011-01-01

Feminist scholars and activists writing about breast cancer care among women have highlighted the sexist and heterosexist assumptions often embedded in the medical management of breast cancer, and of mastectomy in particular. Despite these contributions, and some speculation that sexual minority women may be less interested in breast…

Situating adaptation: How governance challenges and perceptions of uncertainty influence adaptation in the Rocky Mountains

Treesearch

Carina Wyborn; Laurie Yung; Daniel Murphy; Daniel R. Williams

2015-01-01

Adaptation is situated within multiple, interacting social, political, and economic forces. Adaptation pathways envision adaptation as a continual pathway of change and response embedded within this broader sociopolitical context. Pathways emphasize that current decisions are both informed by past actions and shape the landscape of future options. This research...

Equity and Advocacy Expectations of Culturally Diverse Families' Participation in Special Education.

ERIC Educational Resources Information Center

Kalyanpur, Maya; Harry, Beth; Skrtic, Tom

2000-01-01

This article contends that the equity and advocacy expectations embedded in the legal mandate for parent participation in the special education decision-making process directly contradict the hierarchy of professional status and knowledge on which the positivist paradigm of professionalism is based and are also in conflict with the values held by…

Making Decisions: Using Electronic Data Collection to Re-Envision Reference Services at the USF Tampa Libraries

ERIC Educational Resources Information Center

Todorinova, Lily; Huse, Andy; Lewis, Barbara; Torrence, Matt

2011-01-01

Declining reference statistics, diminishing human resources, and the desire to be more proactive and embedded in academic departments, prompted the University of South Florida Library to create a taskforce for re-envisioning reference services. The taskforce was charged with examining the staffing patterns at the desk and developing…

An fMRI Study of Sentence-Embedded Lexical-Semantic Decision in Children and Adults

ERIC Educational Resources Information Center

Moore-Parks, Erin Nicole; Burns, Erin L.; Bazzill, Rebecca; Levy, Sarah; Posada, Valerie; Muller, Ralph-Axel

2010-01-01

Lexical-semantic knowledge is a core language component that undergoes prolonged development throughout childhood and is therefore highly amenable to developmental studies. Most previous lexical-semantic functional MRI (fMRI) studies have been limited to single-word or word-pair tasks, outside a sentence context. Our objective was to investigate…

Future of electronic health records: implications for decision support.

PubMed

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

2012-01-01

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

D-Move: A Mobile Communication Based Delphi for Digital Natives to Support Embedded Research

ERIC Educational Resources Information Center

Petrovic, Otto

2017-01-01

Digital Natives are raised with computers and the Internet, which are a familiar part of their daily life. To gain insights into their attitude and behavior, methods and media for empirical research face new challenges like gamification, context oriented embedded research, integration of multiple data sources, and the increased importance of…

The Moment of Learning: Quantitative Analysis of Exemplar Gameplay Supports CyGaMEs Approach to Embedded Assessment

ERIC Educational Resources Information Center

Reese, Debbie Denise; Tabachnick, Barbara G.

2010-01-01

In this paper, the authors summarize a quantitative analysis demonstrating that the CyGaMEs toolset for embedded assessment of learning within instructional games measures growth in conceptual knowledge by quantifying player behavior. CyGaMEs stands for Cyberlearning through GaME-based, Metaphor Enhanced Learning Objects. Some scientists of…

Evolution of Embedded Processing for Wide Area Surveillance

DTIC Science & Technology

2014-01-01

future vision . 15. SUBJECT TERMS Embedded processing; high performance computing; general-purpose graphical processing units (GPGPUs) 16. SECURITY...recon- naissance (ISR) mission capabilities. The capabilities these advancements are achieving include the ability to provide persistent all...fighters to support and positively affect their mission . Significant improvements in high-performance computing (HPC) technology make it possible to

Embedding Personal Development Planning within a WebCT Supported Module--A Collaborative Venture

ERIC Educational Resources Information Center

Bloxham, Sefton; Cerevkova, Andrea; Waddelove, Christine

2007-01-01

This paper describes the background to and development of a first year undergraduate law module which has been re-designed to enable the embedding of Personal Development Planning (PDP) within the curriculum, with particular emphasis on career management skills. The pedagogic rationale for the approach adopted is identified and it is then…

An Embedded Systems Laboratory to Support Rapid Prototyping of Robotics and the Internet of Things

ERIC Educational Resources Information Center

Hamblen, J. O.; van Bekkum, G. M. E.

2013-01-01

This paper describes a new approach for a course and laboratory designed to allow students to develop low-cost prototypes of robotic and other embedded devices that feature Internet connectivity, I/O, networking, a real-time operating system (RTOS), and object-oriented C/C++. The application programming interface (API) libraries provided permit…

Managing a Real-Time Embedded Linux Platform with Buildroot

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

Diamond, J.; Martin, K.

2015-01-01

Developers of real-time embedded software often need to build the operating system, kernel, tools and supporting applications from source to work with the differences in their hardware configuration. The first attempts to introduce Linux-based real-time embedded systems into the Fermilab accelerator controls system used this approach but it was found to be time-consuming, difficult to maintain and difficult to adapt to different hardware configurations. Buildroot is an open source build system with a menu-driven configuration tool (similar to the Linux kernel build system) that automates this process. A customized Buildroot [1] system has been developed for use in the Fermilabmore » accelerator controls system that includes several hardware configuration profiles (including Intel, ARM and PowerPC) and packages for Fermilab support software. A bootable image file is produced containing the Linux kernel, shell and supporting software suite that varies from 3 to 20 megabytes large – ideal for network booting. The result is a platform that is easier to maintain and deploy in diverse hardware configurations« less

Toward a Multilingual, Experiential Environment for Learning Decision Technology.

ERIC Educational Resources Information Center

Yeo, Gee Kin; Tan, Seng Teen

1999-01-01

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

Maintenance and operations decision support tool : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

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

Applying Cases to Solve Ethical Problems: The Significance of Positive and Process-Oriented Reflection

PubMed Central

Antes, Alison L.; Thiel, Chase E.; Martin, Laura E.; Stenmark, Cheryl K.; Connelly, Shane; Devenport, Lynn D.; Mumford, Michael D.

2015-01-01

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case was viewed as positive or negative, and whether the outcomes, process, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision-making are discussed. PMID:26257506

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

PubMed

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

2017-01-01

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

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

Treesearch

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

2017-01-01

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

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

PubMed

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

2011-11-01

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

Criteria for assessing problem solving and decision making in complex environments

NASA Technical Reports Server (NTRS)

Orasanu, Judith

1993-01-01

Training crews to cope with unanticipated problems in high-risk, high-stress environments requires models of effective problem solving and decision making. Existing decision theories use the criteria of logical consistency and mathematical optimality to evaluate decision quality. While these approaches are useful under some circumstances, the assumptions underlying these models frequently are not met in dynamic time-pressured operational environments. Also, applying formal decision models is both labor and time intensive, a luxury often lacking in operational environments. Alternate approaches and criteria are needed. Given that operational problem solving and decision making are embedded in ongoing tasks, evaluation criteria must address the relation between those activities and satisfaction of broader task goals. Effectiveness and efficiency become relevant for judging reasoning performance in operational environments. New questions must be addressed: What is the relation between the quality of decisions and overall performance by crews engaged in critical high risk tasks? Are different strategies most effective for different types of decisions? How can various decision types be characterized? A preliminary model of decision types found in air transport environments will be described along with a preliminary performance model based on an analysis of 30 flight crews. The performance analysis examined behaviors that distinguish more and less effective crews (based on performance errors). Implications for training and system design will be discussed.

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

PubMed

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

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

PubMed Central

Aronsky, D.; Haug, P. J.

1999-01-01

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

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

USGS Publications Warehouse

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

2016-01-01

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

Monitoring, Modeling, and Diagnosis of Alkali-Silica Reaction in Small Concrete Samples

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

Agarwal, Vivek; Cai, Guowei; Gribok, Andrei V.

Assessment and management of aging concrete structures in nuclear power plants require a more systematic approach than simple reliance on existing code margins of safety. Structural health monitoring of concrete structures aims to understand the current health condition of a structure based on heterogeneous measurements to produce high-confidence actionable information regarding structural integrity that supports operational and maintenance decisions. This report describes alkali-silica reaction (ASR) degradation mechanisms and factors influencing the ASR. A fully coupled thermo-hydro-mechanical-chemical model developed by Saouma and Perotti by taking into consideration the effects of stress on the reaction kinetics and anisotropic volumetric expansion is presentedmore » in this report. This model is implemented in the GRIZZLY code based on the Multiphysics Object Oriented Simulation Environment. The implemented model in the GRIZZLY code is randomly used to initiate ASR in a 2D and 3D lattice to study the percolation aspects of concrete. The percolation aspects help determine the transport properties of the material and therefore the durability and service life of concrete. This report summarizes the effort to develop small-size concrete samples with embedded glass to mimic ASR. The concrete samples were treated in water and sodium hydroxide solution at elevated temperature to study how ingress of sodium ions and hydroxide ions at elevated temperature impacts concrete samples embedded with glass. Thermal camera was used to monitor the changes in the concrete sample and results are summarized.« less

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

PubMed

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

2014-06-01

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

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

PubMed

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

2014-06-01

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

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

PubMed Central

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

2014-01-01

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

Introducing embedded indigenous psychological support teams: a suggested addition to psychological first aid in an international context.

PubMed

Edwards-Stewart, Amanda; Ahmad, Zeba S; Thoburn, John W; Furman, Rich; Lambert, Ashly J; Shelly, Lauren; Gunn, Ginger

2012-01-01

The current article introduces Embedded Indigenous Psychological Support Teams (IPST) as a possible addition to current disaster relief efforts. This article highlights psychological first aid in an international context by drawing on mainstream disaster relief models such as The American Red Cross, Critical Incident Stress Management, and Flexible Psychological First Aid. IPST are explained as teams utilizing techniques from both CISM and FPFA with a focus on resiliency. It is currently theorized that in utilizing IPST existing disaster relief models may be more effective in mitigating negative physical or mental health consequences post-disaster.

Developing the U.S. Wildland Fire Decision Support System

Treesearch

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

2011-01-01

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

Decision Support for Ecosystem Management (Chapter 28)

Treesearch

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

1999-01-01

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

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

PubMed

Wright, Adam; Sittig, Dean F

2008-12-01

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

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

PubMed

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

2013-01-01

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

Cinemicrographic specimen housing

NASA Technical Reports Server (NTRS)

Wilkins, J. R.

1979-01-01

Housing used to observe gravitation effects on specimens embedded in support media, such as agar, supports microbial specimens vertically for time-lapsed cinemicrographic studies. Procedure cannot be performed with conventional microscopes which see specimens in horizontal plane only.

Toward the Modularization of Decision Support Systems

NASA Astrophysics Data System (ADS)

Raskin, R. G.

2009-12-01

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

On the Embedded Complementarity of Agent-Based and Aggregate Reasoning in Students' Developing Understanding of Dynamic Systems

ERIC Educational Resources Information Center

Stroup, Walter M.; Wilensky, Uri

2014-01-01

Placed in the larger context of broadening the engagement with systems dynamics and complexity theory in school-aged learning and teaching, this paper is intended to introduce, situate, and illustrate--with results from the use of network supported participatory simulations in classrooms--a stance we call "embedded complementarity" as an…

Linking Course-Embedded Assessment Measures and Performance on the Educational Testing Service Major Field Test in Business

ERIC Educational Resources Information Center

Barboza, Gustavo A.; Pesek, James

2012-01-01

Assessment of the business curriculum and its learning goals and objectives has become a major field of interest for business schools. The exploratory results of the authors' model using a sample of 173 students show robust support for the hypothesis that high marks in course-embedded assessment on business-specific analytical skills positively…

Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

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

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

DOT National Transportation Integrated Search

2014-12-01

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

Multiview Locally Linear Embedding for Effective Medical Image Retrieval

PubMed Central

Shen, Hualei; Tao, Dacheng; Ma, Dianfu

2013-01-01

Content-based medical image retrieval continues to gain attention for its potential to assist radiological image interpretation and decision making. Many approaches have been proposed to improve the performance of medical image retrieval system, among which visual features such as SIFT, LBP, and intensity histogram play a critical role. Typically, these features are concatenated into a long vector to represent medical images, and thus traditional dimension reduction techniques such as locally linear embedding (LLE), principal component analysis (PCA), or laplacian eigenmaps (LE) can be employed to reduce the “curse of dimensionality”. Though these approaches show promising performance for medical image retrieval, the feature-concatenating method ignores the fact that different features have distinct physical meanings. In this paper, we propose a new method called multiview locally linear embedding (MLLE) for medical image retrieval. Following the patch alignment framework, MLLE preserves the geometric structure of the local patch in each feature space according to the LLE criterion. To explore complementary properties among a range of features, MLLE assigns different weights to local patches from different feature spaces. Finally, MLLE employs global coordinate alignment and alternating optimization techniques to learn a smooth low-dimensional embedding from different features. To justify the effectiveness of MLLE for medical image retrieval, we compare it with conventional spectral embedding methods. We conduct experiments on a subset of the IRMA medical image data set. Evaluation results show that MLLE outperforms state-of-the-art dimension reduction methods. PMID:24349277

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

Energy Decision Science and Informatics | Integrated Energy Solutions |

Science.gov Websites

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

Promoting Teaching, Learning and Informed Decision-Making through the Lenses of International Large-Scale Assessment: Looking beyond Numbers

ERIC Educational Resources Information Center

Säljö, Roger; Radišic, Jelena

2018-01-01

Public discussion on the quality of education in different corners of the world very much relies on the data provided by the international large-scale assessment (ILSA) studies. While aware of different methodological keystones and technicalities embedded in these, the idea behind this special issue is to contribute to the understanding of how…

The (digital) natives are restless: designing and implementing an interactive digital media assignment.

PubMed

Voge, Catherine; Hirvela, Kari; Jarzemsky, Paula

2012-01-01

To create an opportunity for students to connect with the Quality and Safety Education for Nurses competencies and demonstrate learning via knowledge transference, the authors piloted a digital media assignment. Students worked in small groups to create an unfolding patient care scenario with embedded decision points, using presentation software. The authors discuss the assignment and its outcomes.

Symbols of Success: Youth, Peer Pressure and the Role of Adulthood among Juvenile Male Return Migrants in Ghana

ERIC Educational Resources Information Center

Ungruhe, Christian

2010-01-01

Independent youth migration is socially embedded in many African societies. While it is often exclusively perceived of as a process of intergenerational negotiation which leads to higher social positions after returning home, this article points out that peer influences play a major role in the process of decision-making of leaving and returning…

Organizational Context of Human Factors

DTIC Science & Technology

1982-11-01

anthroprometric characteristics of humans (reach, strength, etc.); biological limits of vision, hearing, memory; and work-load issues . This paper is in...developments of the .7A organizational analysis field was the generalization that authoritarian structures led to low morale among personnel, and this led to...emphasized participation in decision making, and freedom to criticize practices, would lead to high morale and more output. Embedded in this

Linkages to Public Land Framework: toward embedding humans in ecosystem analyses by using “inside-out social assessment.”

Treesearch

Joanna Endter-Wada; Dale J. Blahna

2011-01-01

This article presents the " Linkages to Public Land" (LPL) Framework, a general but comprehensive data-gathering and analysis approach aimed at informing citizen and agency decision making about the social environment of public land. This social assessment and planning approach identifies and categorizes various types of linkages that people have to public...

Starting a Learning Progression for Agricultural Literacy: A Qualitative Study of Urban Elementary Student Understandings of Agricultural and Science Education Benchmarks

ERIC Educational Resources Information Center

Hess, Alexander Jay

2010-01-01

Science and agriculture professional organizations have argued for agricultural literacy as a goal for K-12 public education. Due to the complexity of our modern agri-food system, with social, economic, and environmental concerns embedded, an agriculturally literate society is needed for informed decision making, democratic participation, and…

"It's the Way They Do It": Expressions of Agency in Child-Adult Relations at Home and School

ERIC Educational Resources Information Center

Bjerke, Havard

2011-01-01

This article examines children's (8-9 years) and young people's (14-15 years) views about their own participation in decision-making processes with adults, within the context of home and school in Norway. A difference-centred theoretical perspective is used to identify children's participation as expressions of agency embedded in intricate…

Temperature variability is integrated by a spatially embedded decision-making center to break dormancy in Arabidopsis seeds.

PubMed

Topham, Alexander T; Taylor, Rachel E; Yan, Dawei; Nambara, Eiji; Johnston, Iain G; Bassel, George W

2017-06-20

Plants perceive and integrate information from the environment to time critical transitions in their life cycle. Some mechanisms underlying this quantitative signal processing have been described, whereas others await discovery. Seeds have evolved a mechanism to integrate environmental information by regulating the abundance of the antagonistically acting hormones abscisic acid (ABA) and gibberellin (GA). Here, we show that hormone metabolic interactions and their feedbacks are sufficient to create a bistable developmental fate switch in Arabidopsis seeds. A digital single-cell atlas mapping the distribution of hormone metabolic and response components revealed their enrichment within the embryonic radicle, identifying the presence of a decision-making center within dormant seeds. The responses to both GA and ABA were found to occur within distinct cell types, suggesting cross-talk occurs at the level of hormone transport between these signaling centers. We describe theoretically, and demonstrate experimentally, that this spatial separation within the decision-making center is required to process variable temperature inputs from the environment to promote the breaking of dormancy. In contrast to other noise-filtering systems, including human neurons, the functional role of this spatial embedding is to leverage variability in temperature to transduce a fate-switching signal within this biological system. Fluctuating inputs therefore act as an instructive signal for seeds, enhancing the accuracy with which plants are established in ecosystems, and distributed computation within the radicle underlies this signal integration mechanism.

Temperature variability is integrated by a spatially embedded decision-making center to break dormancy in Arabidopsis seeds

PubMed Central

Topham, Alexander T.; Taylor, Rachel E.; Yan, Dawei; Nambara, Eiji; Johnston, Iain G.

2017-01-01

Plants perceive and integrate information from the environment to time critical transitions in their life cycle. Some mechanisms underlying this quantitative signal processing have been described, whereas others await discovery. Seeds have evolved a mechanism to integrate environmental information by regulating the abundance of the antagonistically acting hormones abscisic acid (ABA) and gibberellin (GA). Here, we show that hormone metabolic interactions and their feedbacks are sufficient to create a bistable developmental fate switch in Arabidopsis seeds. A digital single-cell atlas mapping the distribution of hormone metabolic and response components revealed their enrichment within the embryonic radicle, identifying the presence of a decision-making center within dormant seeds. The responses to both GA and ABA were found to occur within distinct cell types, suggesting cross-talk occurs at the level of hormone transport between these signaling centers. We describe theoretically, and demonstrate experimentally, that this spatial separation within the decision-making center is required to process variable temperature inputs from the environment to promote the breaking of dormancy. In contrast to other noise-filtering systems, including human neurons, the functional role of this spatial embedding is to leverage variability in temperature to transduce a fate-switching signal within this biological system. Fluctuating inputs therefore act as an instructive signal for seeds, enhancing the accuracy with which plants are established in ecosystems, and distributed computation within the radicle underlies this signal integration mechanism. PMID:28584126

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

PubMed

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

2016-12-01

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

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

PubMed Central

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

2016-01-01

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

How much of Toyota's philosophy is embedded in health care at the organisational level? A review.

PubMed

Antierens, Alain; Beeckman, Dimitri; Verhaeghe, Sofie; Myny, Dries; Van Hecke, Ann

2018-05-01

Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies. No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care. Sixty studies were identified for the final analysis. Some Toyota Way principles appear more deeply embedded in health care institutions than others are. Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse. This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level. © 2018 John Wiley & Sons Ltd.

Virtual Network Embedding via Monte Carlo Tree Search.

PubMed

Haeri, Soroush; Trajkovic, Ljiljana

2018-02-01

Network virtualization helps overcome shortcomings of the current Internet architecture. The virtualized network architecture enables coexistence of multiple virtual networks (VNs) on an existing physical infrastructure. VN embedding (VNE) problem, which deals with the embedding of VN components onto a physical network, is known to be -hard. In this paper, we propose two VNE algorithms: MaVEn-M and MaVEn-S. MaVEn-M employs the multicommodity flow algorithm for virtual link mapping while MaVEn-S uses the shortest-path algorithm. They formalize the virtual node mapping problem by using the Markov decision process (MDP) framework and devise action policies (node mappings) for the proposed MDP using the Monte Carlo tree search algorithm. Service providers may adjust the execution time of the MaVEn algorithms based on the traffic load of VN requests. The objective of the algorithms is to maximize the profit of infrastructure providers. We develop a discrete event VNE simulator to implement and evaluate performance of MaVEn-M, MaVEn-S, and several recently proposed VNE algorithms. We introduce profitability as a new performance metric that captures both acceptance and revenue to cost ratios. Simulation results show that the proposed algorithms find more profitable solutions than the existing algorithms. Given additional computation time, they further improve embedding solutions.

Regularised extreme learning machine with misclassification cost and rejection cost for gene expression data classification.

PubMed

Lu, Huijuan; Wei, Shasha; Zhou, Zili; Miao, Yanzi; Lu, Yi

2015-01-01

The main purpose of traditional classification algorithms on bioinformatics application is to acquire better classification accuracy. However, these algorithms cannot meet the requirement that minimises the average misclassification cost. In this paper, a new algorithm of cost-sensitive regularised extreme learning machine (CS-RELM) was proposed by using probability estimation and misclassification cost to reconstruct the classification results. By improving the classification accuracy of a group of small sample which higher misclassification cost, the new CS-RELM can minimise the classification cost. The 'rejection cost' was integrated into CS-RELM algorithm to further reduce the average misclassification cost. By using Colon Tumour dataset and SRBCT (Small Round Blue Cells Tumour) dataset, CS-RELM was compared with other cost-sensitive algorithms such as extreme learning machine (ELM), cost-sensitive extreme learning machine, regularised extreme learning machine, cost-sensitive support vector machine (SVM). The results of experiments show that CS-RELM with embedded rejection cost could reduce the average cost of misclassification and made more credible classification decision than others.

Caring for one and all - Exploring ethical challenges in an ICU.

PubMed

Jones, Jennifer; Mitchell, Marion; Milligan, Eleanor

2016-08-01

This discussion paper explores some of the complex ethical and moral issues confronting contemporary critical care nurses. In contemporary healthcare discussions, there is an increased appreciation of the complexity of ethical challenges, the multiplicity of stakeholders and that a broad range of possible and practical outcomes exist. Furthermore, many scholars also acknowledge the limitations of principle based ethical frameworks. In seeking to build critical care nurses' capacity to negotiate the complex - and often conflicting - ethical challenges, the authors have adopted a person-centred, values-based approach in this case study. Furthermore, by exploring these complex issues, this paper supports and builds upon critical care nurses' decision making capacities in the clinical area. This case study has been purposefully left open-ended with the aim of inviting the reader to consider the questions posed in a collegial, collaborative manner within the particular context in which she/he is embedded. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

The effects of community pharmacy public health interventions on population health and health inequalities: a systematic review of reviews protocol.

PubMed

Hillier-Brown, Frances; Bambra, Clare; Thomson, Katie; Balaj, Mirza; Walton, Nick; Todd, Adam

2017-08-30

Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are embedded within communities. In the light of a rapid increase in community pharmacy-delivered public health services and an accompanying increase in the evidence base, this systematic review of reviews will synthesise systematic reviews of public health community pharmacy interventions and assess their effects on public health and health inequalities. Systematic review methodology will be used to identify all systematic reviews that describe the health and health equity effects of community pharmacy public health interventions. Twenty databases will be searched using a pre-determined search strategy to evaluate community pharmacy-delivered public health interventions. Findings from the included reviews will be pooled, and a narrative synthesis executed to identify overarching patterns and results. Findings will support future decision-making around how community pharmacy public health services can be used alongside other strategies to promote health, prevent disease and reduce health inequalities. PROSPERO registration number: CRD42017056264 .

Autonomy and Privacy in Clinical Laboratory Science Policy and Practice.

PubMed

Leibach, Elizabeth Kenimer

2014-01-01

Rapid advancements in diagnostic technologies coupled with growth in testing options and choices mandate the development of evidence-based testing algorithms linked to the care paths of the major chronic diseases and health challenges encountered most frequently. As care paths are evaluated, patient/consumers become partners in healthcare delivery. Clinical laboratory scientists find themselves firmly embedded in both quality improvement and clinical research with an urgent need to translate clinical laboratory information into knowledge required by practitioners and patient/consumers alike. To implement this patient-centered care approach in clinical laboratory science, practitioners must understand their roles in (1) protecting patient/consumer autonomy in the healthcare informed consent process and (2) assuring patient/consumer privacy and confidentiality while blending quality improvement study findings with protected health information. A literature review, describing the current ethical environment, supports a consultative role for clinical laboratory scientists in the clinical decision-making process and suggests guidance for policy and practice regarding the principle of autonomy and its associated operational characteristics: informed consent and privacy.

Improving the Patient Experience by Implementing an ICU Diary for Those at Risk of Post-intensive Care Syndrome.

PubMed

Blair, K Taylor A; Eccleston, Sarah D; Binder, Hannah M; McCarthy, Mary S

2017-03-01

The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay. In this paper we describe our efforts to implement an ICU diary and solicit feedback on its role in fostering teamwork and communication between patients, family members, and ICU staff. Next steps will involve a PICS follow-up clinic where trained staff will coordinate specialty referrals and perform long-term monitoring of mental health and other quality of life outcomes.

Exploratory of society

NASA Astrophysics Data System (ADS)

Cederman, L.-E.; Conte, R.; Helbing, D.; Nowak, A.; Schweitzer, F.; Vespignani, A.

2012-11-01

A huge flow of quantitative social, demographic and behavioral data is becoming available that traces the activities and interactions of individuals, social patterns, transportation infrastructures and travel fluxes. This has caused, together with innovative computational techniques and methods for modeling social actions in hybrid (natural and artificial) societies, a qualitative change in the ways we model socio-technical systems. For the first time, society can be studied in a comprehensive fashion that addresses social and behavioral complexity. In other words we are in the position to envision the development of large data and computational cyber infrastructure defining an exploratory of society that provides quantitative anticipatory, explanatory and scenario analysis capabilities ranging from emerging infectious disease to conflict and crime surges. The goal of the exploratory of society is to provide the basic infrastructure embedding the framework of tools and knowledge needed for the design of forecast/anticipatory/crisis management approaches to socio technical systems, supporting future decision making procedures by accelerating the scientific cycle that goes from data generation to predictions.

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.

Implementation of workflow engine technology to deliver basic clinical decision support functionality

PubMed Central

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform. PMID:21477364

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

PubMed

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

2016-11-01

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

Terra Harvest software architecture

NASA Astrophysics Data System (ADS)

Humeniuk, Dave; Klawon, Kevin

2012-06-01

Under the Terra Harvest Program, the DIA has the objective of developing a universal Controller for the Unattended Ground Sensor (UGS) community. The mission is to define, implement, and thoroughly document an open architecture that universally supports UGS missions, integrating disparate systems, peripherals, etc. The Controller's inherent interoperability with numerous systems enables the integration of both legacy and future UGS System (UGSS) components, while the design's open architecture supports rapid third-party development to ensure operational readiness. The successful accomplishment of these objectives by the program's Phase 3b contractors is demonstrated via integration of the companies' respective plug-'n'-play contributions that include controllers, various peripherals, such as sensors, cameras, etc., and their associated software drivers. In order to independently validate the Terra Harvest architecture, L-3 Nova Engineering, along with its partner, the University of Dayton Research Institute, is developing the Terra Harvest Open Source Environment (THOSE), a Java Virtual Machine (JVM) running on an embedded Linux Operating System. The Use Cases on which the software is developed support the full range of UGS operational scenarios such as remote sensor triggering, image capture, and data exfiltration. The Team is additionally developing an ARM microprocessor-based evaluation platform that is both energy-efficient and operationally flexible. The paper describes the overall THOSE architecture, as well as the design decisions for some of the key software components. Development process for THOSE is discussed as well.

Employing Cognitive Tools within Interactive Multimedia Applications.

ERIC Educational Resources Information Center

Hedberg, John; And Others

This paper describes research into the use of cognitive tools in the classroom using "Exploring the Nardoo", an information landscape designed to support student investigation. Simulations and support tools which allow multimedia reporting are embedded in the package and are supported by several metacognitive tools for the writing…

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

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

Common Web Mapping and Mobile Device Framework for Display of NASA Real-time Data

NASA Astrophysics Data System (ADS)

Burks, J. E.

2013-12-01

Scientists have strategic goals to deliver their unique datasets and research to both collaborative partners and more broadly to the public. These datasets can have a significant impact locally and globally as has been shown by the success of the NASA Short-term Prediction Research and Transition (SPoRT) Center and SERVIR programs at Marshall Space Flight Center. Each of these respective organizations provides near real-time data at the best resolution possible to address concerns of the operational weather forecasting community (SPoRT) and to support environmental monitoring and disaster assessment (SERVIR). However, one of the biggest struggles to delivering the data to these and other Earth science community partners is formatting the product to fit into an end user's Decision Support System (DSS). The problem of delivering the data to the end-user's DSS can be a significant impediment to transitioning research to operational environments especially for disaster response where the deliver time is critical. The decision makers, in addition to the DSS, need seamless access to these same datasets from a web browser or a mobile phone for support when they are away from their DSS or for personnel out in the field. A framework has been developed for MSFC Earth Science program that can be used to easily enable seamless delivery of scientific data to end users in multiple formats. The first format is an open geospatial format, Web Mapping Service (WMS), which is easily integrated into most DSSs. The second format is a web browser display, which can be embedded within any MSFC Science web page with just a few lines of web page coding. The third format is accessible in the form of iOS and Android native mobile applications that could be downloaded from an 'app store'. The framework developed has reduced the level of effort needed to bring new and existing NASA datasets to each of these end user platforms and help extend the reach of science data.

Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis.

PubMed

Khairat, Saif; Marc, David; Crosby, William; Al Sanousi, Ali

2018-04-18

Clinical decision support systems (CDSSs) are an integral component of today's health information technologies. They assist with interpretation, diagnosis, and treatment. A CDSS can be embedded throughout the patient safety continuum providing reminders, recommendations, and alerts to health care providers. Although CDSSs have been shown to reduce medical errors and improve patient outcomes, they have fallen short of their full potential. User acceptance has been identified as one of the potential reasons for this shortfall. The purpose of this paper was to conduct a critical review and task analysis of CDSS research and to develop a new framework for CDSS design in order to achieve user acceptance. A critical review of CDSS papers was conducted with a focus on user acceptance. To gain a greater understanding of the problems associated with CDSS acceptance, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives: the machine (ie, the CDSS engine) and the user (ie, the physician). Favorability of CDSSs was based on user acceptance of clinical guidelines, reminders, alerts, and diagnostic suggestions. We propose two models: (1) the user acceptance and system adaptation design model, which includes optimizing CDSS design based on user needs/expectations, and (2) the input-process-output-engagemodel, which reveals to users the processes that govern CDSS outputs. This research demonstrates that the incorporation of the proposed models will improve user acceptance to support the beneficial effects of CDSSs adoption. Ultimately, if a user does not accept technology, this not only poses a threat to the use of the technology but can also pose a threat to the health and well-being of patients. ©Saif Khairat, David Marc, William Crosby, Ali Al Sanousi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

Common Web Mapping and Mobile Device Framework for Display of NASA Real-time Data

NASA Technical Reports Server (NTRS)

Burks, Jason

2013-01-01

Scientists have strategic goals to deliver their unique datasets and research to both collaborative partners and more broadly to the public. These datasets can have a significant impact locally and globally as has been shown by the success of the NASA Short-term Prediction Research and Transition (SPoRT) Center and SERVIR programs at Marshall Space Flight Center. Each of these respective organizations provides near real-time data at the best resolution possible to address concerns of the operational weather forecasting community (SPoRT) and to support environmental monitoring and disaster assessment (SERVIR). However, one of the biggest struggles to delivering the data to these and other Earth science community partners is formatting the product to fit into an end user's Decision Support System (DSS). The problem of delivering the data to the end-user's DSS can be a significant impediment to transitioning research to operational environments especially for disaster response where the deliver time is critical. The decision makers, in addition to the DSS, need seamless access to these same datasets from a web browser or a mobile phone for support when they are away from their DSS or for personnel out in the field. A framework has been developed for MSFC Earth Science program that can be used to easily enable seamless delivery of scientific data to end users in multiple formats. The first format is an open geospatial format, Web Mapping Service (WMS), which is easily integrated into most DSSs. The second format is a web browser display, which can be embedded within any MSFC Science web page with just a few lines of web page coding. The third format is accessible in the form of iOS and Android native mobile applications that could be downloaded from an "app store". The framework developed has reduced the level of effort needed to bring new and existing NASA datasets to each of these end user platforms and help extend the reach of science data.

A geospatial soil-based DSS to reconcile landscape management and land protection

NASA Astrophysics Data System (ADS)

Manna, Piero; Basile, Angelo; Bonfante, Antonello; D'Antonio, Amedeo; De Michele, Carlo; Iamarino, Michela; Langella, Giuliano; Florindo Mileti, Antonio; Pileri, Paolo; Vingiani, Simona; Terribile, Fabio

2017-04-01

The implementation of UN Agenda 2030 may represent a great opportunity to place soil science at the hearth of many Sustainable Development Goals (e.g. SDGs 2, 3, 13, 15, 15.3, 16.7). On the other side the high complexity embedded in the factual implementation of SDG and many others ambitious objectives (e.g. FAO goals) may cause new frustrations if these policy documents will not bring real progresses. The scientific communities are asked to contribute to disentangle this complexity and possibly identifying a "way to go". This may help the large number of European directives (e.g. WFD, EIA), regulations and communications aiming to achieve a better environment but still facing large difficulties in their full implementation (e.g. COM2015/120; COM2013/683). This contribution has the motivation to provide a different perspective, thinking that the full implementation of SDGs and integrated land policies requires to challenge some key overlooked issues including full competence (and managing capability) about the landscape variability, its multi-functionalities (e.g. agriculture / environment) and its dynamic nature (many processes, including crops growth and fate of pollutants, are dynamic); moreover, it requires to support actions at a very detailed local scale since many processes and problems are site specific. The landscape and all the above issues have the soil as pulsing heart. Accordingly, we aim to demonstrate the multiple benefits in using a smart geoSpatial Decision Support System (S-DSS) grounded on soil modelling, called SOILCONSWEB (EU LIFE+ project and its extensions). It is a freely-accessible web platform based on a Geospatial Cyber-Infrastructure (GCI) and developed in Valle Telesina (South Italy) over an area of 20,000 ha. It supports a multilevel decision-making in agriculture and environment including the interaction with other land uses (such as landscape and urban planning) and thus it simultaneously delivers to SDGs 2, 3, 13, 15, 15.3, 16.7.

Ultra Low Energy Binary Decision Diagram Circuits Using Few Electron Transistors

NASA Astrophysics Data System (ADS)

Saripalli, Vinay; Narayanan, Vijay; Datta, Suman

Novel medical applications involving embedded sensors, require ultra low energy dissipation with low-to-moderate performance (10kHz-100MHz) driving the conventional MOSFETs into sub-threshold operation regime. In this paper, we present an alternate ultra-low power computing architecture using Binary Decision Diagram based logic circuits implemented using Single Electron Transistors (SETs) operating in the Coulomb blockade regime with very low supply voltages. We evaluate the energy - performance tradeoff metrics of such BDD circuits using time domain Monte Carlo simulations and compare them with the energy-optimized CMOS logic circuits. Simulation results show that the proposed approach achieves better energy-delay characteristics than CMOS realizations.

Exploring GPs' experiences of using diagnostic tools for cancer: a qualitative study in primary care.

PubMed

Green, Trish; Martins, Tanimola; Hamilton, William; Rubin, Greg; Elliott, Kathy; Macleod, Una

2015-02-01

The UK has an estimated 5-10000 extra cancer deaths each year when compared to other European countries and diagnostic delays are thought to make a significant contribution to this. One of the initiatives in England intended to support primary care professionals has been the development of cancer risk assessment tools (RATs). These tools assist in identifying and quantifying the risk of cancer in symptomatic primary care patients. To explore GPs' experiences of incorporating the RATs for lung and bowel cancers into their clinical practice and in so doing, identify constraints and facilitators to the wider dissemination of the tools in primary care. We conducted semi-structured interviews over the telephone with 11 project managers who implemented the study and 23 GPs who used the tool. The interviews were digitally recorded, professionally transcribed verbatim and analysed through the construction of a 'thematic framework'. The training and support package was fundamental to the successful integration of the RATs into GPs' daily routines. Ongoing support from cancer networks alongside acknowledgement of the clinical expertize of the GPs by those implementing the study enhanced GPs' uptake of the tool in practice. Findings suggest that the embedding of clinical decision support tools into clinical practice is more likely to be achieved when they are perceived to support but not supersede the clinical judgement of their users. This element of our findings is a focal point of this article. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Impact of decision support in electronic medical records on lipid management in primary care.

PubMed

Gill, James M; Chen, Ying Xia; Glutting, Joseph J; Diamond, James J; Lieberman, Michael I

2009-10-01

Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR. Adult primary care physicians were randomized by office to receive an electronic form that was embedded in the EMR. The form contained prompts regarding suboptimal care based on Adult Treatment Panel-III (ATP-III) guidelines, as well as reporting tools to identify patients outside of office visits whose lipid management was suboptimal. All active patients, ages 20-79 years, whose physicians participated in the study, were categorized as high, moderate, or low cardiovascular risk, and the proportion who were tested for hyperlipidemia, at lipid goal, and on lipid-lowering medications if not at goal were measured according to ATP-III guidelines. A total of 105 physicians from 25 offices and 64,150 patients were included in the study. Outcomes improved for most measures from before to 1 year after the intervention (November 1, 2005 to October 31, 2006). However, after controlling for confounding variables and for clustering in multilevel modeling, only up-to-date lipid testing for high-risk patients was statistically better in the intervention group as compared to the control group (adjusted odds ratio 15.0, P < 0.05). This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. Future studies may need to examine more comprehensive interventions that include office staff in a team approach to care.

Institutionalizing integrated treatment for concurrent disorders: creating new organizational discourse.

PubMed

Novotná, Gabriela

2013-01-01

The high overlap of mental health and substance use problems in the Canadian health care system and the subsequent demand for more effective services for clients with these high-risk issues have stimulated the debate on their integrated treatment. Although the idea of integration has been endorsed by decision makers at both programs and system levels, little attention has been paid to factors that have facilitated this process. In this article, the processes by which organizational texts, language, metaphors, and symbols have facilitated institutionalization of integrated treatment are identified and discussed. Findings from a qualitative case study of 2 treatment programs that were part of a large, urban hospital in Ontario providing services for populations with concurrent disorders are presented. Data were collected using semistructured interviews with professionals and clients, analysis of policy and organizational documents, and nonparticipant observations. Research evidence on comorbidity, government reports, and other organizational texts that were created and disseminated across the province has contributed to the dissemination of the concept of integration. Certain ideas might be successfully implemented when environments are conducive to change; such environmental catalysts include the status of professionals who support new discourse, the characteristics and importance of the problem being addressed, and the timing of implementation. The findings clearly demonstrate that the conditions of the wider institutional environment-the emergence of research evidence on comorbidity and the provincial health care reform, with its focus on rationalizing the existing health care system-supported the idea of integration. The ability to understand how discursive activities of program planners, clinicians, and policy makers contribute to making new ideas deeply embedded in organizational structures can become an important mechanism of effective decision-making activities when health managers attempt to promote new plans and strategies.

Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

PubMed Central

Alagiakrishnan, Kannayiram; Wilson, Patricia; Sadowski, Cheryl A; Rolfson, Darryl; Ballermann, Mark; Ausford, Allen; Vermeer, Karla; Mohindra, Kunal; Romney, Jacques; Hayward, Robert S

2016-01-01

Background Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs. PMID:26869776

The INTERPRET Decision-Support System version 3.0 for evaluation of Magnetic Resonance Spectroscopy data from human brain tumours and other abnormal brain masses

PubMed Central

2010-01-01

Background Proton Magnetic Resonance (MR) Spectroscopy (MRS) is a widely available technique for those clinical centres equipped with MR scanners. Unlike the rest of MR-based techniques, MRS yields not images but spectra of metabolites in the tissues. In pathological situations, the MRS profile changes and this has been particularly described for brain tumours. However, radiologists are frequently not familiar to the interpretation of MRS data and for this reason, the usefulness of decision-support systems (DSS) in MRS data analysis has been explored. Results This work presents the INTERPRET DSS version 3.0, analysing the improvements made from its first release in 2002. Version 3.0 is aimed to be a program that 1st, can be easily used with any new case from any MR scanner manufacturer and 2nd, improves the initial analysis capabilities of the first version. The main improvements are an embedded database, user accounts, more diagnostic discrimination capabilities and the possibility to analyse data acquired under additional data acquisition conditions. Other improvements include a customisable graphical user interface (GUI). Most diagnostic problems included have been addressed through a pattern-recognition based approach, in which classifiers based on linear discriminant analysis (LDA) were trained and tested. Conclusions The INTERPRET DSS 3.0 allows radiologists, medical physicists, biochemists or, generally speaking, any person with a minimum knowledge of what an MR spectrum is, to enter their own SV raw data, acquired at 1.5 T, and to analyse them. The system is expected to help in the categorisation of MR Spectra from abnormal brain masses. PMID:21114820

Will it rise or will it fall? Managing the complex effects of urbanization on base flow

USGS Publications Warehouse

Bhaskar, Aditi; Beesley, Leah; Burns, Matthew J.; Fletcher, T. D.; Hamel, Perrine; Oldham, Carolyn; Roy, Allison

2016-01-01

Sustaining natural levels of base flow is critical to maintaining ecological function as stream catchments are urbanized. Research shows a variable response of stream base flow to urbanization, with base flow or water tables rising in some locations, falling in others, or elsewhere remaining constant. The variable baseflow response is due to the array of natural (e.g., physiographic setting and climate) and anthropogenic (e.g., urban development and infrastructure) factors that influence hydrology. Perhaps as a consequence of this complexity, few simple tools exist to assist managers to predict baseflow change in their local urban area. This paper addresses this management need by presenting a decision support tool. The tool considers the natural vulnerability of the landscape, together with aspects of urban development in predicting the likelihood and direction of baseflow change. Where the tool identifies a likely increase or decrease it guides managers toward strategies that can reduce or increase groundwater recharge, respectively. Where the tool finds an equivocal result, it suggests a detailed water balance be performed. The decision support tool is embedded within an adaptive-management framework that encourages managers to define their ecological objectives, assess the vulnerability of their ecological objectives to changes in water table height, and monitor baseflow responses to urbanization. We trial our framework using two very different case studies: Perth, Western Australia, and Baltimore, Maryland, USA. Together, these studies show how pre-development water table height, climate and geology together with aspects of urban infrastructure (e.g., stormwater practices, leaky pipes) interact such that urbanization has overall led to rising base flow (Perth) and falling base flow (Baltimore). Greater consideration of subsurface components of the water cycle will help to protect and restore the ecology of urban freshwaters.

Semantic Clinical Guideline Documents

PubMed Central

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

2005-01-01

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

T and D-Bench--Innovative Combined Support for Education and Research in Computer Architecture and Embedded Systems

ERIC Educational Resources Information Center

Soares, S. N.; Wagner, F. R.

2011-01-01

Teaching and Design Workbench (T&D-Bench) is a framework aimed at education and research in the areas of computer architecture and embedded systems. It includes a set of features not found in other educational environments. This set of features is the result of an original combination of design requirements for T&D-Bench: that the…

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

PubMed

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

2007-01-01

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

Research on web-based decision support system for sports competitions

NASA Astrophysics Data System (ADS)

Huo, Hanqiang

2010-07-01

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

Delay differential analysis of time series.

PubMed

Lainscsek, Claudia; Sejnowski, Terrence J

2015-03-01

Nonlinear dynamical system analysis based on embedding theory has been used for modeling and prediction, but it also has applications to signal detection and classification of time series. An embedding creates a multidimensional geometrical object from a single time series. Traditionally either delay or derivative embeddings have been used. The delay embedding is composed of delayed versions of the signal, and the derivative embedding is composed of successive derivatives of the signal. The delay embedding has been extended to nonuniform embeddings to take multiple timescales into account. Both embeddings provide information on the underlying dynamical system without having direct access to all the system variables. Delay differential analysis is based on functional embeddings, a combination of the derivative embedding with nonuniform delay embeddings. Small delay differential equation (DDE) models that best represent relevant dynamic features of time series data are selected from a pool of candidate models for detection or classification. We show that the properties of DDEs support spectral analysis in the time domain where nonlinear correlation functions are used to detect frequencies, frequency and phase couplings, and bispectra. These can be efficiently computed with short time windows and are robust to noise. For frequency analysis, this framework is a multivariate extension of discrete Fourier transform (DFT), and for higher-order spectra, it is a linear and multivariate alternative to multidimensional fast Fourier transform of multidimensional correlations. This method can be applied to short or sparse time series and can be extended to cross-trial and cross-channel spectra if multiple short data segments of the same experiment are available. Together, this time-domain toolbox provides higher temporal resolution, increased frequency and phase coupling information, and it allows an easy and straightforward implementation of higher-order spectra across time compared with frequency-based methods such as the DFT and cross-spectral analysis.

Tuning the structural and electronic properties of heterogeneous chalcogenide nanostructures

NASA Astrophysics Data System (ADS)

Giberti, Federico; Voros, Marton; Galli, Giulia

Heterogeneous nanostructures, such as quantum dots (QDs) embedded in solid matrices, are promising platforms for solar energy conversion. Unfortunately, there is scarce information on the structure of the interface between the dots and their embedding matrix, thus hampering the design of functional materials with desired optoelectronic properties. Here, we developed a hierarchical computational strategy to obtain realistic models of semiconductor QDs embedded in matrices using enhanced sampling classical molecular dynamics simulations and predicted their electronic structure using first-principles electronic structure methods. We investigated PbSe/CdSe systems which are promising materials for solar cell applications and found a favorable quasi-type-II band alignments both for PbSe QDs in CdSe matrices and for CdSe embedded in PbSe. However, in the former case, we found the presence of detrimental intra-gap states, while in the latter no defect states are present. Hence we predict that embedding CdSe in PbSe leads to a more efficient platform for solar energy conversion. In addition, we showed that the structure of CdSe QD and in turn its band gap might be tuned by applying pressure to the PbSe matrix, providing a way to engineer the properties of new functional materials. Work by F. Giberti was supported by MICCoM funded by the U.S. Department of Energy (DOE), DOE/BES 5J-30161-0010A; work by M. Voros was supported by the U.S. DOE, under Award DE-AC02-06CH11357.

Integrating Climate and Risk-Informed Science to Support Critical Decisions

ScienceCinema

None

2018-01-16

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

Integrating Climate and Risk-Informed Science to Support Critical Decisions

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

None

2016-07-27

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

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

PubMed

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

2015-10-01

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

Design and implementation of embedded un-interruptible power supply system (EUPSS) for web-based mobile application

NASA Astrophysics Data System (ADS)

Zhang, De-gan; Zhang, Xiao-dan

2012-11-01

With the growth of the amount of information manipulated by embedded application systems, which are embedded into devices and offer access to the devices on the internet, the requirements of saving the information systemically is necessary so as to fulfil access from the client and the local processing more efficiently. For supporting mobile applications, a design and implementation solution of embedded un-interruptible power supply (UPS) system (in brief, EUPSS) is brought forward for long-distance monitoring and controlling of UPS based on Web. The implementation of system is based on ATmega161, RTL8019AS and Arm chips with TCP/IP protocol suite for communication. In the embedded UPS system, an embedded file system is designed and implemented which saves the data and index information on a serial EEPROM chip in a structured way and communicates with a microcontroller unit through I2C bus. By embedding the file system into UPS system or other information appliances, users can access and manipulate local data on the web client side. Embedded file system on chips will play a major role in the growth of IP networking. Based on our experiment tests, the mobile users can easily monitor and control UPS in different places of long-distance. The performance of EUPSS has satisfied the requirements of all kinds of Web-based mobile applications.

The effect of telephone support on depressive symptoms among HIV-infected pregnant women in Thailand: an embedded mixed methods study.

PubMed

Ross, Ratchneewan; Sawatphanit, Wilaiphan; Suwansujarid, Tatirat; Stidham, Andrea W; Drew, Barbara L; Creswell, John W

2013-01-01

Depressive symptoms negatively impact the lives of HIV-infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV-infected pregnant Thai women. HIV-infected pregnant Thai women (n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In-depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV-infected women, including the costs and benefits of such support. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

From nationwide standardized testing to school-based alternative embedded assessment in Israel: Students' performance in the matriculation 2000 project

NASA Astrophysics Data System (ADS)

Dori, Yehudit J.

2003-01-01

Matriculation 2000 was a 5-year project aimed at moving from the nationwide traditional examination system in Israel to a school-based alternative embedded assessment. Encompassing 22 high schools from various communities in the country, the Project aimed at fostering deep understanding, higher-order thinking skills, and students' engagement in learning through alternative teaching and embedded assessment methods. This article describes research conducted during the fifth year of the Project at 2 experimental and 2 control schools. The research objective was to investigate students' learning outcomes in chemistry and biology in the Matriculation 2000 Project. The assumption was that alternative embedded assessment has some effect on students' performance. The experimental students scored significantly higher than their control group peers on low-level assignments and more so on assignments that required higher-order thinking skills. The findings indicate that given adequate support and teachers' consent and collaboration, schools can transfer from nationwide or statewide standardized testing to school-based alter-native embedded assessment.

Tackling Complex Emergency Response Solutions Evaluation Problems in Sustainable Development by Fuzzy Group Decision Making Approaches with Considering Decision Hesitancy and Prioritization among Assessing Criteria.

PubMed

Qi, Xiao-Wen; Zhang, Jun-Ling; Zhao, Shu-Ping; Liang, Chang-Yong

2017-10-02

In order to be prepared against potential balance-breaking risks affecting economic development, more and more countries have recognized emergency response solutions evaluation (ERSE) as an indispensable activity in their governance of sustainable development. Traditional multiple criteria group decision making (MCGDM) approaches to ERSE have been facing simultaneous challenging characteristics of decision hesitancy and prioritization relations among assessing criteria, due to the complexity in practical ERSE problems. Therefore, aiming at the special type of ERSE problems that hold the two characteristics, we investigate effective MCGDM approaches by hiring interval-valued dual hesitant fuzzy set (IVDHFS) to comprehensively depict decision hesitancy. To exploit decision information embedded in prioritization relations among criteria, we firstly define an fuzzy entropy measure for IVDHFS so that its derivative decision models can avoid potential information distortion in models based on classic IVDHFS distance measures with subjective supplementing mechanism; further, based on defined entropy measure, we develop two fundamental prioritized operators for IVDHFS by extending Yager's prioritized operators. Furthermore, on the strength of above methods, we construct two hesitant fuzzy MCGDM approaches to tackle complex scenarios with or without known weights for decision makers, respectively. Finally, case studies have been conducted to show effectiveness and practicality of our proposed approaches.

‘They leave at least believing they had a part in the discussion’: Understanding decision aid use and patient–clinician decision-making through qualitative research

PubMed Central

Tiedje, Kristina; Shippee, Nathan D.; Johnson, Anna M.; Flynn, Priscilla M.; Finnie, Dawn M.; Liesinger, Juliette T.; May, Carl R.; Olson, Marianne E.; Ridgeway, Jennifer L.; Shah, Nilay D.; Yawn, Barbara P.; Montori, Victor M.

2013-01-01

Objective This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. Methods We conducted semistructured in-depth interviews with patients (n = 22) and primary care clinicians (n = 19), and videorecorded consultations (n = 44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes. Results DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants’ literacy regarding shared decision-making (SDM) and DAs). Conclusion DAs’ flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model. Practice implications Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making. PMID:23598292

Tackling Complex Emergency Response Solutions Evaluation Problems in Sustainable Development by Fuzzy Group Decision Making Approaches with Considering Decision Hesitancy and Prioritization among Assessing Criteria

PubMed Central

Qi, Xiao-Wen; Zhang, Jun-Ling; Zhao, Shu-Ping; Liang, Chang-Yong

2017-01-01

In order to be prepared against potential balance-breaking risks affecting economic development, more and more countries have recognized emergency response solutions evaluation (ERSE) as an indispensable activity in their governance of sustainable development. Traditional multiple criteria group decision making (MCGDM) approaches to ERSE have been facing simultaneous challenging characteristics of decision hesitancy and prioritization relations among assessing criteria, due to the complexity in practical ERSE problems. Therefore, aiming at the special type of ERSE problems that hold the two characteristics, we investigate effective MCGDM approaches by hiring interval-valued dual hesitant fuzzy set (IVDHFS) to comprehensively depict decision hesitancy. To exploit decision information embedded in prioritization relations among criteria, we firstly define an fuzzy entropy measure for IVDHFS so that its derivative decision models can avoid potential information distortion in models based on classic IVDHFS distance measures with subjective supplementing mechanism; further, based on defined entropy measure, we develop two fundamental prioritized operators for IVDHFS by extending Yager’s prioritized operators. Furthermore, on the strength of above methods, we construct two hesitant fuzzy MCGDM approaches to tackle complex scenarios with or without known weights for decision makers, respectively. Finally, case studies have been conducted to show effectiveness and practicality of our proposed approaches. PMID:28974045

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

PubMed

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

2017-04-01

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

District Central Office Leadership as Teaching: How Central Office Administrators Support Principals' Development as Instructional Leaders

ERIC Educational Resources Information Center

Honig, Meredith I.

2012-01-01

Purpose: Research on educational leadership underscores the importance of principals operating as instructional leaders and intensive job-embedded supports for such work; this research also identifies central office staff as key support providers. However, it teaches little about what central office staff do when they provide such support and how…

Using Scaffold Supports to Improve Student Practice and Understanding of an Authentic Inquiry Process in Science

ERIC Educational Resources Information Center

Turcotte, Sandrine; Hamel, Christine

2016-01-01

This study addressed computer-supported collaborative scientific inquiries in remote networked schools (Quebec, Canada). Three dyads of Grade 5-6 classrooms from remote locations across the province collaborated using the knowledge-building tool Knowledge Forum. Customized scaffold supports embedded in the online tool were used to support student…

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

Innovative urban forestry governance in Melbourne?: Investigating "green placemaking" as a nature-based solution.

PubMed

Gulsrud, Natalie Marie; Hertzog, Kelly; Shears, Ian

2018-02-01

A nature-based approach to climate resilience aims to challenge and re-frame conventional environmental management methods by refocusing solutions from technological strategies to socio-ecological principles such as human well-being and community-based governance models, thereby improving and legitimizing the delivery of ecosystem services (ES). There are, however, many challenges to applying a socio-ecological agenda to urban climate resilience and thereby re-framing ES delivery as community and people focused, a knowledge gap extensively outlined in the environmental governance literature. In this paper, we aim to contribute to this re-assesment of urban environmental governance by examining the City of Melbourne's approach to urban re-naturing governance from a place-based perspective. Here we focus on the city's internationally-acclaimed urban forest strategy (UFS), investigating how and to which extent the governance arrangements embedded within the UFS draw strength from diverse perspectives and allow for institutional arrangements that support "situated" reflexive decision making and co-creation. We find that Melbourne's UFS governance process fosters green placemaking by re-focusing climate adaptation solutions from technological strategies to situated socio-ecological principles such as human well-being and community-based decision making. In this sense, this case provides valuable insight for the broader UGI governance field regarding the opportunities and challenges associated with a socio-cultural approach to urban re-naturing and ES delivery. Copyright © 2017 Elsevier Inc. All rights reserved.

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

EPA Science Inventory

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

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

DOT National Transportation Integrated Search

2000-07-14

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

Development of a multisensor-based bio-botanic robot and its implementation using a self-designed embedded board.

PubMed

Chang, Chung-Liang; Sie, Ming-Fong; Shie, Jin-Long

2011-01-01

This paper presents the design concept of a bio-botanic robot which demonstrates its behavior based on plant growth. Besides, it can reflect the different phases of plant growth depending on the proportional amounts of light, temperature and water. The mechanism design is made up of a processed aluminum base, spring, polydimethylsiloxane (PDMS) and actuator to constitute the plant base and plant body. The control system consists of two micro-controllers and a self-designed embedded development board where the main controller transmits the values of the environmental sensing module within the embedded board to a sub-controller. The sub-controller determines the growth stage, growth height, and time and transmits its decision value to the main controller. Finally, based on the data transmitted by the sub-controller, the main controller controls the growth phase of the bio-botanic robot using a servo motor and leaf actuator. The research result not only helps children realize the variation of plant growth but also is entertainment-educational through its demonstration of the growth process of the bio-botanic robot in a short time.

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

DTIC Science & Technology

2005-04-01

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

Subjective audio quality evaluation of embedded-optimization-based distortion precompensation algorithms.

PubMed

Defraene, Bruno; van Waterschoot, Toon; Diehl, Moritz; Moonen, Marc

2016-07-01

Subjective audio quality evaluation experiments have been conducted to assess the performance of embedded-optimization-based precompensation algorithms for mitigating perceptible linear and nonlinear distortion in audio signals. It is concluded with statistical significance that the perceived audio quality is improved by applying an embedded-optimization-based precompensation algorithm, both in case (i) nonlinear distortion and (ii) a combination of linear and nonlinear distortion is present. Moreover, a significant positive correlation is reported between the collected subjective and objective PEAQ audio quality scores, supporting the validity of using PEAQ to predict the impact of linear and nonlinear distortion on the perceived audio quality.

Audio Watermark Embedding Technique Applying Auditory Stream Segregation: "G-encoder Mark" Able to Be Extracted by Mobile Phone

NASA Astrophysics Data System (ADS)

Modegi, Toshio

We are developing audio watermarking techniques which enable extraction of embedded data by cell phones. For that we have to embed data onto frequency ranges, where our auditory response is prominent, therefore data embedding will cause much auditory noises. Previously we have proposed applying a two-channel stereo play-back feature, where noises generated by a data embedded left-channel signal will be reduced by the other right-channel signal. However, this proposal has practical problems of restricting extracting terminal location. In this paper, we propose synthesizing the noise reducing right-channel signal with the left-signal and reduces noises completely by generating an auditory stream segregation phenomenon to users. This newly proposed makes the noise reducing right-channel signal unnecessary and supports monaural play-back operations. Moreover, we propose a wide-band embedding method causing dual auditory stream segregation phenomena, which enables data embedding on whole public phone frequency ranges and stable extractions with 3-G mobile phones. From these proposals, extraction precisions become higher than those by the previously proposed method whereas the quality damages of embedded signals become smaller. In this paper we present an abstract of our newly proposed method and experimental results comparing with those by the previously proposed method.

Extracting similar terms from multiple EMR-based semantic embeddings to support chart reviews.

PubMed

Cheng Ye, M S; Fabbri, Daniel

2018-05-21

Word embeddings project semantically similar terms into nearby points in a vector space. When trained on clinical text, these embeddings can be leveraged to improve keyword search and text highlighting. In this paper, we present methods to refine the selection process of similar terms from multiple EMR-based word embeddings, and evaluate their performance quantitatively and qualitatively across multiple chart review tasks. Word embeddings were trained on each clinical note type in an EMR. These embeddings were then combined, weighted, and truncated to select a refined set of similar terms to be used in keyword search and text highlighting. To evaluate their quality, we measured the similar terms' information retrieval (IR) performance using precision-at-K (P@5, P@10). Additionally a user study evaluated users' search term preferences, while a timing study measured the time to answer a question from a clinical chart. The refined terms outperformed the baseline method's information retrieval performance (e.g., increasing the average P@5 from 0.48 to 0.60). Additionally, the refined terms were preferred by most users, and reduced the average time to answer a question. Clinical information can be more quickly retrieved and synthesized when using semantically similar term from multiple embeddings. Copyright © 2018. Published by Elsevier Inc.

Self-Learning Embedded System for Object Identification in Intelligent Infrastructure Sensors.

PubMed

Villaverde, Monica; Perez, David; Moreno, Felix

2015-11-17

The emergence of new horizons in the field of travel assistant management leads to the development of cutting-edge systems focused on improving the existing ones. Moreover, new opportunities are being also presented since systems trend to be more reliable and autonomous. In this paper, a self-learning embedded system for object identification based on adaptive-cooperative dynamic approaches is presented for intelligent sensor's infrastructures. The proposed system is able to detect and identify moving objects using a dynamic decision tree. Consequently, it combines machine learning algorithms and cooperative strategies in order to make the system more adaptive to changing environments. Therefore, the proposed system may be very useful for many applications like shadow tolls since several types of vehicles may be distinguished, parking optimization systems, improved traffic conditions systems, etc.

To analyse a trace or not? Evaluating the decision-making process in the criminal investigation.

PubMed

Bitzer, Sonja; Ribaux, Olivier; Albertini, Nicola; Delémont, Olivier

2016-05-01

In order to broaden our knowledge and understanding of the decision steps in the criminal investigation process, we started by evaluating the decision to analyse a trace and the factors involved in this decision step. This decision step is embedded in the complete criminal investigation process, involving multiple decision and triaging steps. Considering robbery cases occurring in a geographic region during a 2-year-period, we have studied the factors influencing the decision to submit biological traces, directly sampled on the scene of the robbery or on collected objects, for analysis. The factors were categorised into five knowledge dimensions: strategic, immediate, physical, criminal and utility and decision tree analysis was carried out. Factors in each category played a role in the decision to analyse a biological trace. Interestingly, factors involving information available prior to the analysis are of importance, such as the fact that a positive result (a profile suitable for comparison) is already available in the case, or that a suspect has been identified through traditional police work before analysis. One factor that was taken into account, but was not significant, is the matrix of the trace. Hence, the decision to analyse a trace is not influenced by this variable. The decision to analyse a trace first is very complex and many of the tested variables were taken into account. The decisions are often made on a case-by-case basis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Architecture of a general purpose embedded Slow-Control Adapter ASIC for future high-energy physics experiments

NASA Astrophysics Data System (ADS)

Gabrielli, Alessandro; Loddo, Flavio; Ranieri, Antonio; De Robertis, Giuseppe

2008-10-01

This work is aimed at defining the architecture of a new digital ASIC, namely Slow-Control Adapter (SCA), which will be designed in a commercial 130-nm CMOS technology. This chip will be embedded within a high-speed data acquisition optical link (GBT) to control and monitor the front-end electronics in future high-energy physics experiments. The GBT link provides a transparent transport layer between the SCA and control electronics in the counting room. The proposed SCA supports a variety of common bus protocols to interface with end-user general-purpose electronics. Between the GBT and the SCA a standard 100 Mb/s IEEE-802.3 compatible protocol will be implemented. This standard protocol allows off-line tests of the prototypes using commercial components that support the same standard. The project is justified because embedded applications in modern large HEP experiments require particular care to assure the lowest possible power consumption, still offering the highest reliability demanded by very large particle detectors.

Bi-Level Decision Making for Supporting Energy and Water Nexus

NASA Astrophysics Data System (ADS)

Zhang, X.; Vesselinov, V. V.

2016-12-01

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

Harnessing Macroscopic Forces in Catalysis

DTIC Science & Technology

2009-11-09

Figure 1. Schematic representation of biasing reaction selectivity via mechanocatalysis. A catalyst, “ mcat ”, is embedded in an elastomeric support...Deformation of the elastomeric support transfers mechanical stress to mcat . Under stress-free conditions, mcat catalyzes the transformation of reactant

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

DOT National Transportation Integrated Search

2017-08-09

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

3D Printing PDMS Elastomer in a Hydrophilic Support Bath via Freeform Reversible Embedding.

PubMed

Hinton, Thomas J; Hudson, Andrew; Pusch, Kira; Lee, Andrew; Feinberg, Adam W

2016-10-10

Polydimethylsiloxane (PDMS) elastomer is used in a wide range of biomaterial applications including microfluidics, cell culture substrates, flexible electronics, and medical devices. However, it has proved challenging to 3D print PDMS in complex structures due to its low elastic modulus and need for support during the printing process. Here we demonstrate the 3D printing of hydrophobic PDMS prepolymer resins within a hydrophilic Carbopol gel support via freeform reversible embedding (FRE). In the FRE printing process, the Carbopol support acts as a Bingham plastic that yields and fluidizes when the syringe tip of the 3D printer moves through it, but acts as a solid for the PDMS extruded within it. This, in combination with the immiscibility of hydrophobic PDMS in the hydrophilic Carbopol, confines the PDMS prepolymer within the support for curing times up to 72 h while maintaining dimensional stability. After printing and curing, the Carbopol support gel releases the embedded PDMS prints by using phosphate buffered saline solution to reduce the Carbopol yield stress. As proof-of-concept, we used Sylgard 184 PDMS to 3D print linear and helical filaments via continuous extrusion and cylindrical and helical tubes via layer-by-layer fabrication. Importantly, we show that the 3D printed tubes were manifold and perfusable. The results demonstrate that hydrophobic polymers with low viscosity and long cure times can be 3D printed using a hydrophilic support, expanding the range of biomaterials that can be used in additive manufacturing. Further, by implementing the technology using low cost open-source hardware and software tools, the FRE printing technique can be rapidly implemented for research applications.

3D Printing PDMS Elastomer in a Hydrophilic Support Bath via Freeform Reversible Embedding

PubMed Central

2016-01-01

Polydimethylsiloxane (PDMS) elastomer is used in a wide range of biomaterial applications including microfluidics, cell culture substrates, flexible electronics, and medical devices. However, it has proved challenging to 3D print PDMS in complex structures due to its low elastic modulus and need for support during the printing process. Here we demonstrate the 3D printing of hydrophobic PDMS prepolymer resins within a hydrophilic Carbopol gel support via freeform reversible embedding (FRE). In the FRE printing process, the Carbopol support acts as a Bingham plastic that yields and fluidizes when the syringe tip of the 3D printer moves through it, but acts as a solid for the PDMS extruded within it. This, in combination with the immiscibility of hydrophobic PDMS in the hydrophilic Carbopol, confines the PDMS prepolymer within the support for curing times up to 72 h while maintaining dimensional stability. After printing and curing, the Carbopol support gel releases the embedded PDMS prints by using phosphate buffered saline solution to reduce the Carbopol yield stress. As proof-of-concept, we used Sylgard 184 PDMS to 3D print linear and helical filaments via continuous extrusion and cylindrical and helical tubes via layer-by-layer fabrication. Importantly, we show that the 3D printed tubes were manifold and perfusable. The results demonstrate that hydrophobic polymers with low viscosity and long cure times can be 3D printed using a hydrophilic support, expanding the range of biomaterials that can be used in additive manufacturing. Further, by implementing the technology using low cost open-source hardware and software tools, the FRE printing technique can be rapidly implemented for research applications. PMID:27747289

Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients--the INDICA study: a cluster randomized controlled trial.

PubMed

Ramallo-Fariña, Yolanda; García-Pérez, Lidia; Castilla-Rodríguez, Iván; Perestelo-Pérez, Lilisbeth; Wägner, Ana María; de Pablos-Velasco, Pedro; Domínguez, Armando Carrillo; Cortés, Mauro Boronat; Vallejo-Torres, Laura; Ramírez, Marcos Estupiñán; Martín, Pablo Pedrianes; García-Puente, Ignacio; Salinero-Fort, Miguel Ángel; Serrano-Aguilar, Pedro Guillermo

2015-04-09

Type 2 diabetes mellitus is a chronic disease whose health outcomes are related to patients and healthcare professionals' decision-making. The Diabetes Intervention study in the Canary Islands (INDICA study) aims to evaluate the effectiveness and cost-effectiveness of educational interventions supported by new technology decision tools for type 2 diabetes patients and primary care professionals in the Canary Islands. The INDICA study is an open, community-based, multicenter, clinical controlled trial with random allocation by clusters to one of three interventions or to usual care. The setting is primary care where physicians and nurses are invited to participate. Patients with diabetes diagnosis, 18-65 years of age, and regular users of mobile phone were randomly selected. Patients with severe comorbidities were excluded. The clusters are primary healthcare practices with enough professionals and available places to provide the intervention. The calculated sample size was 2,300 patients. Patients in group 1 are receiving an educational group program of eight sessions every 3 months led by trained nurses and monitored by means of logs and a web-based platform and tailored semi-automated SMS for continuous support. Primary care professionals in group 2 are receiving a short educational program to update their diabetes knowledge, which includes a decision support tool embedded into the electronic clinical record and a monthly feedback report of patients' results. Group 3 is receiving a combination of the interventions for patients and professionals. The primary endpoint is the change in HbA1c in 2 years. Secondary endpoints are cardiovascular risk factors, macrovascular and microvascular diabetes complications, quality of life, psychological outcomes, diabetes knowledge, and healthcare utilization. Data is being collected from interviews, questionnaires, clinical examinations, and records. Generalized linear mixed models with repeated time measurements will be used to analyze changes in outcomes. The cost-effectiveness analysis, from the healthcare services perspective, involves direct medical costs per quality-adjusted life year gained and two periods, a 'within-trial' period and a lifetime Markov model. Deterministic and probabilistic sensitivity analyses are planned. This ongoing trial aims to set up the implementation of evidence-based programs in the clinical setting for chronic patients. Clinical Trial.gov NCT01657227.

Modifications and integration of the electronic tracking board in a pediatric emergency department.

PubMed

Dexheimer, Judith W; Kennebeck, Stephanie

2013-07-01

Electronic health records (EHRs) are used for data storage; provider, laboratory, and patient communication; clinical decision support; procedure and medication orders; and decision support alerts. Clinical decision support is part of any EHR and is designed to help providers make better decisions. The emergency department (ED) poses a unique environment to the use of EHRs and clinical decision support. Used effectively, computerized tracking boards can help improve flow, communication, and the dissemination of pertinent visit information between providers and other departments in a busy ED. We discuss the unique modifications and decisions made in the implementation of an EHR and computerized tracking board in a pediatric ED. We discuss the changing views based on provider roles, customization to the user interface including the layout and colors, decision support, tracking board best practices collected from other institutions and colleagues, and a case study of using reminders on the electronic tracking board to drive pain reassessments.

How research funding agencies support science integration into policy and practice: An international overview

PubMed Central

2014-01-01

Background Funding agencies constitute one essential pillar for policy makers, researchers and health service delivery institutions. Such agencies are increasingly providing support for science implementation. In this paper, we investigate health research funding agencies and how they support the integration of science into policy, and of science into practice, and vice versa. Methods We selected six countries: Australia, The Netherlands, France, Canada, England and the United States. For 13 funding agencies, we compared their intentions to support, their actions related to science integration into policy and practice, and the reported benefits of this integration. We did a qualitative content analysis of the reports and information provided on the funding agencies’ websites. Results Most funding agencies emphasized the importance of science integration into policy and practice in their strategic orientation, and stated how this integration was structured. Their funding activities were embedded in the push, pull, or linkage/exchange knowledge transfer model. However, few program funding efforts were based on all three models. The agencies reported more often on the benefits of integration on practice, rather than on policy. External programs that were funded largely covered science integration into policy and practice at the end of grant stage, while overlooking the initial stages. Finally, external funding actions were more prominent than internally initiated bridging activities and training activities on such integration. Conclusions This paper contributes to research on science implementation because it goes beyond the two community model of researchers versus end users, to include funding agencies. Users of knowledge may be end users in health organizations like hospitals; civil servants assigned to decision making positions within funding agencies; civil servants outside of the Ministry of Health, such as the Ministry of the Environment; politicians deciding on health-related legislation; or even university researchers whose work builds on previous research. This heterogeneous sample of users may require different user-specific mechanisms for research initiation, development and dissemination. This paper builds the foundation for further discussion on science implementation from the perspective of funding agencies in the health field. In general, case studies can help in identifying best practices for evidence-informed decision making. PMID:24565209

How research funding agencies support science integration into policy and practice: an international overview.

PubMed

Smits, Pernelle A; Denis, Jean-Louis

2014-02-24

Funding agencies constitute one essential pillar for policy makers, researchers and health service delivery institutions. Such agencies are increasingly providing support for science implementation. In this paper, we investigate health research funding agencies and how they support the integration of science into policy, and of science into practice, and vice versa. We selected six countries: Australia, The Netherlands, France, Canada, England and the United States. For 13 funding agencies, we compared their intentions to support, their actions related to science integration into policy and practice, and the reported benefits of this integration. We did a qualitative content analysis of the reports and information provided on the funding agencies' websites. Most funding agencies emphasized the importance of science integration into policy and practice in their strategic orientation, and stated how this integration was structured. Their funding activities were embedded in the push, pull, or linkage/exchange knowledge transfer model. However, few program funding efforts were based on all three models. The agencies reported more often on the benefits of integration on practice, rather than on policy. External programs that were funded largely covered science integration into policy and practice at the end of grant stage, while overlooking the initial stages. Finally, external funding actions were more prominent than internally initiated bridging activities and training activities on such integration. This paper contributes to research on science implementation because it goes beyond the two community model of researchers versus end users, to include funding agencies. Users of knowledge may be end users in health organizations like hospitals; civil servants assigned to decision making positions within funding agencies; civil servants outside of the Ministry of Health, such as the Ministry of the Environment; politicians deciding on health-related legislation; or even university researchers whose work builds on previous research. This heterogeneous sample of users may require different user-specific mechanisms for research initiation, development and dissemination. This paper builds the foundation for further discussion on science implementation from the perspective of funding agencies in the health field. In general, case studies can help in identifying best practices for evidence-informed decision making.

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

Treesearch

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

1997-01-01

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

Parameter Estimation of Computationally Expensive Watershed Models Through Efficient Multi-objective Optimization and Interactive Decision Analytics

NASA Astrophysics Data System (ADS)

Akhtar, Taimoor; Shoemaker, Christine

2016-04-01

Watershed model calibration is inherently a multi-criteria problem. Conflicting trade-offs exist between different quantifiable calibration criterions indicating the non-existence of a single optimal parameterization. Hence, many experts prefer a manual approach to calibration where the inherent multi-objective nature of the calibration problem is addressed through an interactive, subjective, time-intensive and complex decision making process. Multi-objective optimization can be used to efficiently identify multiple plausible calibration alternatives and assist calibration experts during the parameter estimation process. However, there are key challenges to the use of multi objective optimization in the parameter estimation process which include: 1) multi-objective optimization usually requires many model simulations, which is difficult for complex simulation models that are computationally expensive; and 2) selection of one from numerous calibration alternatives provided by multi-objective optimization is non-trivial. This study proposes a "Hybrid Automatic Manual Strategy" (HAMS) for watershed model calibration to specifically address the above-mentioned challenges. HAMS employs a 3-stage framework for parameter estimation. Stage 1 incorporates the use of an efficient surrogate multi-objective algorithm, GOMORS, for identification of numerous calibration alternatives within a limited simulation evaluation budget. The novelty of HAMS is embedded in Stages 2 and 3 where an interactive visual and metric based analytics framework is available as a decision support tool to choose a single calibration from the numerous alternatives identified in Stage 1. Stage 2 of HAMS provides a goodness-of-fit measure / metric based interactive framework for identification of a small subset (typically less than 10) of meaningful and diverse set of calibration alternatives from the numerous alternatives obtained in Stage 1. Stage 3 incorporates the use of an interactive visual analytics framework for decision support in selection of one parameter combination from the alternatives identified in Stage 2. HAMS is applied for calibration of flow parameters of a SWAT model, (Soil and Water Assessment Tool) designed to simulate flow in the Cannonsville watershed in upstate New York. Results from the application of HAMS to Cannonsville indicate that efficient multi-objective optimization and interactive visual and metric based analytics can bridge the gap between the effective use of both automatic and manual strategies for parameter estimation of computationally expensive watershed models.

A Reference-Intensive Embedded Librarian Program: Kresge Business Administration Library's Program to Support Action-Based Learning at the Ross School of Business

ERIC Educational Resources Information Center

Berdish, Laura; Seeman, Corey

2010-01-01

While a great deal of literature on embedded librarians in academic libraries is focused on the role of instructor, there are many other services that could be provided by librarians working closely with students. The Kresge Business Administration Library (Stephen M. Ross School of Business at the University of Michigan) has created a unique…

Shifting State Partnership Program Resources to the Asia-Pacific Region

DTIC Science & Technology

2013-03-01

deployed along with embedded Soldiers from their partnered states in the form of Bilateral Embedded Support Teams (BEST). In these two cases , Illinois...services, and tourism and their contributions to quality of life.38 SPP built partner capacity to deter, prevent, and prepare for threats to trade and...Bulgaria, Czech Republic, and Macedonia. SOUTHCOM SPP includes Guatamala, Uruguay, Trinidad-Tobago, Jamaica, Venezuela, Guyana, Virgin Islands, Ecuador

The design of patient decision support interventions: addressing the theory-practice gap.

PubMed

Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky

2011-08-01

Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions. © 2010 Blackwell Publishing Ltd.

Advanced decision support for winter road maintenance

DOT National Transportation Integrated Search

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

Detroit deicing decision support tool : description, operation, and simulation results

DOT National Transportation Integrated Search

2006-01-01

The John A. Volpe National Transportation Systems Center, sponsored by the National Aeronautics and Space Administration, : developed a deicing decision support tool, for Detroit Metropolitan Wayne County Airport (DTW).1 The deicing decision support ...

Clinical decision support systems at the Vienna General Hospital using Arden Syntax: Design, implementation, and integration.

PubMed

Schuh, Christian; de Bruin, Jeroen S; Seeling, Walter

2015-12-01

The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years. We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance. Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration. Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted. Copyright © 2015 Elsevier B.V. All rights reserved.

Repetition priming influences distinct brain systems: evidence from task-evoked data and resting-state correlations.

PubMed

Wig, Gagan S; Buckner, Randy L; Schacter, Daniel L

2009-05-01

Behavioral dissociations suggest that a single experience can separately influence multiple processing components. Here we used a repetition priming functional magnetic resonance imaging paradigm that directly contrasted the effects of stimulus and decision changes to identify the underlying brain systems. Direct repetition of stimulus features caused marked reductions in posterior regions of the inferior temporal lobe that were insensitive to whether the decision was held constant or changed between study and test. By contrast, prefrontal cortex showed repetition effects that were sensitive to the exact stimulus-to-decision mapping. Analysis of resting-state functional connectivity revealed that the dissociated repetition effects are embedded within distinct brain systems. Regions that were sensitive to changes in the stimulus correlated with perceptual cortices, whereas the decision changes attenuated activity in regions correlated with middle-temporal regions and a frontoparietal control system. These results thus explain the long-known dissociation between perceptual and conceptual components of priming by revealing how a single experience can separately influence distinct, concurrently active brain systems.

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

ERIC Educational Resources Information Center

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

2009-01-01

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

Supported Decision Making: A Synthesis of the Literature across Intellectual Disability, Mental Health, and Aging

ERIC Educational Resources Information Center

Shogren, Karrie A.; Wehmeyer, Michael L.; Lassmann, Heather; Forber-Pratt, Anjali J.

2017-01-01

Supported decision making (SDM) has begun to receive significant attention as means to enable people to exercise autonomy and self-determination over decisions about their life. Practice frameworks that can be used to promote the provision of supports for decision making are needed. This paper integrates the literature across intellectual and…

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care.

PubMed

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

2015-10-01

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.

A methodology for the valuation and selection of adaptable technology portfolios and its application to small and medium airports

NASA Astrophysics Data System (ADS)

Pinon, Olivia J.

The increase in the types of airspace users (large aircraft, small and regional jets, very light jets, unmanned aerial vehicles, etc.), as well as the very limited number of future new airport development projects are some of the factors that will characterize the next decades in air transportation. These factors, associated with a persistent growth in air traffic will worsen the current gridlock situation experienced at some major airports. As airports are becoming the major capacity bottleneck to continued growth in air traffic, it is therefore primordial to make the most efficient use of the current, and very often, underutilized airport infrastructure. This research thus proposes to address the increase in air traffic demand and resulting capacity issues by considering the implementation of operational concepts and technologies at underutilized airports. However, there are many challenges associated with sustaining the development of this type of airports. First, the need to synchronize evolving technologies with airports’ needs and investment capabilities is paramount. Additionally, it was observed that the evolution of secondary airports, and their needs, is tightly linked to the environment in which they operate. In particular, sensitivity of airports to changes in the dynamics of their environment is important, therefore requiring that the factors that drive the need for technology acquisition be identified and characterized. Finally, the difficulty to evaluate risk and make financially viable decisions, particularly when investing in new technologies, cannot be ignored. This research provides a methodology that addresses these challenges and ensures the sustainability of airport capacity-enhancement investments in a continuously changing environment. In particular, it is articulated around the need to provide decision makers with the capability to valuate and select adaptable technology portfolios to ensure airport financial viability. Hence, the four-step process developed in this research leverages the benefits yielded by impact assessment techniques, system dynamics modeling, and real options analysis to 1) provide the decision maker with a rigorous, structured, and traceable process for technology selection, 2) assess the combined impact of interrelated technologies, 3) support the translation of technology impact factors into airport performance indicators, and help identify the factors that drive the need for capacity expansion, and finally 4) enable the quantitative assessment of the strategic value of embedding flexibility in the formulation of technology portfolios and investment options. In particular, the development of this methodology highlights the successful implementation of relevance tree analysis, morphological analysis, filters and dependency tables to support the aforementioned process for technology selection. Further, it illustrates the limited capability of Cross Impact Analysis to identify technology relationships for the problem at hand. Finally, this methodology demonstrates, through a change in demand at the airport modeled, the importance of being able to weigh both the technological and strategic performance of the technology portfolios considered. In particular, it illustrates the impact that the level of traffic, the presence of congestion, the timing and sequence of investments, and the number of technologies included, have on the strategic value of a portfolio. Hence, by capturing the time dimension and technology causality impacts in technology portfolio selection, this work helps identify key technologies or technology groupings, and assess their performance on airport metrics. By embedding flexibility in the formulation of investment scenarios, it provides the decision maker with a more accurate picture of the options available to him, as well as the time and sequence under which these should be exercised.

A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery.

PubMed

Fowler, G E; Baker, D M; Lee, M J; Brown, S R

2017-11-01

The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8). Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.

Palliative Care: Video Tells a Mother's Story of Caring Support

MedlinePlus

... page please turn JavaScript on. Feature: Palliative Care Video Tells a Mother's Story of Caring Support Past Issues / Spring 2014 Table of Contents YouTube embedded video: http://www.youtube-nocookie.com/embed/-hOBYFS_Z68 ...

Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: an introduction.

PubMed

Gent, David H; De Wolf, Erick; Pethybridge, Sarah J

2011-06-01

Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence

PubMed Central

2014-01-01

Background Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. Methods We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Results Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Conclusion Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs. PMID:25167807

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence.

PubMed

Pevnick, Joshua M; Li, Ning; Asch, Steven M; Jackevicius, Cynthia A; Bell, Douglas S

2014-08-28

Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence. We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care physicians (PCPs) who were offered e-prescribing with formulary decision support, including 297 PCPs who adopted it. Formulary decision support was initially non-interruptive, such that formulary tier symbols were displayed adjacent to medication names. Subsequently, interruptive formulary decision support alerts also interrupted e-prescribing when preferred-tier alternatives were available. A difference in differences design was used to compare the pre-post differences in medication tier for each new prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication. Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place (OR 1.9 [95% CI 1.0-3.4], p = 0.04), but no more likely to prescribe preferred-tier when only non-interruptive formulary decision support was in place (p = 0.90). Preferred-tier claims had only slightly lower mean monthly copayments than non-preferred tier claims (angiotensin receptor blocker: $10.60 versus $11.81, inhaled steroid: $14.86 versus $16.42, p < 0.0001). Medication possession ratio was 8% lower for each $1.00 increase in monthly copayment to the one quarter power (p < 0.0001). However, we detected no significant direct association between formulary decision support usage and adherence. Interruptive formulary decision support shifted prescribing toward preferred tiers, but these medications were only minimally less expensive in the studied patient population. In this context, formulary decision support did not significantly increase adherence. To impact cost-related non-adherence, formulary decision support will likely need to be paired with complementary drug benefit design. Formulary decision support should be studied further, with particular attention to its effect on adherence in the setting of different benefit designs.

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

PubMed

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

2017-12-28

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

Learning in Educational Computer Games for Novices: The Impact of Support Provision Types on Virtual Presence, Cognitive Load, and Learning Outcomes

ERIC Educational Resources Information Center

Schrader, Claudia; Bastiaens, Theo

2012-01-01

Embedding support devices in educational computer games has been asserted to positively affect learning outcomes. However, there is only limited direct empirical evidence on which design variations of support provision influence learning. In order to better understand the impact of support design on novices' learning, the current study…

Decision Support Systems for Research and Management in Advanced Life Support

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.

2004-01-01

Decision support systems have been implemented in many applications including strategic planning for battlefield scenarios, corporate decision making for business planning, production planning and control systems, and recommendation generators like those on Amazon.com(Registered TradeMark). Such tools are reviewed for developing a similar tool for NASA's ALS Program. DSS are considered concurrently with the development of the OPIS system, a database designed for chronicling of research and development in ALS. By utilizing the OPIS database, it is anticipated that decision support can be provided to increase the quality of decisions by ALS managers and researchers.

Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding.

PubMed

Sinclair, Shane; Hagen, Neil A; Chambers, Carole; Manns, Braden; Simon, Anita; Browman, George P

2008-05-01

Drug decision-makers are involved in developing and implementing policy, procedure and processes to support health resource allocation regarding drug treatment formularies. A variety of approaches to decision-making, including formal decision-making frameworks, have been developed to support transparent and fair priority setting. Recently, a decision tool, 'The 6-STEPPPs Tool', was developed to assist in making decisions about new cancer drugs within the public health care system. We conducted a qualitative study, utilizing focus groups and participant observation, in order to investigate the internal frameworks that supported and challenged individual participants as they applied this decision tool within a multi-stakeholder decision process. We discovered that health care resource allocation engaged not only the minds of decision-makers but profoundly called on the often conflicting values of the heart. Objective decision-making frameworks for new drug therapies need to consider the subjective internal frameworks of decision-makers that affect decisions. Understanding the very human, internal turmoil experienced by individuals involved in health care resource allocation, sheds additional insight into how to account for reasonableness and how to better support difficult decisions through transparent, values-based resource allocation policy, procedures and processes.

Decision Support Systems and the Conflict Model of Decision Making: A Stimulus for New Computer-Assisted Careers Guidance Systems.

ERIC Educational Resources Information Center

Ballantine, R. Malcolm

Decision Support Systems (DSSs) are computer-based decision aids to use when making decisions which are partially amenable to rational decision-making procedures but contain elements where intuitive judgment is an essential component. In such situations, DSSs are used to improve the quality of decision-making. The DSS approach is based on Simon's…

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: a randomized clinical trial.

PubMed

Dexheimer, Judith W; Abramo, Thomas J; Arnold, Donald H; Johnson, Kevin; Shyr, Yu; Ye, Fei; Fan, Kang-Hsien; Patel, Neal; Aronsky, Dominik

2014-11-01

The use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision. We performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2-18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision. The Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR=(141, 326)) and control group (223 min; IQR=(129, 316)); (p=0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p=0.867). ED length of stay did not differ among intervention (262 min; IQR=(165, 410)) and control group (247 min; IQR=(163, 379)); (p=0.818). The control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians' communication. Copyright © 2014. Published by Elsevier Ireland Ltd.

Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

PubMed

Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

2016-11-01

Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

Do occupation and work conditions really matter? A longitudinal analysis of psychological distress experiences among Canadian workers.

PubMed

Marchand, Alain; Demers, Andrée; Durand, Pierre

2005-07-01

This study analyses the relationship between occupation, work conditions and the experience of psychological distress within a model encompassing the stress promoted by constraints-resources embedded in macrosocial structures (occupational structure), structures of daily life (workplace, family, social networks outside the workplace) and agent personality (demography, physical health, psychological traits, life habits, stressful childhood events). Longitudinal data were derived from Statistics Canada's National Population Health Survey and comprised 6,359 workers nested in 471 occupations, followed four times between 1994-1995 and 2000-2001. Discrete time survival multilevel regressions were conducted on first and repeated episodes of psychological distress. Results showed that 42.9 per cent of workers had reported one episode of psychological distress and 18.7 per cent had done so more than once. Data supported the model and challenged the results of previous studies. The individual's position in the occupational structure plays a limited role when the structures of daily life and agent personality are accounted for. In the workplace, job insecurity and social support are important determinants, but greater decision authority increases the risk of psychological distress. Workplace constraints-resources are not moderated either by the other structures of daily life or by agent personality.

Addressing Risk in the Valuation of Energy Systems

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

Veeramany, Arun; Hammerstrom, Donald J.; Woodward, James T.

2017-06-26

Valuation is a mechanism by which potential worth of a transaction between two or more parties can be evaluated. Examples include valuation of transactive energy systems such as electric power system and building energy systems. Uncertainties can manifest while exercising a valuation methodology in the form of lack of knowledge or be inherently embedded in the valuation process. Uncertainty could also exist in the temporal dimension while planning for long-term growth. This paper discusses risk considerations associated with valuation studies in support of decision-making in the presence of such uncertainties. It is often important to have foresight of uncertain entitiesmore » that can impact real-world deployments, such as the comparison or ranking of two valuation studies to determine cost-benefit impacts to multiple stakeholders. The research proposes to address this challenge through simulation and sensitivity analyses to support ‘what-if’ analysis of well-defined future scenarios. This paper describes foundational value of diagrammatic representation techniques such as unified modeling language to understand the implications of not addressing some of the risk elements encountered during the valuation process. The paper includes examples from generation resource adequacy assessment studies (e.g. loss of load) to illustrate the principles of risk in valuation.« less

Social Withdrawal Among Individuals Receiving Psychiatric Care: Derivation of a Scale Using Routine Clinical Assessment Data to Support Screening and Outcome Measurement.

PubMed

Rios, Sebastian; Perlman, Christopher M

2017-04-24

Social withdrawal is a symptom experienced by individuals with an array of mental health conditions, particularly those with schizophrenia and mood disorders. Assessments of social withdrawal are often lengthy and may not be routinely integrated within the comprehensive clinical assessment of the individual. This study utilized item response and classical test theory methods to derive a Social Withdrawal Scale (SWS) using items embedded within a routine clinical assessment, the RAI-Mental Health (RAI-MH). Using data from 60,571 inpatients in Ontario, Canada, a common factor analysis identified seven items from the RAI-MH that measure social withdrawal. A graded response model found that six items had acceptable discrimination parameters: lack of motivation, reduced interaction, decreased energy, flat affect, anhedonia, and loss of interest. Summing these items, the SWS was found to have strong internal consistency (Cronbach's alpha = 0.82) and showed a medium to large effect size (d = 0.77) from admission to discharge. Fewer individuals with high SWS scores participated in social activity or reported having a confidant compared to those with lower scores. Since the RAI-MH is available across clinical subgroups in several jurisdictions, the SWS is a useful tool for screening, clinical decision support, and evaluation.

Collaborative Response and Recovery from a Foot-and-Mouth Disease Animal Health Emergency: Supporting Decision Making in a Complex Environment with Multiple Stakeholders

DTIC Science & Technology

2013-12-01

RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING IN A COMPLEX ENVIRONMENT WITH MULTIPLE...Thesis 4. TITLE AND SUBTITLE COLLABORATIVE RESPONSE AND RECOVERY FROM A FOOT-AND- MOUTH DISEASE ANIMAL HEALTH EMERGENCY: SUPPORTING DECISION MAKING...200 words ) This thesis recommends ways to support decision makers who must operate within the multi-stakeholder complex situation of response and

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

PubMed Central

Wright, Adam; Sittig, Dean F.

2008-01-01

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

AppBuilder for DSSTools; an application development environment for developing decision support systems in Prolog

Treesearch

Geneho Kim; Donald Nute; H. Michael Rauscher; David L. Loftis

2000-01-01

A programming environment for developing complex decision support systems (DSSs) should support rapid prototyping and modular design, feature a flexible knowledge representation scheme and sound inference mechanisms, provide project management, and be domain independent. We have previously developed DSSTools (Decision Support System Tools), a reusable, domain-...

Pragmatic clinical trials embedded in healthcare systems: generalizable lessons from the NIH Collaboratory.

PubMed

Weinfurt, Kevin P; Hernandez, Adrian F; Coronado, Gloria D; DeBar, Lynn L; Dember, Laura M; Green, Beverly B; Heagerty, Patrick J; Huang, Susan S; James, Kathryn T; Jarvik, Jeffrey G; Larson, Eric B; Mor, Vincent; Platt, Richard; Rosenthal, Gary E; Septimus, Edward J; Simon, Gregory E; Staman, Karen L; Sugarman, Jeremy; Vazquez, Miguel; Zatzick, Douglas; Curtis, Lesley H

2017-09-18

The clinical research enterprise is not producing the evidence decision makers arguably need in a timely and cost effective manner; research currently involves the use of labor-intensive parallel systems that are separate from clinical care. The emergence of pragmatic clinical trials (PCTs) poses a possible solution: these large-scale trials are embedded within routine clinical care and often involve cluster randomization of hospitals, clinics, primary care providers, etc. Interventions can be implemented by health system personnel through usual communication channels and quality improvement infrastructure, and data collected as part of routine clinical care. However, experience with these trials is nascent and best practices regarding design operational, analytic, and reporting methodologies are undeveloped. To strengthen the national capacity to implement cost-effective, large-scale PCTs, the Common Fund of the National Institutes of Health created the Health Care Systems Research Collaboratory (Collaboratory) to support the design, execution, and dissemination of a series of demonstration projects using a pragmatic research design. In this article, we will describe the Collaboratory, highlight some of the challenges encountered and solutions developed thus far, and discuss remaining barriers and opportunities for large-scale evidence generation using PCTs. A planning phase is critical, and even with careful planning, new challenges arise during execution; comparisons between arms can be complicated by unanticipated changes. Early and ongoing engagement with both health care system leaders and front-line clinicians is critical for success. There is also marked uncertainty when applying existing ethical and regulatory frameworks to PCTS, and using existing electronic health records for data capture adds complexity.

Changing hospitals, choosing chemotherapy and deciding you've made the right choice: Understanding the role of online support groups in different health decision-making activities.

PubMed

Sillence, Elizabeth; Bussey, Lauren

2017-05-01

To investigate the ways in which people use online support groups (OSGs) in relation to their health decision-making and to identify the key features of the resource that support those activities. Eighteen participants who used OSGs for a range of health conditions participated in qualitative study in which they were interviewed about their experiences of using OSGs in relation to decision-making. Exploration of their experiences was supported by discussion of illustrative quotes. Across the health conditions OSGs supported two main decision-making activities: (i) prompting decision making and (ii) evaluating and confirming decisions already made. Depending on the activity, participants valued information about the process, the experience and the outcome of patient narratives. The importance of forum interactivity was highlighted in relation to advice-seeking and the selection of relevant personal experiences. People use OSGs in different ways to support their health related decision-making valuing the different content types of the narratives and the interactivity provided by the resource. Engaging with OSGs helps people in a number of different ways in relation to decision-making. However, it only forms one part of people's decision-making strategies and appropriate resources should be signposted where possible. Copyright © 2017 Elsevier B.V. All rights reserved.

The Design and Use of Decision Support Systems by Academic Departments. AIR 1987 Annual Forum Paper.

ERIC Educational Resources Information Center

Johnson, F. Craig

The design and use of a departmental decision support system at Florida State University are described from the perspective of a department head. The decisions selected for study are ones of adequacy, equitability, quality, efficiency, and consistency. The complexity of the decision is related to the complexity of the support system. The major…

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

ERIC Educational Resources Information Center

Erskine, Michael A.

2013-01-01

As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…

The embedded operating system project

NASA Technical Reports Server (NTRS)

Campbell, R. H.

1985-01-01

The design and construction of embedded operating systems for real-time advanced aerospace applications was investigated. The applications require reliable operating system support that must accommodate computer networks. Problems that arise in the construction of such operating systems, reconfiguration, consistency and recovery in a distributed system, and the issues of real-time processing are reported. A thesis that provides theoretical foundations for the use of atomic actions to support fault tolerance and data consistency in real-time object-based system is included. The following items are addressed: (1) atomic actions and fault-tolerance issues; (2) operating system structure; (3) program development; (4) a reliable compiler for path Pascal; and (5) mediators, a mechanism for scheduling distributed system processes.

Gender inequality in the welfare state: sex segregation in housework, 1965-2003.

PubMed

Hook, Jennifer L

2010-03-01

National context may influence sex segregation of household tasks through both pragmatic decision making and the normative context in which decision making is embedded. This study utilizes 36 time use surveys from 19 countries (spanning 1965-2003) combined with original national-level data in multilevel models to examine household task segregation. Analyses reveal that men do less and women do more time-inflexible housework in nations where work hours and parental leave are long. Women do less of this work where there is more public child care and men are eligible to take parental leave. National context affects the character of gender inequality in the home through individual- and national-level pathways.

From guideline modeling to guideline execution: defining guideline-based decision-support services.

PubMed Central

Tu, S. W.; Musen, M. A.

2000-01-01

We describe our task-based approach to defining the guideline-based decision-support services that the EON system provides. We categorize uses of guidelines in patient-specific decision support into a set of generic tasks--making of decisions, specification of work to be performed, interpretation of data, setting of goals, and issuance of alert and reminders--that can be solved using various techniques. Our model includes constructs required for representing the knowledge used by these techniques. These constructs form a toolkit from which developers can select modeling solutions for guideline task. Based on the tasks and the guideline model, we define a guideline-execution architecture and a model of interactions between a decision-support server and clients that invoke services provided by the server. These services use generic interfaces derived from guideline tasks and their associated modeling constructs. We describe two implementations of these decision-support services and discuss how this work can be generalized. We argue that a well-defined specification of guideline-based decision-support services will facilitate sharing of tools that implement computable clinical guidelines. PMID:11080007

Platform for real-time simulation of dynamic systems and hardware-in-the-loop for control algorithms.

PubMed

de Souza, Isaac D T; Silva, Sergio N; Teles, Rafael M; Fernandes, Marcelo A C

2014-10-15

The development of new embedded algorithms for automation and control of industrial equipment usually requires the use of real-time testing. However, the equipment required is often expensive, which means that such tests are often not viable. The objective of this work was therefore to develop an embedded platform for the distributed real-time simulation of dynamic systems. This platform, called the Real-Time Simulator for Dynamic Systems (RTSDS), could be applied in both industrial and academic environments. In industrial applications, the RTSDS could be used to optimize embedded control algorithms. In the academic sphere, it could be used to support research into new embedded solutions for automation and control and could also be used as a tool to assist in undergraduate and postgraduate teaching related to the development of projects concerning on-board control systems.

Platform for Real-Time Simulation of Dynamic Systems and Hardware-in-the-Loop for Control Algorithms

PubMed Central

de Souza, Isaac D. T.; Silva, Sergio N.; Teles, Rafael M.; Fernandes, Marcelo A. C.

2014-01-01

The development of new embedded algorithms for automation and control of industrial equipment usually requires the use of real-time testing. However, the equipment required is often expensive, which means that such tests are often not viable. The objective of this work was therefore to develop an embedded platform for the distributed real-time simulation of dynamic systems. This platform, called the Real-Time Simulator for Dynamic Systems (RTSDS), could be applied in both industrial and academic environments. In industrial applications, the RTSDS could be used to optimize embedded control algorithms. In the academic sphere, it could be used to support research into new embedded solutions for automation and control and could also be used as a tool to assist in undergraduate and postgraduate teaching related to the development of projects concerning on-board control systems. PMID:25320906

Tales from the frontline: the experiences of early childhood practitioners working with an 'embedded' research team.

PubMed

Wong, Sandie

2009-05-01

In late 2006, SDN Children's Services, an Australian not-for-profit provider of services for children, families and communities, engaged a research team that was 'embedded' within the organisation for 1 year. This action represented a significant investment of resources, such as staff time and organisational funds, and demonstrates SDN's strong commitment to research and evaluation as a means of supporting organisational learning and development. This paper highlights the innovative nature of the approach by positioning the role of the embedded researcher within the current theoretical and socio-political context. It also provides evidence of the success of the approach by reporting on the findings of a study that investigated staff's experiences of being involved in this type of collaborative investigation of their work. I argue that the employment of an embedded researcher can have positive benefits both for the organisation and the practitioners--but who the researchers are really matters.

On second harmonic generation and multiphoton-absorption induced luminescence from laser-reshaped silver nanoparticles embedded in glass.

PubMed

Zolotovskaya, S A; Tyrk, M A; Stalmashonak, A; Gillespie, W A; Abdolvand, A

2016-10-28

Spherical silver nanoparticles (NPs) of 30 nm diameter embedded in soda-lime glass were uniformly reshaped (elongated) after irradiation by a linearly polarised 250 fs pulsed laser operating within the NPs' surface plasmon resonance band. We observed second harmonic generation (SHG) and multiphoton-absorption-induced luminescence (MAIL) in the embedded laser-reshaped NPs upon picosecond (10 ps) pulsed laser excitation at 1064 nm. A complementary study of SHG and MAIL was conducted in soda-lime glass containing embedded, mechanically-reshaped silver NPs of a similar elongation ratio (aspect ratio) to the laser-reshaped NPs. This supports the notion that the observed difference in SHG and MAIL in the studied nanocomposite systems is due to the shape modification mechanism. The discrete dipole approximation method was used to assess the absorption and scattering cross-sections of the reshaped NPs with different elongation ratios.

Biological embedding of perinatal social relationships in infant stress reactivity.

PubMed

Thomas, Jenna C; Letourneau, Nicole; Bryce, Crystal I; Campbell, Tavis S; Giesbrecht, Gerald F

2017-05-01

Whereas significant advances have been made in understanding how exposure to early adversity "gets under the skin" of children to result in long term changes in developmental outcomes, the processes by which positive social relationships become biologically embedded remain poorly understood. The aim of this study was to understand the pathways by which maternal and infant social environments become biologically embedded in infant cortisol reactivity. Two hundred seventy-two pregnant women and their infants were prospectively assessed during pregnancy and at 6 months postpartum. In serial mediation analyses, higher perceived social support from partners during pregnancy was associated with lower infant cortisol reactivity or larger decreases in cortisol in response to a stressor at 6 months of age via lower self-reported prenatal maternal depression and higher mother-infant interaction quality. The findings add to our understanding of how perinatal social relationships become biologically embedded in child development. © 2017 Wiley Periodicals, Inc.

Tools to support GHG emissions reduction : a regional effort, part 1 - carbon footprint estimation and decision support.

DOT National Transportation Integrated Search

2010-09-01

Tools are proposed for carbon footprint estimation of transportation construction projects and decision support : for construction firms that must make equipment choice and usage decisions that affect profits, project duration : and greenhouse gas em...

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

EPA Science Inventory

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

The Feasibility of a Decision Support System for the Determination of Source Selection Evaluation Criteria

DTIC Science & Technology

1984-09-01

is not only difficult and time consuming , but also crucial to the success of the project, the question is whether a decision support system designed...KtI I - uAujvhIMtf IENE In THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR THE DETERMINATION OF SOURCE SELECTION EVALUATION ’CRITERIA THESIS .2...INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio DZM=0N STATEMENT A ,’r !’ILMILSHIM S /8 4 THE FEASIBILITY OF A DECISION SUPPORT SYSTEM FOR

Adaptation of a Knowledge-Based Decision-Support System in the Tactical Environment.

DTIC Science & Technology

1981-12-01

002-04-6411S1CURITY CL All PICATION OF 1,416 PAGE (00HIR Onto ea0aOW .L10 *GU9WVC 4bGSI.CAYON S. Voss 10466lVka t... OftesoE ’ making decisons . The...noe..aaw Ad tdlalttt’ IV 680011 MMib) Artificial Intelligence; Decision-Support Systems; Tactical Decision- making ; Knowledge-based Decision-support...tactical information to assist tactical commanders in making decisions. The system, TAC*, for "Tactical Adaptable Consultant," incorporates a database

Engaging Caregivers Through Mission and Values Review.

PubMed

Lucy, Rachel; Ponzetti, Rosanne; Pruitt, Kathleen

2016-07-01

Leaders of today's Catholic ministries are entrusted with an organizational responsibility to promote, sustain and remain true to Christ's healing ministry and the Catholic tradi- tion of caring for and nurturing people in need. Mission integration is a dynamic pro- cess that sets the context for the ministry of service, embedding mission into organizational practices, policies, structures and decisions and formally socializing people into a collective culture of mission and service.

Control of autonomous ground vehicles: a brief technical review

NASA Astrophysics Data System (ADS)

Babak, Shahian-Jahromi; Hussain, Syed A.; Karakas, Burak; Cetin, Sabri

2017-07-01

This paper presents a brief review of the developments achieved in autonomous vehicle systems technology. A concise history of autonomous driver assistance systems is presented, followed by a review of current state of the art sensor technology used in autonomous vehicles. Standard sensor fusion method that has been recently explored is discussed. Finally, advances in embedded software methodologies that define the logic between sensory information and actuation decisions are reviewed.

Leadership, Decision Making, and the Judeo-Christian Ethic

DTIC Science & Technology

1993-06-04

Major General Buckingham writes, "The moral justification for 3 our profession is embedded in the Constitution. ൕ Superficially, the basis for the...foundational structure suggests the existence of an ancient foundation that continues influencing it. Buckingham notes, "Our Western value system of right...Nehemiah, Cyril Barber writes: Nehemiah is serving as a cupbearer in Susa, the principal palace and winter residence of the king (Arraxerxes, King of the

Embedded Meta-Material Antennas

DTIC Science & Technology

2009-01-31

influence of the overall capacitance . Based on the tunable SRRs, we designed a tunable loop antenna with SRRs and HPTs as tuning elements. In this case, we...are those of the authors) and should not be construed as an official Department of the Army position, policy or decision, unless so designated by...single aperture, which can provide significant miniaturization and flexibility to the entire system. To design such miniaturized antennas, new materials

Systematic Model-in-the-Loop Test of Embedded Control Systems

NASA Astrophysics Data System (ADS)

Krupp, Alexander; Müller, Wolfgang

Current model-based development processes offer new opportunities for verification automation, e.g., in automotive development. The duty of functional verification is the detection of design flaws. Current functional verification approaches exhibit a major gap between requirement definition and formal property definition, especially when analog signals are involved. Besides lack of methodical support for natural language formalization, there does not exist a standardized and accepted means for formal property definition as a target for verification planning. This article addresses several shortcomings of embedded system verification. An Enhanced Classification Tree Method is developed based on the established Classification Tree Method for Embeded Systems CTM/ES which applies a hardware verification language to define a verification environment.

Product-based Safety Certification for Medical Devices Embedded Software.

PubMed

Neto, José Augusto; Figueiredo Damásio, Jemerson; Monthaler, Paul; Morais, Misael

2015-01-01

Worldwide medical device embedded software certification practices are currently focused on manufacturing best practices. In Brazil, the national regulatory agency does not hold a local certification process for software-intensive medical devices and admits international certification (e.g. FDA and CE) from local and international industry to operate in the Brazilian health care market. We present here a product-based certification process as a candidate process to support the Brazilian regulatory agency ANVISA in medical device software regulation. Center of Strategic Technology for Healthcare (NUTES) medical device embedded software certification is based on a solid safety quality model and has been tested with reasonable success against the Class I risk device Generic Infusion Pump (GIP).

A biomolecular detection method based on charge pumping in a nanogap embedded field-effect-transistor biosensor

NASA Astrophysics Data System (ADS)

Kim, Sungho; Ahn, Jae-Hyuk; Park, Tae Jung; Lee, Sang Yup; Choi, Yang-Kyu

2009-06-01

A unique direct electrical detection method of biomolecules, charge pumping, was demonstrated using a nanogap embedded field-effect-transistor (FET). With aid of a charge pumping method, sensitivity can fall below the 1 ng/ml concentration regime in antigen-antibody binding of an avian influenza case. Biomolecules immobilized in the nanogap are mainly responsible for the acute changes of the interface trap density due to modulation of the energy level of the trap. This finding is supported by a numerical simulation. The proposed detection method for biomolecules using a nanogap embedded FET represents a foundation for a chip-based biosensor capable of high sensitivity.

Advanced DC/DC Converters Towards Higher Volumetric Efficiencies For Space Applications

NASA Technical Reports Server (NTRS)

Shaw, Harry; Shue, Jack; Liu, David; Wang, Bright; Plante, Jeanette

2005-01-01

A new emphasis on planetary exploration by NASA drives the need for small, high power DC/DC converters which are functionally modular. NASA GSFC and other government space organizations are supporting technology development in the DC/DC converter area to both meet new needs and to promote more sources of supply. New technologies which enable miniaturization such as embedded passive technologies and thermal management using high thermal conductivity materials are features of the new designs. Construction of some simple DC/DC converter core circuits using embedded components was found to be successful for increasing volumetric efficiency to 37 W/inch. The embedded passives were also able to perform satisfactorily in this application in cryogenic temperatures.

Slice&Dice: Recognizing Food Preparation Activities Using Embedded Accelerometers

NASA Astrophysics Data System (ADS)

Pham, Cuong; Olivier, Patrick

Within the context of an endeavor to provide situated support for people with cognitive impairments in the kitchen, we developed and evaluated classifiers for recognizing 11 actions involved in food preparation. Data was collected from 20 lay subjects using four specially designed kitchen utensils incorporating embedded 3-axis accelerometers. Subjects were asked to prepare a mixed salad in our laboratory-based instrumented kitchen environment. Video of each subject's food preparation activities were independently annotated by three different coders. Several classifiers were trained and tested using these features. With an overall accuracy of 82.9% our investigation demonstrated that a broad set of food preparation actions can be reliably recognized using sensors embedded in kitchen utensils.

Role-playing simulation as an educational tool for health care personnel: developing an embedded assessment framework.

PubMed

Libin, Alexander; Lauderdale, Manon; Millo, Yuri; Shamloo, Christine; Spencer, Rachel; Green, Brad; Donnellan, Joyce; Wellesley, Christine; Groah, Suzanne

2010-04-01

Simulation- and video game-based role-playing techniques have been proven effective in changing behavior and enhancing positive decision making in a variety of professional settings, including education, the military, and health care. Although the need for developing assessment frameworks for learning outcomes has been clearly defined, there is a significant gap between the variety of existing multimedia-based instruction and technology-mediated learning systems and the number of reliable assessment algorithms. This study, based on a mixed methodology research design, aims to develop an embedded assessment algorithm, a Knowledge Assessment Module (NOTE), to capture both user interaction with the educational tool and knowledge gained from the training. The study is regarded as the first step in developing an assessment framework for a multimedia educational tool for health care professionals, Anatomy of Care (AOC), that utilizes Virtual Experience Immersive Learning Simulation (VEILS) technology. Ninety health care personnel of various backgrounds took part in online AOC training, choosing from five possible scenarios presenting difficult situations of everyday care. The results suggest that although the simulation-based training tool demonstrated partial effectiveness in improving learners' decision-making capacity, a differential learner-oriented approach might be more effective and capable of synchronizing educational efforts with identifiable relevant individual factors such as sociobehavioral profile and professional background.

Planetary micro-rover operations on Mars using a Bayesian framework for inference and control

NASA Astrophysics Data System (ADS)

Post, Mark A.; Li, Junquan; Quine, Brendan M.

2016-03-01

With the recent progress toward the application of commercially-available hardware to small-scale space missions, it is now becoming feasible for groups of small, efficient robots based on low-power embedded hardware to perform simple tasks on other planets in the place of large-scale, heavy and expensive robots. In this paper, we describe design and programming of the Beaver micro-rover developed for Northern Light, a Canadian initiative to send a small lander and rover to Mars to study the Martian surface and subsurface. For a small, hardware-limited rover to handle an uncertain and mostly unknown environment without constant management by human operators, we use a Bayesian network of discrete random variables as an abstraction of expert knowledge about the rover and its environment, and inference operations for control. A framework for efficient construction and inference into a Bayesian network using only the C language and fixed-point mathematics on embedded hardware has been developed for the Beaver to make intelligent decisions with minimal sensor data. We study the performance of the Beaver as it probabilistically maps a simple outdoor environment with sensor models that include uncertainty. Results indicate that the Beaver and other small and simple robotic platforms can make use of a Bayesian network to make intelligent decisions in uncertain planetary environments.

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

NASA Astrophysics Data System (ADS)

Huang, L. Xinglai; Sheng, Grant

2006-10-01

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

Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

PubMed

Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

2016-01-01

Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. Copyright 2016, SLACK Incorporated.

My Lived Experiences Are More Important Than Your Probabilities: The Role of Individualized Risk Estimates for Decision Making about Participation in the Study of Tamoxifen and Raloxifene (STAR).

PubMed

Holmberg, Christine; Waters, Erika A; Whitehouse, Katie; Daly, Mary; McCaskill-Stevens, Worta

2015-11-01

Decision-making experts emphasize that understanding and using probabilistic information are important for making informed decisions about medical treatments involving complex risk-benefit tradeoffs. Yet empirical research demonstrates that individuals may not use probabilities when making decisions. To explore decision making and the use of probabilities for decision making from the perspective of women who were risk-eligible to enroll in the Study of Tamoxifen and Raloxifene (STAR). We conducted narrative interviews with 20 women who agreed to participate in STAR and 20 women who declined. The project was based on a narrative approach. Analysis included the development of summaries of each narrative, and thematic analysis with developing a coding scheme inductively to code all transcripts to identify emerging themes. Interviewees explained and embedded their STAR decisions within experiences encountered throughout their lives. Such lived experiences included but were not limited to breast cancer family history, a personal history of breast biopsies, and experiences or assumptions about taking tamoxifen or medicines more generally. Women's explanations of their decisions about participating in a breast cancer chemoprevention trial were more complex than decision strategies that rely solely on a quantitative risk-benefit analysis of probabilities derived from populations In addition to precise risk information, clinicians and risk communicators should recognize the importance and legitimacy of lived experience in individual decision making. © The Author(s) 2015.

Assessing the Value of Post-processed State-of-the-art Long-term Weather Forecast Ensembles within An Integrated Agronomic Modelling Framework

NASA Astrophysics Data System (ADS)

LI, Y.; Castelletti, A.; Giuliani, M.

2014-12-01

Over recent years, long-term climate forecast from global circulation models (GCMs) has been demonstrated to show increasing skills over the climatology, thanks to the advances in the modelling of coupled ocean-atmosphere dynamics. Improved information from long-term forecast is supposed to be a valuable support to farmers in optimizing farming operations (e.g. crop choice, cropping time) and for more effectively coping with the adverse impacts of climate variability. Yet, evaluating how valuable this information can be is not straightforward and farmers' response must be taken into consideration. Indeed, while long-range forecast are traditionally evaluated in terms of accuracy by comparison of hindcast and observed values, in the context of agricultural systems, potentially useful forecast information should alter the stakeholders' expectation, modify their decisions and ultimately have an impact on their annual benefit. Therefore, it is more desirable to assess the value of those long-term forecasts via decision-making models so as to extract direct indication of probable decision outcomes from farmers, i.e. from an end-to-end perspective. In this work, we evaluate the operational value of thirteen state-of-the-art long-range forecast ensembles against climatology forecast and subjective prediction (i.e. past year climate and historical average) within an integrated agronomic modeling framework embedding an implicit model of farmers' behavior. Collected ensemble datasets are bias-corrected and downscaled using a stochastic weather generator, in order to address the mismatch of the spatio-temporal scale between forecast data from GCMs and distributed crop simulation model. The agronomic model is first simulated using the forecast information (ex-ante), followed by a second run with actual climate (ex-post). Multi-year simulations are performed to account for climate variability and the value of the different climate forecast is evaluated against the perfect foresight scenario based on the expected crop productivity as well as the land-use decisions. Our results show that not all the products generate beneficial effects to farmers and that the forecast errors might be amplified by the farmers decisions.

The Contribution of a Decision Support System to Educational Decision-Making Processes

ERIC Educational Resources Information Center

Klein, Joseph; Ronen, Herman

2003-01-01

In the light of reports of bias, the present study investigated the hypothesis that administrative educational decisions assisted by Decision Support Systems (DSS) are characterized by different pedagogical and organizational orientation than decisions made without computer assistance. One hundred and ten high school teachers were asked to suggest…

Strategies to facilitate shared decision-making about pediatric oncology clinical trial enrollment: A systematic review.

PubMed

Robertson, Eden G; Wakefield, Claire E; Signorelli, Christina; Cohn, Richard J; Patenaude, Andrea; Foster, Claire; Pettit, Tristan; Fardell, Joanna E

2018-07-01

We conducted a systematic review to identify the strategies that have been recommended in the literature to facilitate shared decision-making regarding enrolment in pediatric oncology clinical trials. We searched seven databases for peer-reviewed literature, published 1990-2017. Of 924 articles identified, 17 studies were eligible for the review. We assessed study quality using the 'Mixed-Methods Appraisal Tool'. We coded the results and discussions of papers line-by-line using nVivo software. We categorized strategies thematically. Five main themes emerged: 1) decision-making as a process, 2) individuality of the process; 3) information provision, 4) the role of communication, or 5) decision and psychosocial support. Families should have adequate time to make a decision. HCPs should elicit parents' and patients' preferences for level of information and decision involvement. Information should be clear and provided in multiple modalities. Articles also recommended providing training for healthcare professionals and access to psychosocial support for families. High quality, individually-tailored information, open communication and psychosocial support appear vital in supporting decision-making regarding enrollment in clinical trials. These data will usefully inform future decision-making interventions/tools to support families making clinical trial decisions. A solid evidence-base for effective strategies which facilitate shared decision-making is needed. Copyright © 2018 Elsevier B.V. All rights reserved.

Introduction to Decision Support Systems for Risk Based Management of Contaminated Sites

EPA Science Inventory

A book on Decision Support Systems for Risk-based Management of contaminated sites is appealing for two reasons. First, it addresses the problem of contaminated sites, which has worldwide importance. Second, it presents Decision Support Systems (DSSs), which are powerful comput...

Illness Experiences, Collective Decisions, and the Therapeutic Encounter in Indian Oncology.

PubMed

Broom, Alex; Chittem, Mahati; Bowden, Vanessa; Muppavaram, Nagesh; Rajappa, Senthil

2017-06-01

Social science scholarship on cancer has been almost exclusively focused on Organization for Economic Cooperation and Development (OECD) countries, despite a significant epidemiological transition taking place in many non-OECD contexts, with cancer emerging as a prominent, and strongly feared, illness experience. With cancer gaining an increasingly high profile in India, there is an urgent need to explore how experiences of cancer may be socially and culturally embedded, and in turn, how localized practices may shape the therapeutic encounter. Here, drawing on interviews with 40 people living with cancer in Hyderabad, India, we focus on some specific components of their therapeutic journeys, including diagnostic and prognostic disclosure, collective versus individual decision making, the dynamics of medical authority, and the reception of cancer within their social milieu. These participants' accounts provide insight into a range of cultural sensibilities around illness and care, and reinforce the importance of understanding the cultural inflections of communication, decisions, and illness experiences.

Repetition priming across distinct contexts: effects of lexical status, word frequency, and retrieval test.

PubMed

Coane, Jennifer H; Balota, David A

2010-12-01

Repetition priming, the facilitation observed when a target is preceded by an identity prime, is a robust phenomenon that occurs across a variety of conditions. Oliphant (1983), however, failed to observe repetition priming for targets embedded in the instructions to an experiment in a subsequent lexical decision task. In the present experiments, we examined the roles of priming context (list or instructions), target lexicality, and target frequency in both lexical decision and episodic recognition performance. Initial encoding context did not modulate priming in lexical decision or recognition memory for low-frequency targets or nonwords, whereas context strongly modulated episodic recognition for high-frequency targets. The results indicate that priming across contexts is sensitive to the distinctiveness of the trace and the reliance on episodic retrieval mechanisms. These results also shed light on the influence of event boundaries, such that priming occurs across different events for relatively distinct (low-frequency) items.

Evolutionary fuzzy modeling human diagnostic decisions.

PubMed

Peña-Reyes, Carlos Andrés

2004-05-01

Fuzzy CoCo is a methodology, combining fuzzy logic and evolutionary computation, for constructing systems able to accurately predict the outcome of a human decision-making process, while providing an understandable explanation of the underlying reasoning. Fuzzy logic provides a formal framework for constructing systems exhibiting both good numeric performance (accuracy) and linguistic representation (interpretability). However, fuzzy modeling--meaning the construction of fuzzy systems--is an arduous task, demanding the identification of many parameters. To solve it, we use evolutionary computation techniques (specifically cooperative coevolution), which are widely used to search for adequate solutions in complex spaces. We have successfully applied the algorithm to model the decision processes involved in two breast cancer diagnostic problems, the WBCD problem and the Catalonia mammography interpretation problem, obtaining systems both of high performance and high interpretability. For the Catalonia problem, an evolved system was embedded within a Web-based tool-called COBRA-for aiding radiologists in mammography interpretation.

Decision support systems in water and wastewater treatment process selection and design: a review.

PubMed

Hamouda, M A; Anderson, W B; Huck, P M

2009-01-01

The continuously changing drivers of the water treatment industry, embodied by rigorous environmental and health regulations and the challenge of emerging contaminants, necessitates the development of decision support systems for the selection of appropriate treatment trains. This paper explores a systematic approach to developing decision support systems, which includes the analysis of the treatment problem(s), knowledge acquisition and representation, and the identification and evaluation of criteria controlling the selection of optimal treatment systems. The objective of this article is to review approaches and methods used in decision support systems developed to aid in the selection, sequencing of unit processes and design of drinking water, domestic wastewater, and industrial wastewater treatment systems. Not surprisingly, technical considerations were found to dominate the logic of the developed systems. Most of the existing decision-support tools employ heuristic knowledge. It has been determined that there is a need to develop integrated decision support systems that are generic, usable and consider a system analysis approach.

A decision-supported outpatient practice system.

PubMed Central

Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

1996-01-01

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

ETHERNET BASED EMBEDDED SYSTEM FOR FEL DIAGNOSTICS AND CONTROLS

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

Jianxun Yan; Daniel Sexton; Steven Moore

2006-10-24

An Ethernet based embedded system has been developed to upgrade the Beam Viewer and Beam Position Monitor (BPM) systems within the free-electron laser (FEL) project at Jefferson Lab. The embedded microcontroller was mounted on the front-end I/O cards with software packages such as Experimental Physics and Industrial Control System (EPICS) and Real Time Executive for Multiprocessor System (RTEMS) running as an Input/Output Controller (IOC). By cross compiling with the EPICS, the RTEMS kernel, IOC device supports, and databases all of these can be downloaded into the microcontroller. The first version of the BPM electronics based on the embedded controller wasmore » built and is currently running in our FEL system. The new version of BPM that will use a Single Board IOC (SBIOC), which integrates with an Field Programming Gate Array (FPGA) and a ColdFire embedded microcontroller, is presently under development. The new system has the features of a low cost IOC, an open source real-time operating system, plug&play-like ease of installation and flexibility, and provides a much more localized solution.« less

The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt

PubMed Central

Miller, Randolph A.; Waitman, Lemuel R.; Chen, Sutin; Rosenbloom, S. Trent

2006-01-01

The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt’s inpatient “WizOrder” care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. From their empirical observations, the authors have developed a generic model for decision support within inpatient CPOE systems. They believe that the model’s utility extends beyond Vanderbilt, because it is based on characteristics of end-user workflows and on decision support considerations that are common to a variety of inpatient settings and CPOE systems. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create (for which the authors describe 4 general categories); when to introduce the intervention into the user’s workflow (for which the authors present 7 categories), and how disruptive, during use of the system, the intervention might be to end-users’ workflows (for which the authors describe 6 categories). Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise. PMID:16290243

Home care decision support using an Arden engine--merging smart home and vital signs data.

PubMed

Marschollek, Michael; Bott, Oliver J; Wolf, Klaus-H; Gietzelt, Matthias; Plischke, Maik; Madiesh, Moaaz; Song, Bianying; Haux, Reinhold

2009-01-01

The demographic change with a rising proportion of very old people and diminishing resources leads to an intensification of the use of telemedicine and home care concepts. To provide individualized decision support, data from different sources, e.g. vital signs sensors and home environmental sensors, need to be combined and analyzed together. Furthermore, a standardized decision support approach is necessary. The aim of our research work is to present a laboratory prototype home care architecture that integrates data from different sources and uses a decision support system based on the HL7 standard Arden Syntax for Medical Logical Modules. Data from environmental sensors connected to a home bus system are stored in a data base along with data from wireless medical sensors. All data are analyzed using an Arden engine with the medical knowledge represented in Medical Logic Modules. Multi-modal data from four different sensors in the home environment are stored in a single data base and are analyzed using an HL7 standard conformant decision support system. Individualized home care decision support must be based on all data available, including context data from smart home systems and medical data from electronic health records. Our prototype implementation shows the feasibility of using an Arden engine for decision support in a home setting. Our future work will include the utilization of medical background knowledge for individualized decision support, as there is no one-size-fits-all knowledge base in medicine.

Adolescent and parental perceptions of medical decision-making in Hong Kong.

PubMed

Hui, Edwin

2011-11-01

To investigate whether Chinese adolescents in Hong Kong share similar perceptions with their Western counterparts regarding their capacity for autonomous decision-making, and secondarily whether Chinese parents underestimate their adolescent children's desire and capacity for autonomous decision-making. 'Healthy Adolescents' and their parents were recruited from four local secondary schools, and 'Sick Adolescents' and their parents from the pediatric wards and outpatient clinics. Their perceptions of adolescents' understanding of illnesses and treatments, maturity in judgment, risk-taking, openness to divergent opinions, pressure from parents and doctors, submission to parental authority and preference for autonomy in medical decision-making are surveyed by a 50-item questionnaire on a five-point Likert scale. Findings indicate that Chinese adolescents aged 14-16 perceive themselves to possess the necessary cognitive abilities and maturity in judgment to be autonomous decision-makers like their Western counterparts. Paradoxically, although they hesitate to assert their autonomy, they are also unwilling to surrender that autonomy to their parents even under coercion or intimidation. Parents tend to underestimate their adolescents' preferences for making autonomous decisions and overestimate the importance of parental authority in decision-making. '14-and-above' Chinese adolescents in Hong Kong perceive themselves as capable of autonomous decision-making in medically-related matters, but hesitate to assert their autonomy, probably because of the Confucian values of parental authority and filial piety that are deeply embedded in the local culture. © 2010 Blackwell Publishing Ltd.

Embedding Information Literacy Skills in the Psychology Curriculum: Supporting Students in Their Transition to Independent Researchers

ERIC Educational Resources Information Center

Bohan, Jason; Friel, Niamh; Szymanek, Larissa

2015-01-01

Here we report on a new initiative which supported first-year psychology undergraduates in developing their information literacy skills. These skills were taught in a small-group tutorial setting with tutor guidance and peer-supported activities. We measured student's Autonomous Learning and Academic Self-Efficacy before and after the teaching…

Supporting Digital Literacy across the Curriculum through Blended Support: A Pilot Project Report

ERIC Educational Resources Information Center

Smith, Samara

2014-01-01

This article describes the Collaborative Media Center pilot at SUNY Old Westbury, a digital literacy project with the aim of narrowing the digital divide at the College by embedding digital projects across the curriculum. The article explains how the Center supported students in four linked courses to create digital projects. Assessment data and…

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

PubMed

Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

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

PubMed

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

2018-05-01

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

Decision support models for solid waste management: Review and game-theoretic approaches

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

Karmperis, Athanasios C., E-mail: athkarmp@mail.ntua.gr; Army Corps of Engineers, Hellenic Army General Staff, Ministry of Defence; Aravossis, Konstantinos

Highlights: ► The mainly used decision support frameworks for solid waste management are reviewed. ► The LCA, CBA and MCDM models are presented and their strengths, weaknesses, similarities and possible combinations are analyzed. ► The game-theoretic approach in a solid waste management context is presented. ► The waste management bargaining game is introduced as a specific decision support framework. ► Cooperative and non-cooperative game-theoretic approaches to decision support for solid waste management are discussed. - Abstract: This paper surveys decision support models that are commonly used in the solid waste management area. Most models are mainly developed within three decisionmore » support frameworks, which are the life-cycle assessment, the cost–benefit analysis and the multi-criteria decision-making. These frameworks are reviewed and their strengths and weaknesses as well as their critical issues are analyzed, while their possible combinations and extensions are also discussed. Furthermore, the paper presents how cooperative and non-cooperative game-theoretic approaches can be used for the purpose of modeling and analyzing decision-making in situations with multiple stakeholders. Specifically, since a waste management model is sustainable when considering not only environmental and economic but also social aspects, the waste management bargaining game is introduced as a specific decision support framework in which future models can be developed.« less

Surface transportation weather decision support requirements : advanced-integrated decision support using weather information for surface transportation decisions makers : draft (truncated*) version 1.0

DOT National Transportation Integrated Search

1997-09-19

This report gives an overview of the National Intelligent Transportation Infrastructure Initiative (NITI). NITI refers to the integrated electronics, communications, and hardware and software elements that are available to support Intelligent Transpo...

E-Estuary: Developing a Decision-support System for Coastal Management in the Conterminous United States

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The United States Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E...

New approaches for real time decision support systems

NASA Technical Reports Server (NTRS)

Hair, D. Charles; Pickslay, Kent

1994-01-01

NCCOSC RDT&E Division (NRaD) is conducting research into ways of improving decision support systems (DSS) that are used in tactical Navy decision making situations. The research has focused on the incorporation of findings about naturalistic decision-making processes into the design of the DSS. As part of that research, two computer tools were developed that model the two primary naturalistic decision-making strategies used by Navy experts in tactical settings. Current work is exploring how best to incorporate the information produced by those tools into an existing simulation of current Navy decision support systems. This work has implications for any applications involving the need to make decisions under time constraints, based on incomplete or ambiguous data.

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Audio-video decision support for patients: the documentary genré as a basis for decision aids.

PubMed

Volandes, Angelo E; Barry, Michael J; Wood, Fiona; Elwyn, Glyn

2013-09-01

Decision support tools are increasingly using audio-visual materials. However, disagreement exists about the use of audio-visual materials as they may be subjective and biased. This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio-visual materials. Three concerns arising from documentary film studies as they apply to the use of audio-visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio-visual materials (selection bias) and how to ensure objectivity (editorial bias). Decision science needs to start a debate about how audio-visual materials are to be used in decision support tools. Simply because audio-visual materials may be subjective and open to bias does not mean that we should not use them. Methods need to be found to ensure consensus around balance and editorial control, such that audio-visual materials can be used. © 2011 John Wiley & Sons Ltd.

Audio‐video decision support for patients: the documentary genré as a basis for decision aids

PubMed Central

Volandes, Angelo E.; Barry, Michael J.; Wood, Fiona; Elwyn, Glyn

2011-01-01

Abstract Objective  Decision support tools are increasingly using audio‐visual materials. However, disagreement exists about the use of audio‐visual materials as they may be subjective and biased. Methods  This is a literature review of the major texts for documentary film studies to extrapolate issues of objectivity and bias from film to decision support tools. Results  The key features of documentary films are that they attempt to portray real events and that the attempted reality is always filtered through the lens of the filmmaker. The same key features can be said of decision support tools that use audio‐visual materials. Three concerns arising from documentary film studies as they apply to the use of audio‐visual materials in decision support tools include whose perspective matters (stakeholder bias), how to choose among audio‐visual materials (selection bias) and how to ensure objectivity (editorial bias). Discussion  Decision science needs to start a debate about how audio‐visual materials are to be used in decision support tools. Simply because audio‐visual materials may be subjective and open to bias does not mean that we should not use them. Conclusion  Methods need to be found to ensure consensus around balance and editorial control, such that audio‐visual materials can be used. PMID:22032516

Decision-Making Amplification under Uncertainty: An Exploratory Study of Behavioral Similarity and Intelligent Decision Support Systems

ERIC Educational Resources Information Center

Campbell, Merle Wayne

2013-01-01

Intelligent decision systems have the potential to support and greatly amplify human decision-making across a number of industries and domains. However, despite the rapid improvement in the underlying capabilities of these "intelligent" systems, increasing their acceptance as decision aids in industry has remained a formidable challenge.…

The design of aircraft using the decision support problem technique

NASA Technical Reports Server (NTRS)

Mistree, Farrokh; Marinopoulos, Stergios; Jackson, David M.; Shupe, Jon A.

1988-01-01

The Decision Support Problem Technique for unified design, manufacturing and maintenance is being developed at the Systems Design Laboratory at the University of Houston. This involves the development of a domain-independent method (and the associated software) that can be used to process domain-dependent information and thereby provide support for human judgment. In a computer assisted environment, this support is provided in the form of optimal solutions to Decision Support Problems.

E-Estuary: Developing a Decision Support System for Coastal Management in the Conterminous United States (IAHR)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-Estuary: Developing a Decision-support System for Coastal Management in the Counterminous Untied States (Coastal Geotools 09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

E-estuary: A Decision Support System for Coastal Water and Ecosystem Management in the US (CZ09)

EPA Science Inventory

Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

Becoming a Mother: Supported Decision-Making in Context

ERIC Educational Resources Information Center

Jamieson, Rhiann; Theodore, Kate; Raczka, Roman

2016-01-01

Little is known about how women with intellectual disabilities make decisions in relation to pregnancy. Social support is important for mothers with intellectual disabilities in many areas. This study explored how the support network influenced the decision-making of women with intellectual disabilities in relation to pregnancy. The study extended…

Moving toward climate-informed agricultural decision support - can we use PRISM data for more than just monthly averages?

USDA-ARS?s Scientific Manuscript database

Decision support systems/models for agriculture are varied in target application and complexity, ranging from simple worksheets to near real-time forecast systems requiring significant computational and manpower resources. Until recently, most such decision support systems have been constructed with...

Design and realization of tourism spatial decision support system based on GIS

NASA Astrophysics Data System (ADS)

Ma, Zhangbao; Qi, Qingwen; Xu, Li

2008-10-01

In this paper, the existing problems of current tourism management information system are analyzed. GIS, tourism as well as spatial decision support system are introduced, and the application of geographic information system technology and spatial decision support system to tourism management and the establishment of tourism spatial decision support system based on GIS are proposed. System total structure, system hardware and software environment, database design and structure module design of this system are introduced. Finally, realization methods of this systemic core functions are elaborated.

Structural Embeddings: Mechanization with Method

NASA Technical Reports Server (NTRS)

Munoz, Cesar; Rushby, John

1999-01-01

The most powerful tools for analysis of formal specifications are general-purpose theorem provers and model checkers, but these tools provide scant methodological support. Conversely, those approaches that do provide a well-developed method generally have less powerful automation. It is natural, therefore, to try to combine the better-developed methods with the more powerful general-purpose tools. An obstacle is that the methods and the tools often employ very different logics. We argue that methods are separable from their logics and are largely concerned with the structure and organization of specifications. We, propose a technique called structural embedding that allows the structural elements of a method to be supported by a general-purpose tool, while substituting the logic of the tool for that of the method. We have found this technique quite effective and we provide some examples of its application. We also suggest how general-purpose systems could be restructured to support this activity better.

Enabling Housing Cooperatives: policy lessons from Sweden, India and the United States.

PubMed

Ganapati, Sukumar

2010-01-01

Housing cooperatives became active in urban areas in Sweden, India and the United States during the interwar period. Yet, after the second world war, while housing cooperatives grew phenomenally nationwide in Sweden and India, they did not do so in the United States. This article makes a comparative institutional analysis of the evolution of housing cooperatives in these three countries. The analysis reveals that housing cooperatives' relationship with the state and the consequent support structures explain the divergent evolution. Although the relationships between cooperatives and the state evolved over time, they can be characterized as embedded autonomy, overembeddedness and disembeddedness in Sweden, India and the United States respectively. Whereas the consequent support structures for housing cooperatives became well developed in Sweden and India, such structures have been weak in the United States. The article highlights the need for embedded autonomy and the need for supportive structures to enable the growth of housing cooperatives.

Students' experiences of embedded academic literacy support in a graduate entry nursing program: A qualitative study.

PubMed

Ramjan, Lucie M; Maneze, Della; Everett, Bronwyn; Glew, Paul; Trajkovski, Suza; Lynch, Joan; Salamonson, Yenna

2018-01-01

Graduate entry nursing (GEN) programs were designed to address the predicted nursing shortfall. In Australia, although these programs attract students from culturally and linguistically diverse (CALD) backgrounds, the workload is compounded by cultural differences and a new academic learning environment which presents additional challenges. This qualitative descriptive study explored the experiences of GEN students enrolled in the introductory unit of their nursing program with embedded academic literacy support in Sydney, Australia. Twenty-four commencing GEN students were interviewed in January 2016. Interviews were transcribed verbatim and thematically analysed. Three main themes emerged which illustrated that GEN students were 'diamonds in the rough'. They possessed a raw natural beauty that required some shaping and polishing to ensure academic needs were met. To ensure retention is high, institutions need to evaluate how best to support and harness the potential of these unique students. Copyright © 2017 Elsevier Ltd. All rights reserved.

Long shelf-life streptavidin support-films suitable for electron microscopy of biological macromolecules

DOE PAGES

Han, Bong-Gyoon; Watson, Zoe; Kang, Hannah; ...

2016-06-15

We describe a rapid and convenient method of growing streptavidin (SA) monolayer crystals directly on holey-carbon EM grids. As expected, these SA monolayer crystals retain their biotin-binding function and crystalline order through a cycle of embedding in trehalose and, later, its removal. This fact allows one to prepare, and store for later use, EM grids on which SA monolayer crystals serve as an affinity substrate for preparing specimens of biological macromolecules. In addition, we report that coating the lipid-tail side of trehalose-embedded monolayer crystals with evaporated carbon appears to improve the consistency with which well-ordered, single crystals are observed tomore » span over entire, 2 μm holes of the support films. Randomly biotinylated 70S ribosomes are used as a test specimen to show that these support films can be used to obtain a high-resolution cryo-EM structure« less

Uniaxial Tensile Test for Soil.

DTIC Science & Technology

1987-04-01

2.0 by 5.0 cm. This test was also performed on a horizontal specimen; however loading was applied through small metal plates that were embedded in the 6...i. enlarged ends. The specimen was supported by a bed of mercury and had two small ceramic markers mounted in the gage length that were monitored...with a cathetometer to determine displacements. It was found that most tests failed near the location of the embedded metal loading plates making their

A highly active PtCu3 intermetallic core-shell, multilayered Pt-skin, carbon embedded electrocatalyst produced by a scale-up sol-gel synthesis.

PubMed

Bele, M; Jovanovič, P; Pavlišič, A; Jozinović, B; Zorko, M; Rečnik, A; Chernyshova, E; Hočevar, S; Hodnik, N; Gaberšček, M

2014-11-07

We present a novel, scaled-up sol-gel synthesis which enables one to produce 20 g batches of highly active and stable carbon supported PtCu3 nanoparticles as cathode materials for low temperature fuel cell application. We confirm the presence of an ordered intermetallic phase underneath a multilayered Pt-skin together with firm embedment of nanoparticles in the carbon matrix.

Post-flare loops embedded in a hot coronal fan-like structure

NASA Technical Reports Server (NTRS)

Svestka, Z.; Farnik, F.; Hudson, H. S.; Hick, P.

1997-01-01

Limb events were demonstrated on the sun in which rising post-flare loops were embedded in hot structures looking in soft X-rays like fans of rays, formed during the flare and extending high into the corona. One of these structures is analyzed and it is suggested that these fans of rays represent temporary ministreamers, along which mass flows into interplanetary space. This suggestion is supported by maps of solar wind density constructed from scintillation measurements.

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation.

PubMed

Jiang, Yun; Sereika, Susan M; DeVito Dabbs, Annette; Handler, Steven M; Schlenk, Elizabeth A

2016-10-01

Lung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH(®), a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators. To examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation. A cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support. Of the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n=23) were less likely to follow technology decision support than the high (odds ratio [OR]=0.11, p=0.02) and low (OR=0.04, p=0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR=0.01, p=0.01) or who had longer hospital stays (OR=0.94, p=0.004). A significant interaction was found between gender and past technology experience (OR=0.21, p=0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women. The majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

PubMed

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

PubMed

Brabers, Anne E M; de Jong, Judith D; Groenewegen, Peter P; van Dijk, Liset

2016-09-21

There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.

Improvement of the ab initio embedded cluster method for luminescence properties of doped materials by taking into account impurity induced distortions: the example of Y2O3:Bi(3+).

PubMed

Réal, Florent; Ordejón, Belén; Vallet, Valérie; Flament, Jean-Pierre; Schamps, Joël

2009-11-21

New ab initio embedded-cluster calculations devoted to simulating the electronic spectroscopy of Bi(3+) impurities in Y(2)O(3) sesquioxide for substitutions in either S(6) or C(2) cationic sites have been carried out taking special care of the quality of the environment. A considerable quantitative improvement with respect to previous studies [F. Real et al. J. Chem. Phys. 125, 174709 (2006); F. Real et al. J. Chem. Phys. 127, 104705 (2007)] is brought by using environments of the impurities obtained via supercell techniques that allow the whole (pseudo) crystal to relax (WCR geometries) instead of environments obtained from local relaxation of the first coordination shell only (FSR geometries) within the embedded cluster approach, as was done previously. In particular the uniform 0.4 eV discrepancy of absorption energies found previously with FSR environments disappears completely when the new WCR environments of the impurities are employed. Moreover emission energies and hence Stokes shifts are in much better agreement with experiment. These decisive improvements are mainly due to a lowering of the local point-group symmetry (S(6)-->C(3) and C(2)-->C(1)) when relaxing the geometry of the emitting (lowest) triplet state. This symmetry lowering was not observed in FSR embedded cluster relaxations because the crystal field of the embedding frozen at the genuine pure crystal positions seems to be a more important driving force than the interactions within the cluster, thus constraining the overall symmetry of the system. Variations of the doping rate are found to have negligible influence on the spectra. In conclusion, the use of WCR environments may be crucial to render the structural distortions occurring in a doped crystal and it may help to significantly improve the embedded-cluster methodology to reach the quantitative accuracy necessary to interpret and predict luminescence properties of doped materials of this type.

Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

PubMed

Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

2015-07-01

Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting.

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

NASA Astrophysics Data System (ADS)

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

2012-04-01

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

Identifying the decision to be supported: a review of papers from environmental modelling and software

USGS Publications Warehouse

Sojda, Richard S.; Chen, Serena H.; El Sawah, Sondoss; Guillaume, Joseph H.A.; Jakeman, A.J.; Lautenbach, Sven; McIntosh, Brian S.; Rizzoli, A.E.; Seppelt, Ralf; Struss, Peter; Voinov, Alexey; Volk, Martin

2012-01-01

Two of the basic tenets of decision support system efforts are to help identify and structure the decisions to be supported, and to then provide analysis in how those decisions might be best made. One example from wetland management would be that wildlife biologists must decide when to draw down water levels to optimise aquatic invertebrates as food for breeding ducks. Once such a decision is identified, a system or tool to help them make that decision in the face of current and projected climate conditions could be developed. We examined a random sample of 100 papers published from 2001-2011 in Environmental Modelling and Software that used the phrase “decision support system” or “decision support tool”, and which are characteristic of different sectors. In our review, 41% of the systems and tools related to the water resources sector, 34% were related to agriculture, and 22% to the conservation of fish, wildlife, and protected area management. Only 60% of the papers were deemed to be reporting on DSS. This was based on the papers reviewed not having directly identified a specific decision to be supported. We also report on the techniques that were used to identify the decisions, such as formal survey, focus group, expert opinion, or sole judgment of the author(s). The primary underlying modelling system, e.g., expert system, agent based model, Bayesian belief network, geographical information system (GIS), and the like was categorised next. Finally, since decision support typically should target some aspect of unstructured decisions, we subjectively determined to what degree this was the case. In only 23% of the papers reviewed, did the system appear to tackle unstructured decisions. This knowledge should be useful in helping workers in the field develop more effective systems and tools, especially by being exposed to the approaches in different, but related, disciplines. We propose that a standard blueprint for reporting on DSS be developed for consideration by journal editors to aid them in filtering papers that use the term, “decision support”.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

PubMed

Militello, Laura G; Saleem, Jason J; Borders, Morgan R; Sushereba, Christen E; Haverkamp, Donald; Wolf, Steven P; Doebbeling, Bradley N

2016-03-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise

PubMed Central

Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.

2016-01-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441

An Embedded Sensor Node Microcontroller with Crypto-Processors.

PubMed

Panić, Goran; Stecklina, Oliver; Stamenković, Zoran

2016-04-27

Wireless sensor network applications range from industrial automation and control, agricultural and environmental protection, to surveillance and medicine. In most applications, data are highly sensitive and must be protected from any type of attack and abuse. Security challenges in wireless sensor networks are mainly defined by the power and computing resources of sensor devices, memory size, quality of radio channels and susceptibility to physical capture. In this article, an embedded sensor node microcontroller designed to support sensor network applications with severe security demands is presented. It features a low power 16-bitprocessor core supported by a number of hardware accelerators designed to perform complex operations required by advanced crypto algorithms. The microcontroller integrates an embedded Flash and an 8-channel 12-bit analog-to-digital converter making it a good solution for low-power sensor nodes. The article discusses the most important security topics in wireless sensor networks and presents the architecture of the proposed hardware solution. Furthermore, it gives details on the chip implementation, verification and hardware evaluation. Finally, the chip power dissipation and performance figures are estimated and analyzed.

An Embedded Sensor Node Microcontroller with Crypto-Processors

PubMed Central

Panić, Goran; Stecklina, Oliver; Stamenković, Zoran

2016-01-01

Wireless sensor network applications range from industrial automation and control, agricultural and environmental protection, to surveillance and medicine. In most applications, data are highly sensitive and must be protected from any type of attack and abuse. Security challenges in wireless sensor networks are mainly defined by the power and computing resources of sensor devices, memory size, quality of radio channels and susceptibility to physical capture. In this article, an embedded sensor node microcontroller designed to support sensor network applications with severe security demands is presented. It features a low power 16-bitprocessor core supported by a number of hardware accelerators designed to perform complex operations required by advanced crypto algorithms. The microcontroller integrates an embedded Flash and an 8-channel 12-bit analog-to-digital converter making it a good solution for low-power sensor nodes. The article discusses the most important security topics in wireless sensor networks and presents the architecture of the proposed hardware solution. Furthermore, it gives details on the chip implementation, verification and hardware evaluation. Finally, the chip power dissipation and performance figures are estimated and analyzed. PMID:27128925