EXPLORING VALUES OF HEALTH TECHNOLOGY ASSESSMENT AGENCIES USING REFLECTIVE MULTICRITERIA AND RARE DISEASE CASE.

PubMed

Goetghebeur, Mireille M; Wagner, Monika; Samaha, Dima; O'Neil, William; Badgley, Danielle; Castro-Jaramillo, Hector; Abrishami, Payam; Sarria-Santamera, Antonio; Cleemput, Irina; Tringali, Michele

2017-01-01

Tackling ethical dilemmas faced by reimbursement decision makers requires deeper understanding of values on which health technology assessment (HTA) agencies are founded and how trade-offs are made. This was explored in this study including the case of rare disease. Representatives from eight HTA explored values on which institutions are founded using a narrative approach and reflective multicriteria (developed from EVIDEM, criteria derived from ethical imperatives of health care). Trade-offs between criteria and the impact of incorporating defined priorities (including for rare diseases) were explored through a quantitative values elicitation exercise. Participants reported a diversity of substantive and procedural values with a common emphasis on scientific excellence, stakeholder involvement, independence, and transparency. Examining the ethical imperatives behind EVIDEM criteria was found to be useful to further explore substantive values. Most criteria were deemed to reflect institutions' values, while 70 percent of the criteria were reported by at least half of participants to be considered formally by their institutions. The quantitative values elicitation highlighted the difficulty to balance imperatives of "alleviating or preventing patient suffering," "serving the whole population equitably," "upholding healthcare system sustainability," and "making decisions informed by evidence and context" but may help share the ethical reasoning behind decisions. Incorporating "Priorities" (including for rare diseases) helped reveal trade-offs from other criteria and their underlying ethical imperatives. Reflective multicriteria are useful to explore substantive values of HTAs, reflect how these values and their ethical underpinnings can be operationalized into criteria, and explore the ethical reasoning at the heart of the healthcare debate.

School and District Intervention: A Decision-Making Framework for Policymakers.

ERIC Educational Resources Information Center

Bowles, Susan A.; Churchill, Andrew M.; Effrat, Andrew; McDermott, Kathryn A.

This paper seeks to help state policymakers understand their relatively new role in improving the academic performance of local schools and districts. The first section, "Intervention Decision-Making Framework," focuses on the intervention decision making framework model, performance criteria, strategic criteria, diagnostic…

Comparative analysis of nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks: a discussion paper.

PubMed

Kennedy, Catriona; O'Reilly, Pauline; Fealy, Gerard; Casey, Mary; Brady, Anne-Marie; McNamara, Martin; Prizeman, Geraldine; Rohde, Daniela; Hegarty, Josephine

2015-08-01

To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks. Scope of practice in professional nursing and midwifery is an evolving process which needs to be responsive to clinical, service, societal, demographic and fiscal changes. Codes and frameworks offer a system of rules and principles by which the nursing and midwifery professions are expected to regulate members and demonstrate responsibility to society. Discussion paper. Twelve scope of practice and associated decision-making frameworks (January 2000-March 2014). Two main approaches to the regulation of the scope of practice and associated decision-making frameworks exist internationally. The first approach is policy and regulation driven and behaviour oriented. The second approach is based on notions of autonomous decision-making, professionalism and accountability. The two approaches are not mutually exclusive, but have similar elements with a different emphasis. Both approaches lack explicit recognition of the aesthetic aspects of care and patient choice, which is a fundamental principle of evidence-based practice. Nursing organizations, regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction. © 2015 John Wiley & Sons Ltd.

Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.

PubMed

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte; Verhoef, Marja

2014-01-01

Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.

Iowa pavement asset management decision-making framework.

DOT National Transportation Integrated Search

2015-10-01

Most local agencies in Iowa currently make their pavement treatment decisions based on their limited experience due primarily to : lack of a systematic decision-making framework and a decision-aid tool. The lack of objective condition assessment data...

Maternal Decision-making During Pregnancy: Parental Obligations and Cultural Differences.

PubMed

Malek, Janet

2017-08-01

Decision-making during pregnancy can be ethically complex. This paper offers a framework for maternal decision-making and clinical counseling that can be used to approach such decisions in a systematic way. Three fundamental questions are addressed: (1) Who should make decisions? (2) How should decisions be made? and (3) What is the role of the clinician? The proposed framework emphasizes the decisional authority of the pregnant woman. It draws ethical support from the concept of a good parent and the requirements of parental obligations. It also describes appropriate counseling methods for clinicians in light of those parental obligations. Finally, the paper addresses how cultural differences may shape the framework's guidance of maternal decision-making during pregnancy. Copyright © 2017. Published by Elsevier Ltd.

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

PubMed

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

2016-01-01

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

PubMed Central

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte

2014-01-01

Background: Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decisionmaking by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. Methods: We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Results: Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of informationseeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. Interpretation: CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theorybased decision-support programs that are responsive to patients' beliefs and preferences. PMID:25009685

Framework for culturally competent decisionmaking in child welfare.

PubMed

Cohen, Elena P

2003-01-01

This article provides a framework to understand the cultural, social, political, and economic factors that affect decisionmaking when working with ethnically and racially diverse families in the child welfare system. The article describes external factors affecting the decisionmaking process, including community environment, agency structure, and family characteristics. It then reviews the core stages of the casework process, describing key decisions during intake, assessment, service planning, implementation, evaluation, and closure. Although the framework is based on casework process in the child welfare system, it can be adapted to other child-serving systems, including education, mental health, and juvenile justice.

A Framework for Multi-Stakeholder Decision-Making and Conflict Resolution (abstract)

EPA Science Inventory

This contribution describes the implementation of the conditional-value-at-risk (CVaR) metric to create a general multi-stakeholder decision-making framework. It is observed that stakeholder dissatisfactions (distance to their individual ideal solutions) can be interpreted as ran...

A framework for multi-stakeholder decision-making and conflict resolution

EPA Science Inventory

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimiz...

FRAMEWORK FOR RESPONSIBLE ENVIRONMENTAL DECISION-MAKING (FRED): USING LIFE CYCLE ASSESSMENT TO EVALUATE PREFERABILITY OF PRODUCTS

EPA Science Inventory

Framework for Responsible Environmental Decision-Making (FRED) demonstrates how the life-cycle concept can be used to quantify competing products' environmental performance so that this information may be integrated with considerations of total ownership cost and technical perfor...

A judgment and decision-making model for plant behavior.

PubMed

Karban, Richard; Orrock, John L

2018-06-12

Recently plant biologists have documented that plants, like animals, engage in many activities that can be considered as behaviors, although plant biologists currently lack a conceptual framework to understand these processes. Borrowing the well-established framework developed by psychologists, we propose that plant behaviors can be constructively modeled by identifying four distinct components: 1) a cue or stimulus that provides information, 2) a judgment whereby the plant perceives and processes this informative cue, 3) a decision whereby the plant chooses among several options based on their relative costs and benefits, and 4) action. Judgment for plants can be determined empirically by monitoring signaling associated with electrical, calcium, or hormonal fluxes. Decision-making can be evaluated empirically by monitoring gene expression or differential allocation of resources. We provide examples of the utility of this judgment and decision-making framework by considering cases in which plants either successfully or unsuccessfully induced resistance against attacking herbivores. Separating judgment from decision-making suggests new analytical paradigms (i.e., Bayesian methods for judgment and economic utility models for decision-making). Following this framework, we propose an experimental approach to plant behavior that explicitly manipulates the stimuli provided to plants, uses plants that vary in sensory abilities, and examines how environmental context affects plant responses. The concepts and approaches that follow from the judgment and decision-making framework can shape how we study and understand plant-herbivore interactions, biological invasions, plant responses to climate change, and the susceptibility of plants to evolutionary traps. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Decision-making theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2011-06-01

What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery. © 2011 Blackwell Publishing Asia Pty Ltd.

Decision-Making Under Risk: Integrating Perspectives From Biology, Economics, and Psychology.

PubMed

Mishra, Sandeep

2014-08-01

Decision-making under risk has been variably characterized and examined in many different disciplines. However, interdisciplinary integration has not been forthcoming. Classic theories of decision-making have not been amply revised in light of greater empirical data on actual patterns of decision-making behavior. Furthermore, the meta-theoretical framework of evolution by natural selection has been largely ignored in theories of decision-making under risk in the human behavioral sciences. In this review, I critically examine four of the most influential theories of decision-making from economics, psychology, and biology: expected utility theory, prospect theory, risk-sensitivity theory, and heuristic approaches. I focus especially on risk-sensitivity theory, which offers a framework for understanding decision-making under risk that explicitly involves evolutionary considerations. I also review robust empirical evidence for individual differences and environmental/situational factors that predict actual risky decision-making that any general theory must account for. Finally, I offer steps toward integrating various theoretical perspectives and empirical findings on risky decision-making. © 2014 by the Society for Personality and Social Psychology, Inc.

DEVELOPING A CONSISTENT DECISION-MAKING FRAMEWORK BY USING THE U.S. EPA'S TRACI

EPA Science Inventory

The most effective way to achieve long-term environmental results is through the use of a consistent set of metrics and decision-making framework. The U.S. EPA has developed TRACI, the Tool for the Reduction and Assessment of Chemical and other environmental Impacts, which allows...

Implicit Theoretical Leadership Frameworks of Higher Education Administrators.

ERIC Educational Resources Information Center

Lees, Kimberly; And Others

Colleges and universities have a unique organizational culture that influences the decision-making processes used by leaders of higher education. This paper presents findings of a study that attempted to identify the theoretical frameworks that administrators of higher education use to guide their decision-making processes. The following…

A Framework for Sexual Decision-Making Among Female Sex Workers in Jamaica.

PubMed

Bailey, Althea; Figueroa, J Peter

2016-05-01

The Jamaican government has provided targeted HIV and sexually transmitted infection prevention, treatment, and other services for female sex workers (FSW) since 1989. HIV prevalence among FSW declined from 20 to 12% between 1989 and 1994, then to 9% in 2005, 5% in 2008, and 4.1% in 2011. This article distills the literature and two decades of experience working with FSW in Jamaica. Drawing on the constant comparative method, we put forward an innovative conceptual framework for explaining sexual decision-making and risk behaviors within both transactional and relational sexual situations. This framework helps fill the gaps in existing models that focus on individual behaviors. The model identifies interactions between environmental and structural elements of sex work, and three individual-level factors: risk perception, perceived relationship intimacy, and perceived control, as the four primary mediating factors influencing sexual decision-making among FSW. We propose that other factors such as violence, socioeconomic vulnerability, and policy/legal frameworks influence sexual decision-making through these primary mediating factors. This conceptual model may offer a useful framework for planning and evaluating prevention interventions among sex workers. However, it remains to be tested in order to establish its value.

Cognitive Continuum Theory in nursing decision-making.

PubMed

Cader, Raffik; Campbell, Steve; Watson, Don

2005-02-01

The purpose of this paper is to analyse and evaluate Cognitive Continuum Theory and to provide evidence for its relevance to nurses' decision-making. It is critical that theories used in nursing are evaluated to provide an understanding of their aims, concepts and usefulness. With the advent of evidence-based care, theories on decision-making have acquired increased significance. The criteria identified by Fawcett's framework has been used to analyse and evaluate Hammond's Cognitive Continuum Theory. Findings. There is empirical evidence to support many of the concepts and propositions of Cognitive Continuum Theory. The theory has been applied to the decision-making process of many professionals, including medical practitioners and nurses. Existing evidence suggests that Cognitive Continuum Theory can provide the framework to explain decision-making in nursing. Cognitive Continuum Theory has the potential to make major contributions towards understanding the decision-making process of nurses in the clinical environment. Knowledge of the theory in nursing practice has become crucial.

Determining the Value of Two Biologic Drugs for Chronic Inflammatory Skin Diseases: Results of a Multi-Criteria Decision Analysis.

PubMed

Zozaya, Néboa; Martínez-Galdeano, Lucía; Alcalá, Bleric; Armario-Hita, Jose Carlos; Carmona, Concepción; Carrascosa, Jose Manuel; Herranz, Pedro; Lamas, María Jesús; Trapero-Bertran, Marta; Hidalgo-Vega, Álvaro

2018-06-01

Multi-criteria decision analysis (MCDA) is a tool that systematically considers multiple factors relevant to health decision-making. The aim of this study was to use an MCDA to assess the value of dupilumab for severe atopic dermatitis compared with secukinumab for moderate to severe plaque psoriasis in Spain. Following the EVIDEM (Evidence and Value: Impact on DEcision Making) methodology, the estimated value of both interventions was obtained by means of an additive linear model that combined the individual weighting (between 1 and 5) of each criterion with the individual scoring of each intervention in each criterion. Dupilumab was evaluated against placebo, while secukinumab was evaluated against placebo, etanercept and ustekinumab. A retest was performed to assess the reproducibility of weights, scores and value estimates. The overall MCDA value estimate for dupilumab versus placebo was 0.51 ± 0.14. This value was higher than those obtained for secukinumab: 0.48 ± 0.15 versus placebo, 0.45 ± 0.15 versus etanercept and 0.39 ± 0.18 versus ustekinumab. The highest-value contribution was reported by the patients' group, followed by the clinical professionals and the decision makers. A fundamental element that explained the difference in the scoring between pathologies was the availability of therapeutic alternatives. The retest confirmed the consistency and replicability of the analysis. Under this methodology, and assuming similar economic costs per patient for both treatments, the results indicated that the overall value estimated of dupilumab for severe atopic dermatitis was similar to, or slightly higher than, that of secukinumab for moderate to severe plaque psoriasis.

The evaluation of lifestyle interventions in the Netherlands.

PubMed

Rappange, David R; Brouwer, Werner B F

2012-04-01

Current investments in preventive lifestyle interventions are relatively low, despite the significant impact of unhealthy behaviour on population health. This raises the question of whether the criteria used in reimbursement decisions about healthcare interventions put preventive interventions at a disadvantage. In this paper, we highlight the decision-making framework used in the Netherlands to delineate the basic benefits package. Important criteria in that framework are 'necessity' and 'cost-effectiveness'. Several normative choices need to be made, and these choices can have an important impact on the evaluation of lifestyle interventions, especially when making these criteria operational and quantifiable. Moreover, the implementation of the decision-making framework may prove to be difficult for lifestyle interventions. Improvements of the decision-making framework in the Netherlands are required to guarantee sound evaluations of lifestyle interventions aimed at improving health.

Using Recommendations in Evaluation: A Decision-Making Framework for Evaluators

ERIC Educational Resources Information Center

Iriti, Jennifer E.; Bickel, William E.; Nelson, Catherine Awsumb

2005-01-01

Is it appropriate and useful for evaluators to use findings to make recommendations? If so, under what circumstances? How specific should they be? This article presents a decision-making framework for the appropriateness of recommendations in varying contexts. On the basis of reviews of evaluation theory, selected evaluation reports, and feedback…

Identifying functional communities for use in forest planning and decisionmaking

Treesearch

Pamela J. Jakes; Thomas E. Fish

1998-01-01

Public land managers are searching for frameworks for organizing and displaying social information that will make it useful in forest management and decisionmaking. On the Chequamegon-Nicolet National Forests in Wisconsin, managers and researchers have used the concept of functional communities to develop such a framework. Functional communities define geographic areas...

Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context.

PubMed

Qu, Haiyan; Shewchuk, Richard M; Alarcón, Graciela; Fraenkel, Liana; Leong, Amye; Dall'Era, Maria; Yazdany, Jinoos; Singh, Jasvinder A

2016-12-01

Numerous factors can impede or facilitate patients' medication decision-making and adherence to physicians' recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach. We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis. A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders' perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for "me," 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics. Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication. © 2016, American College of Rheumatology.

Constructing a clinical decision-making framework for image-guided radiotherapy using a Bayesian Network

NASA Astrophysics Data System (ADS)

Hargrave, C.; Moores, M.; Deegan, T.; Gibbs, A.; Poulsen, M.; Harden, F.; Mengersen, K.

2014-03-01

A decision-making framework for image-guided radiotherapy (IGRT) is being developed using a Bayesian Network (BN) to graphically describe, and probabilistically quantify, the many interacting factors that are involved in this complex clinical process. Outputs of the BN will provide decision-support for radiation therapists to assist them to make correct inferences relating to the likelihood of treatment delivery accuracy for a given image-guided set-up correction. The framework is being developed as a dynamic object-oriented BN, allowing for complex modelling with specific subregions, as well as representation of the sequential decision-making and belief updating associated with IGRT. A prototype graphic structure for the BN was developed by analysing IGRT practices at a local radiotherapy department and incorporating results obtained from a literature review. Clinical stakeholders reviewed the BN to validate its structure. The BN consists of a sub-network for evaluating the accuracy of IGRT practices and technology. The directed acyclic graph (DAG) contains nodes and directional arcs representing the causal relationship between the many interacting factors such as tumour site and its associated critical organs, technology and technique, and inter-user variability. The BN was extended to support on-line and off-line decision-making with respect to treatment plan compliance. Following conceptualisation of the framework, the BN will be quantified. It is anticipated that the finalised decision-making framework will provide a foundation to develop better decision-support strategies and automated correction algorithms for IGRT.

Depressive Symptoms Enhance Loss-Minimization, but Attenuate Gain-Maximization in History-Dependent Decision-Making

ERIC Educational Resources Information Center

Maddox, W. Todd; Gorlick, Marissa A.; Worthy, Darrell A.; Beevers, Christopher G.

2012-01-01

Individuals with depressive symptoms typically show deficits in decision-making. However, most work has emphasized decision-making under gain-maximization conditions. A gain-maximization framework may undermine decision-making when depressive symptoms are present because depressives are generally more sensitive to losses than gains. The present…

A hierarchical-multiobjective framework for risk management

NASA Technical Reports Server (NTRS)

Haimes, Yacov Y.; Li, Duan

1991-01-01

A broad hierarchical-multiobjective framework is established and utilized to methodologically address the management of risk. United into the framework are the hierarchical character of decision-making, the multiple decision-makers at separate levels within the hierarchy, the multiobjective character of large-scale systems, the quantitative/empirical aspects, and the qualitative/normative/judgmental aspects. The methodological components essentially consist of hierarchical-multiobjective coordination, risk of extreme events, and impact analysis. Examples of applications of the framework are presented. It is concluded that complex and interrelated forces require an analysis of trade-offs between engineering analysis and societal preferences, as in the hierarchical-multiobjective framework, to successfully address inherent risk.

Determining the psychometric properties of the Enhancing Decision-making Assessment in Midwifery (EDAM) measure in a cross cultural context.

PubMed

Jefford, Elaine; Jomeen, Julie; Martin, Colin R

2016-04-28

The ability to act on and justify clinical decisions as autonomous accountable midwifery practitioners, is encompassed within many international regulatory frameworks, yet decision-making within midwifery is poorly defined. Decision-making theories from medicine and nursing may have something to offer, but fail to take into consideration midwifery context and philosophy and the decisional autonomy of women. Using an underpinning qualitative methodology, a decision-making framework was developed, which identified Good Clinical Reasoning and Good Midwifery Practice as two conditions necessary to facilitate optimal midwifery decision-making during 2nd stage labour. This study aims to confirm the robustness of the framework and describe the development of Enhancing Decision-making Assessment in Midwifery (EDAM) as a measurement tool through testing of its factor structure, validity and reliability. A cross-sectional design for instrument development and a 2 (country; Australia/UK) x 2 (Decision-making; optimal/sub-optimal) between-subjects design for instrument evaluation using exploratory and confirmatory factor analysis, internal consistency and known-groups validity. Two 'expert' maternity panels, based in Australia and the UK, comprising of 42 participants assessed 16 midwifery real care episode vignettes using the empirically derived 26 item framework. Each item was answered on a 5 point likert scale based on the level of agreement to which the participant felt each item was present in each of the vignettes. Participants were then asked to rate the overall decision-making (optimal/sub-optimal). Post factor analysis the framework was reduced to a 19 item EDAM measure, and confirmed as two distinct scales of 'Clinical Reasoning' (CR) and 'Midwifery Practice' (MP). The CR scale comprised of two subscales; 'the clinical reasoning process' and 'integration and intervention'. The MP scale also comprised two subscales; women's relationship with the midwife' and 'general midwifery practice'. EDAM would generally appear to be a robust, valid and reliable psychometric instrument for measuring midwifery decision-making, which performs consistently across differing international contexts. The 'women's relationship with midwife' subscale marginally failed to meet the threshold for determining good instrument reliability, which may be due to its brevity. Further research using larger samples and in a wider international context to confirm the veracity of the instrument's measurement properties and its wider global utility, would be advantageous.

Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

2016-07-01

Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions.

PubMed

Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J

2017-06-01

Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.

A novel framework for improvement of road accidents considering decision-making styles of drivers in a large metropolitan area.

PubMed

Azadeh, Ali; Zarrin, Mansour; Hamid, Mehdi

2016-02-01

Road accidents can be caused by different factors such as human factors. Quality of the decision-making process of drivers could have a considerable impact on preventing disasters. The main objective of this study is the analysis of factors affecting road accidents by considering the severity of accidents and decision-making styles of drivers. To this end, a novel framework is proposed based on data envelopment analysis (DEA) and statistical methods (SMs) to assess the factors affecting road accidents. In this study, for the first time, dominant decision-making styles of drivers with respect to severity of injuries are identified. To show the applicability of the proposed framework, this research employs actual data of more than 500 samples in Tehran, Iran. The empirical results indicate that the flexible decision style is the dominant style for both minor and severe levels of accident injuries. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Grounded Theory Approach to the Development of a Framework for Researching Children's Decision-Making Skills within Design and Technology Education

ERIC Educational Resources Information Center

Mettas, Alexandros; Norman, Eddie

2011-01-01

This paper discusses the establishment of a framework for researching children's decision-making skills in design and technology education through taking a grounded theory approach. Three data sources were used: (1) analysis of available literature; (2) curriculum analysis and interviews with teachers concerning their practice in relation to their…

History matching through dynamic decision-making

PubMed Central

Maschio, Célio; Santos, Antonio Alberto; Schiozer, Denis; Rocha, Anderson

2017-01-01

History matching is the process of modifying the uncertain attributes of a reservoir model to reproduce the real reservoir performance. It is a classical reservoir engineering problem and plays an important role in reservoir management since the resulting models are used to support decisions in other tasks such as economic analysis and production strategy. This work introduces a dynamic decision-making optimization framework for history matching problems in which new models are generated based on, and guided by, the dynamic analysis of the data of available solutions. The optimization framework follows a ‘learning-from-data’ approach, and includes two optimizer components that use machine learning techniques, such as unsupervised learning and statistical analysis, to uncover patterns of input attributes that lead to good output responses. These patterns are used to support the decision-making process while generating new, and better, history matched solutions. The proposed framework is applied to a benchmark model (UNISIM-I-H) based on the Namorado field in Brazil. Results show the potential the dynamic decision-making optimization framework has for improving the quality of history matching solutions using a substantial smaller number of simulations when compared with a previous work on the same benchmark. PMID:28582413

Identifying Decision-Makers’ Science Needs for Adaptation to Climate-Related Impacts on Forest Ecosystem Services

NASA Astrophysics Data System (ADS)

Gordon, E.; Lukas, J.

2009-12-01

Through the Western Water Assessment RISA program, we are conducting a research project that will produce science synthesis information to help local, state, and federal decision-makers in Colorado and Wyoming develop adaptation strategies to deal with climate-related threats to forest ecosystem services, in particular bark beetle infestations and stand-replacing wildfires. We begin by using the problem orientation framework, a policy sciences methodology, to understand how decision-makers can most effectively address policy problems that threaten the attainment of socially accepted goals. By applying this framework to the challenges facing decision-makers, we more accurately identify specific areas where scientific research can improve decision-making. WWA researchers will next begin to connect decision-makers with relevant scientific literature and identify specific areas of future scientific research that will be most effective at addressing their needs.

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes.

PubMed

Clarinval, Caroline; Biller-Andorno, Nikola

2014-06-23

This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.

Pandemic influenza preparedness: an ethical framework to guide decision-making.

PubMed

Thompson, Alison K; Faith, Karen; Gibson, Jennifer L; Upshur, Ross E G

2006-12-04

Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

On the Decision-Making Process in Music Education.

ERIC Educational Resources Information Center

Jorgensen, Estelle R.

1985-01-01

Sketches a conceptual framework for the systematic description of decision-making processes in music education. Refers to existing formulations in education, management, marketing, and economics. Lists decision-making phases in music education, each exhibiting the characteristics of a social system. Offers a historical example of each phase. (AYC)

Study design and the estimation of the size of key populations at risk of HIV: lessons from Viet Nam.

PubMed

Safarnejad, Ali; Groot, Wim; Pavlova, Milena

2018-01-30

Estimation of the size of populations at risk of HIV is a key activity in the surveillance of the HIV epidemic. The existing framework for considering future research needs may provide decision-makers with a basis for a fair process of deciding on the methods of the estimation of the size of key populations at risk of HIV. This study explores the extent to which stakeholders involved with population size estimation agree with this framework, and thus, the study updates the framework. We conducted 16 in-depth interviews with key informants from city and provincial governments, NGOs, research institutes, and the community of people at risk of HIV. Transcripts were analyzed and reviewed for significant statements pertaining to criteria. Variations and agreement around criteria were analyzed, and emerging criteria were validated against the existing framework. Eleven themes emerged which are relevant to the estimation of the size of populations at risk of HIV in Viet Nam. Findings on missing criteria, inclusive participation, community perspectives and conflicting weight and direction of criteria provide insights for an improved framework for the prioritization of population size estimation methods. The findings suggest that the exclusion of community members from decision-making on population size estimation methods in Viet Nam may affect the validity, use, and efficiency of the evidence generated. However, a wider group of decision-makers, including community members among others, may introduce diverse definitions, weight and direction of criteria. Although findings here may not apply to every country with a transitioning economy or to every emerging epidemic, the principles of fair decision-making, value of community participation in decision-making and the expected challenges faced, merit consideration in every situation.

A critical review of recent US market level health care strategy literature.

PubMed

Wells, R; Banaszak-Holl, J

2000-09-01

In this review, we argue that it would be profitable if the neoclassical economic theories that have dominated recent US market level health care strategy research could be complemented by greater use of sociological frameworks. Sociological theory can address three central questions that neoclassical economic theories have tended to slight: (1) how decision-makers' preferences are determined; (2) who the decision-makers are; and (3) how decision-makers' plans are translated into organizational action. We suggest five sociological frameworks that would enable researchers to address these issues better relative to market level strategy in health care. The frameworks are (1) institutional theory, (2) organizational ecology, (3) social movements, (4) social networks, and (5) internal organizational change. A recent global trend toward privatization of health care provision makes US market level strategy research increasingly applicable to non-US readers.

Decision-making in nursing practice: An integrative literature review.

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes. © 2017 John Wiley & Sons Ltd.

A framework for multi-stakeholder decision-making and ...

EPA Pesticide Factsheets

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimization problem. The CVaR problem is parameterized by a probability level that shapes the tail of the dissatisfaction distribution. The proposed approach allows us to compute a family of compromise solutions and generalizes multi-stakeholder settings previously proposed in the literature that minimize average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem +and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework that involve complex decision-making processes. We demonstrate the developments using a biowaste facility location case study in which we seek to balance stakeholder priorities on transportation, safety, water quality, and capital costs. This manuscript describes the methodology of a new decision-making framework that computes compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives as needed for SHC Decision Science and Support Tools project. A biowaste facility location is employed as the case study

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes

PubMed Central

Clarinval, Caroline; Biller-Andorno, Nikola

2014-01-01

Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context. PMID:24987575

Leadership emergence: the application of the Cynefin framework during a bio-social HIV/AIDS risk-reduction pilot.

PubMed

Burman, Christopher J; Aphane, Marota A

2016-09-01

This article focuses on the utility of a knowledge management heuristic called the Cynefin framework, which was applied during an ongoing pilot intervention in the Limpopo province, South Africa. The intervention aimed to identify and then consolidate low-cost, innovative bio-social responses to reinforce the biomedical opportunities that now have the potential to "end AIDS by 2030″. The Cynefin framework is designed to enable leaders to identify specific decision-making domain typologies as a mechanism to maximise the effectiveness of leadership responses to both opportunities and challenges that emerge during interventions. In this instance the Cynefin framework was used to: (1) provide an indication to the project managers whether the early stages of the intervention had been effective; (2) provide the participants an opportunity to identify emergent knowledge action spaces (opportunities and challenges); and (3) categorise them into appropriate decision-making domains in preparation for the next phases of the intervention. A qualitative methodology was applied to collect and analyse the findings. The findings indicate that applying the Cynefin framework enabled the participants to situate knowledge action spaces into appropriate decision-making domains. From this participatory evaluation a targeted management strategy was developed for the next phases of the initiative. The article concludes by arguing that the Cynefin framework was an effective mechanism for situating emergent knowledge action spaces into appropriate decision-making domains, which enabled them to prepare for the next phases of the intervention. This process of responsive decision making could have utility in other development related interventions.

Strategic Decision-Making by Deans in Academic Health Centers: A Framework Analysis

ERIC Educational Resources Information Center

Keeney, Brianne

2012-01-01

This study examines strategic decision-making at the college level in relation to seven theoretical frames. Strategic decisions are those made by top executives, have wide-ranging influence throughout the organization, affect the long-term future of the organization, and are connected to the external environment. The seven decision-making frames…

Decision-Making Models in a Tunisian University: Towards a Framework for Analysis

ERIC Educational Resources Information Center

Khefacha, I.; Belkacem, L.

2014-01-01

This study investigates how decisions are made in Tunisian public higher education establishments. Some factors are identified as having a potentially significant impact on the odds that the decision-making process follows the characteristics of one of the most well known decision-making models: collegial, political, bureaucratic or anarchical…

Considering Risk and Resilience in Decision-Making

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2015-01-01

This paper examines the concepts of decision-making, risk analysis, uncertainty and resilience analysis. The relation between risk, vulnerability, and resilience is analyzed. The paper describes how complexity, uncertainty, and ambiguity are the most critical factors in the definition of the approach and criteria for decision-making. Uncertainty in its various forms is what limits our ability to offer definitive answers to questions about the outcomes of alternatives in a decision-making process. It is shown that, although resilience-informed decision-making would seem fundamentally different from risk-informed decision-making, this is not the case as resilience-analysis can be easily incorporated within existing analytic-deliberative decision-making frameworks.

Pandemic influenza preparedness: an ethical framework to guide decision-making

PubMed Central

Thompson, Alison K; Faith, Karen; Gibson, Jennifer L; Upshur, Ross EG

2006-01-01

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. PMID:17144926

Effectiveness of an Electronic Performance Support System on Computer Ethics and Ethical Decision-Making Education

ERIC Educational Resources Information Center

Kert, Serhat Bahadir; Uz, Cigdem; Gecu, Zeynep

2014-01-01

This study examined the effectiveness of an electronic performance support system (EPSS) on computer ethics education and the ethical decision-making processes. There were five different phases to this ten month study: (1) Writing computer ethics scenarios, (2) Designing a decision-making framework (3) Developing EPSS software (4) Using EPSS in a…

A Framework for Multi-Stakeholder Decision-Making and ...

EPA Pesticide Factsheets

This contribution describes the implementation of the conditional-value-at-risk (CVaR) metric to create a general multi-stakeholder decision-making framework. It is observed that stakeholder dissatisfactions (distance to their individual ideal solutions) can be interpreted as random variables. We thus shape the dissatisfaction distribution and find an optimal compromise solution by solving a CVaR minimization problem parameterized in the probability level. This enables us to generalize multi-stakeholder settings previously proposed in the literature that minimizes average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework. We demonstrate the framework in a bio-waste processing facility location case study, where we seek compromise solutions (facility locations) that balance stakeholder priorities on transportation, safety, water quality, and capital costs. This conference presentation abstract explains a new decision-making framework that computes compromise solution alternatives (reach consensus) by mitigating dissatisfactions among stakeholders as needed for SHC Decision Science and Support Tools project.

Registered nurses' decision-making regarding documentation in patients' progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive continuum theory as a decision-making framework, provides a powerful means of guiding nurses' decision-making. © 2012 Blackwell Publishing Ltd.

How do small groups make decisions? : A theoretical framework to inform the implementation and study of clinical competency committees.

PubMed

Chahine, Saad; Cristancho, Sayra; Padgett, Jessica; Lingard, Lorelei

2017-06-01

In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees' competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April-June 2016 to consolidate the literature included in this review.Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group's perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence. The way in which these committees make decisions can have huge implications for trainee progression and, ultimately, patient care. Therefore, there is a pressing need to build the science of how such group decision-making works in practice. This synthesis suggests a preliminary organizing framework that can be used in the implementation and study of clinical competency committees.

Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications.

PubMed

Gawron, Lori M; Watson, Katie

2017-02-01

We explored whether the decision-making process of women aborting a pregnancy for a fetal indication fit common medical ethical frameworks. We applied three ethical frameworks (principlism, care ethics, and narrative ethics) in a secondary analysis of 30 qualitative interviews from women choosing 2nd trimester abortion for fetal indications. All 30 women offered reasoning consistent with one or more ethical frameworks. Principlism themes included avoidance of personal suffering (autonomy), and sparing a child a poor quality of life and painful medical interventions (beneficence/non-maleficence). Care ethics reasoning included relational considerations of family needs and resources, and narrative ethics reasoning contextualized this experience into the patient's life story. This population's universal application of commonly accepted medical ethical frameworks supports the position that patients choosing fetal indication abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures. These findings suggest recent political efforts blocking abortion access should be reframed as attempts to undermine the moral decision-making of women. Published by Elsevier Inc.

A conceptual framework for automating the operational and strategic decision-making process in the health care delivery system.

PubMed

Ruohonen, Toni; Ennejmy, Mohammed

2013-01-01

Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.

Seven Basic Steps to Solving Ethical Dilemmas in Special Education: A Decision-Making Framework

ERIC Educational Resources Information Center

Stockall, Nancy; Dennis, Lindsay R.

2015-01-01

This article presents a seven-step framework for decision making to solve ethical issues in special education. The authors developed the framework from the existing literature and theoretical frameworks of justice, critique, care, and professionalism. The authors briefly discuss each theoretical framework and then describe the decision-making…

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

PubMed

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

2008-03-01

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

The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage.

PubMed

Bechara, Antoine

2004-06-01

Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information normally suggest that people make judgments not only by evaluating the consequences and their probability of occurring, but also and even sometimes primarily at a gut or emotional level. Lesions of the ventromedial (which includes the orbitofrontal) sector of the prefrontal cortex interfere with the normal processing of "somatic" or emotional signals, while sparing most basic cognitive functions. Such damage leads to impairments in the decision-making process, which seriously compromise the quality of decisions in daily life. The aim of this paper is to review evidence in support of "The Somatic Marker Hypothesis," which provides a systems-level neuroanatomical and cognitive framework for decision-making and suggests that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. The implications of this theoretical framework for the normal and abnormal development of the orbitofrontal cortex are also discussed.

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

PubMed

Astbury, Ruth; Shepherd, Ashley; Cheyne, Helen

2017-01-01

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

Decision framework for corridor planning within the roadside right-of-way.

DOT National Transportation Integrated Search

2013-08-01

A decision framework was developed for context-sensitive planning within the roadside ROW in : Michigan. This framework provides a roadside suitability assessment model that may be used to : support integrated decision-making and policy level conside...

A conceptual framework for negotiating public involvement in municipal waste management decision-making in the UK.

PubMed

Garnett, Kenisha; Cooper, Tim; Longhurst, Philip; Jude, Simon; Tyrrel, Sean

2017-08-01

The technical expertise that politicians relied on in the past to produce cost-effective and environmentally sound solutions no longer provides sufficient justification to approve waste facilities. Local authorities need to find more effective ways to involve stakeholders and communities in decision-making since public acceptance of municipal waste facilities is integral to delivering effective waste strategies. This paper presents findings from a research project that explored attitudes towards greater levels of public involvement in UK waste management decision-making. The study addressed questions of perception, interests, the decision context, the means of engagement and the necessary resources and capacity for adopting a participatory decision process. Adopting a mixed methods approach, the research produced an empirical framework for negotiating the mode and level of public involvement in waste management decision-making. The framework captures and builds on theories of public involvement and the experiences of practitioners, and offers guidance for integrating analysis and deliberation with public groups in different waste management decision contexts. Principles in the framework operate on the premise that the decision about 'more' and 'better' forms of public involvement can be negotiated, based on the nature of the waste problem and wider social context of decision-making. The collection of opinions from the wide range of stakeholders involved in the study has produced new insights for the design of public engagement processes that are context-dependent and 'fit-for-purpose'; these suggest a need for greater inclusivity in the case of contentious technologies and high levels of uncertainty regarding decision outcomes. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Advanced Computational Framework for Environmental Management ZEM, Version 1.x

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

Vesselinov, Velimir V.; O'Malley, Daniel; Pandey, Sachin

2016-11-04

Typically environmental management problems require analysis of large and complex data sets originating from concurrent data streams with different data collection frequencies and pedigree. These big data sets require on-the-fly integration into a series of models with different complexity for various types of model analyses where the data are applied as soft and hard model constraints. This is needed to provide fast iterative model analyses based on the latest available data to guide decision-making. Furthermore, the data and model are associated with uncertainties. The uncertainties are probabilistic (e.g. measurement errors) and non-probabilistic (unknowns, e.g. alternative conceptual models characterizing site conditions).more » To address all of these issues, we have developed an integrated framework for real-time data and model analyses for environmental decision-making called ZEM. The framework allows for seamless and on-the-fly integration of data and modeling results for robust and scientifically-defensible decision-making applying advanced decision analyses tools such as Bayesian- Information-Gap Decision Theory (BIG-DT). The framework also includes advanced methods for optimization that are capable of dealing with a large number of unknown model parameters, and surrogate (reduced order) modeling capabilities based on support vector regression techniques. The framework is coded in Julia, a state-of-the-art high-performance programing language (http://julialang.org). The ZEM framework is open-source and can be applied to any environmental management site. The framework will be open-source and released under GPL V3 license.« less

Application of Construal Level and Value-Belief Norm Theories to Undergraduate Decision-Making on a Wildlife Socio-Scientific Issue

ERIC Educational Resources Information Center

Sutter, A. McKinzie; Dauer, Jenny M.; Forbes, Cory T.

2018-01-01

One aim of science education is to develop scientific literacy for decision-making in daily life. Socio-scientific issues (SSI) and structured decision-making frameworks can help students reach these objectives. This research uses value belief norm (VBN) theory and construal level theory (CLT) to explore students' use of personal values in their…

Shared Decisions That Count.

ERIC Educational Resources Information Center

Schlechty, Phillip C.

1993-01-01

Advocates of participatory leadership, site-based management, and decentralization often assume that changing decision-making group composition will automatically improve the quality of decisions being made. Stakeholder satisfaction does not guarantee quality results. This article offers a framework for moving the decision-making discussion from…

Big data and high-performance analytics in structural health monitoring for bridge management

NASA Astrophysics Data System (ADS)

Alampalli, Sharada; Alampalli, Sandeep; Ettouney, Mohammed

2016-04-01

Structural Health Monitoring (SHM) can be a vital tool for effective bridge management. Combining large data sets from multiple sources to create a data-driven decision-making framework is crucial for the success of SHM. This paper presents a big data analytics framework that combines multiple data sets correlated with functional relatedness to convert data into actionable information that empowers risk-based decision-making. The integrated data environment incorporates near real-time streams of semi-structured data from remote sensors, historical visual inspection data, and observations from structural analysis models to monitor, assess, and manage risks associated with the aging bridge inventories. Accelerated processing of dataset is made possible by four technologies: cloud computing, relational database processing, support from NOSQL database, and in-memory analytics. The framework is being validated on a railroad corridor that can be subjected to multiple hazards. The framework enables to compute reliability indices for critical bridge components and individual bridge spans. In addition, framework includes a risk-based decision-making process that enumerate costs and consequences of poor bridge performance at span- and network-levels when rail networks are exposed to natural hazard events such as floods and earthquakes. Big data and high-performance analytics enable insights to assist bridge owners to address problems faster.

Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer.

PubMed

Ogawa, Asao; Kondo, Kyoko; Takei, Hiroyuki; Fujisawa, Daisuke; Ohe, Yuichiro; Akechi, Tatsuo

2018-04-01

The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. © AlphaMed Press 2017.

Ethical Frameworks in Public Health Decision-Making: Defending a Value-Based and Pluralist Approach.

PubMed

Grill, Kalle; Dawson, Angus

2017-12-01

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim's and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health.

Characterizing the orthodontic patient's purchase decision: A novel approach using netnography.

PubMed

Pittman, Joseph W; Bennett, M Elizabeth; Koroluk, Lorne D; Robinson, Stacey G; Phillips, Ceib L

2017-06-01

A deeper and more thorough characterization of why patients do or do not seek orthodontic treatment is needed for effective shared decision making about receiving treatment. Previous orthodontic qualitative research has identified important dimensions that influence treatment decisions, but our understanding of patients' decisions and how they interpret benefits and barriers of treatment are lacking. The objectives of this study were to expand our current list of decision-making dimensions and to create a conceptual framework to describe the decision-making process. Discussion boards, rich in orthodontic decision-making data, were identified and analyzed with qualitative methods. An iterative process of data collection, dimension identification, and dimension refinement were performed to saturation. A conceptual framework was created to describe the decision-making process. Fifty-four dimensions captured the ideas discussed in regard to a patient's decision to receive orthodontic treatment. Ten domains were identified: function, esthetics, psychosocial benefits, diagnosis, finances, inconveniences, risks of treatment, individual aspects, societal attitudes, and child-specific influences, each containing specific descriptive and conceptual dimensions. A person's desires, self-perceptions, and viewpoints, the public's views on esthetics and orthodontics, and parenting philosophies impacted perceptions of benefits and barriers associated with orthodontic treatment. We identified an expanded list of dimensions, created a conceptual framework describing the orthodontic patient's decision-making process, and identified dimensions associated with yes and no decisions, giving doctors a better understanding of patient attitudes and expectations. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2012-11-01

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

Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria.

PubMed

Feig, Chiara; Cheung, Kei Long; Hiligsmann, Mickaël; Evers, Silvia M A A; Simon, Judit; Mayer, Susanne

2018-04-01

Although Health Technology Assessment (HTA) is increasingly used to support evidence-based decision-making in health care, several barriers and facilitators for the use of HTA have been identified. This best-worst scaling (BWS) study aims to assess the relative importance of selected barriers and facilitators of the uptake of HTA studies in Austria. A BWS object case survey was conducted among 37 experts in Austria to assess the relative importance of HTA barriers and facilitators. Hierarchical Bayes estimation was applied, with the best-worst count analysis as sensitivity analysis. Subgroup analyses were also performed on professional role and HTA experience. The most important barriers were 'lack of transparency in the decision-making process', 'fragmentation', 'absence of appropriate incentives', 'no explicit framework for decision-making process', and 'insufficient legal support'. The most important facilitators were 'transparency in the decision-making process', 'availability of relevant HTA research for policy makers', 'availability of explicit framework for decision-making process', 'sufficient legal support', and 'appropriate incentives'. This study suggests that HTA barriers and facilitators related to the context of decision makers, especially 'policy characteristics' and 'organization and resources' are the most important in Austria. A transparent and participatory decision-making process could improve the adoption of HTA evidence.

Iowa pavement asset management decision-making framework : [tech transfer summary].

DOT National Transportation Integrated Search

2015-10-01

A structured framework and tool that can reflect local requirements, : practices, and operational conditions would greatly assist local : agencies in making consistent and defensible pavement treatment : selection decisions.

Computational Complexity and Human Decision-Making.

PubMed

Bossaerts, Peter; Murawski, Carsten

2017-12-01

The rationality principle postulates that decision-makers always choose the best action available to them. It underlies most modern theories of decision-making. The principle does not take into account the difficulty of finding the best option. Here, we propose that computational complexity theory (CCT) provides a framework for defining and quantifying the difficulty of decisions. We review evidence showing that human decision-making is affected by computational complexity. Building on this evidence, we argue that most models of decision-making, and metacognition, are intractable from a computational perspective. To be plausible, future theories of decision-making will need to take into account both the resources required for implementing the computations implied by the theory, and the resource constraints imposed on the decision-maker by biology. Copyright © 2017 Elsevier Ltd. All rights reserved.

A geospatial framework for dynamic route planning using congestion prediction in transportation systems.

DOT National Transportation Integrated Search

2011-01-01

The goal this research is to develop an end-to-end data-driven system, dubbed TransDec : (short for Transportation Decision-Making), to enable decision-making queries in : transportation systems with dynamic, real-time and historical data. With Trans...

A Framework for Facilitating Ecosystem Services-based Decision-making and the Development of Decision-making Tools

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. The vast majority of environmenta...

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

PubMed Central

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

PubMed Central

Iskrov, Georgi; Stefanov, Rumen

2016-01-01

Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen involvement in public health decision-making. Drug reimbursement criteria have to be integrated into legitimate public health decision support tools that ensure the achievement of national public health objectives. These recommendations could be expanded to all Eastern European countries who share common public health problems. PMID:26966615

A Framework for Measurement Feedback to Improve Decision-Making in Mental Health

PubMed Central

Chorpita, Bruce F.; Reay, William E.; Stelk, Wayne; Garland, Ann F.; Kutash, Krista; Mullican, Charlotte; Ringeisen, Heather

2009-01-01

The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field. PMID:20041342

Development of a First-of-a-Kind Deterministic Decision-Making Tool for Supervisory Control System

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

Cetiner, Sacit M; Kisner, Roger A; Muhlheim, Michael David

2015-07-01

Decision-making is the process of identifying and choosing alternatives where each alternative offers a different approach or path to move from a given state or condition to a desired state or condition. The generation of consistent decisions requires that a structured, coherent process be defined, immediately leading to a decision-making framework. The overall objective of the generalized framework is for it to be adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or nomore » human intervention. The overriding goal of automation is to replace or supplement human decision makers with reconfigurable decision- making modules that can perform a given set of tasks reliably. Risk-informed decision making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The implementation of the probabilistic portion of the decision-making engine of the proposed supervisory control system was detailed in previous milestone reports. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic multi-attribute decision-making framework uses variable sensor data (e.g., outlet temperature) and calculates where it is within the challenge state, its trajectory, and margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. Metrics to be evaluated include stability, cost, time to complete (action), power level, etc. The integration of deterministic calculations using multi-physics analyses (i.e., neutronics, thermal, and thermal-hydraulics) and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermal-hydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies.« less

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

PubMed

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Shared decision-making in epilepsy management.

PubMed

Pickrell, W O; Elwyn, G; Smith, P E M

2015-06-01

Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance. Copyright © 2015 Elsevier Inc. All rights reserved.

Emotion, decision-making and the brain.

PubMed

Chang, Luke J; Sanfey, Alan G

2008-01-01

Initial explorations in the burgeoning field of neuroeconomics have highlighted evidence supporting a potential dissociation between a fast automatic system and a slow deliberative controlled system. Growing research in the role of emotion in decision-making has attempted to draw parallels to the automatic system. This chapter will discuss a theoretical framework for understanding the role of emotion in decision-making and evidence supporting the underlying neural substrates. This chapter applies a conceptual framework to understanding the role of emotion in decision-making, and emphasizes a distinction between expected and immediate emotions. Expected emotions refer to anticipated emotional states associated with a given decision that are never actually experienced. Immediate emotions, however, are experienced at the time of decision, and either can occur in response to a particular decision or merely as a result of a transitory fluctuation. This chapter will review research from the neuroeconomics literature that supports a neural dissociation between these two classes of emotion and also discuss a few interpretive caveats. Several lines of research including regret, uncertainty, social decision-making, and moral decision-making have yielded evidence consistent with our formulization--expected and immediate emotions may invoke dissociable neural systems. This chapter provides a more specific conceptualization of the mediating role of emotions in the decision-making process, which has important implications for understanding the interacting neural systems underlying the interface between emotion and cognition--a topic of immediate value to anyone investigating topics within the context of social-cognitive-affective-neuroscience.

Ethical Decision-Making in Academic Administration: A Qualitative Study of College Deans' Ethical Frameworks

ERIC Educational Resources Information Center

Catacutan, Maria Rosario G.; de Guzman, Allan B.

2015-01-01

Ethical decision-making in school administration has received considerable attention in educational leadership literature. However, most research has focused on principals working in secondary school settings while studies that explore ethical reasoning processes of academic deans have been significantly few. This qualitative study aims to…

Towards a conceptual multi-agent-based framework to simulate the spatial group decision-making process

NASA Astrophysics Data System (ADS)

Ghavami, Seyed Morsal; Taleai, Mohammad

2017-04-01

Most spatial problems are multi-actor, multi-issue and multi-phase in nature. In addition to their intrinsic complexity, spatial problems usually involve groups of actors from different organizational and cognitive backgrounds, all of whom participate in a social structure to resolve or reduce the complexity of a given problem. Hence, it is important to study and evaluate what different aspects influence the spatial problem resolution process. Recently, multi-agent systems consisting of groups of separate agent entities all interacting with each other have been put forward as appropriate tools to use to study and resolve such problems. In this study, then in order to generate a better level of understanding regarding the spatial problem group decision-making process, a conceptual multi-agent-based framework is used that represents and specifies all the necessary concepts and entities needed to aid group decision making, based on a simulation of the group decision-making process as well as the relationships that exist among the different concepts involved. The study uses five main influencing entities as concepts in the simulation process: spatial influence, individual-level influence, group-level influence, negotiation influence and group performance measures. Further, it explains the relationship among different concepts in a descriptive rather than explanatory manner. To illustrate the proposed framework, the approval process for an urban land use master plan in Zanjan—a provincial capital in Iran—is simulated using MAS, the results highlighting the effectiveness of applying an MAS-based framework when wishing to study the group decision-making process used to resolve spatial problems.

Forensic issues in medical evaluation: competency and end-of-life issues.

PubMed

Soliman, Sherif; Hall, Ryan C W

2015-01-01

Decision-making capacity is a common reason for psychiatric consultation that is likely to become more common as the population ages. Capacity assessments are frequently compromised by misconceptions, such as the belief that incapacity is permanent or that patients with dementia categorically lack capacity. This chapter will review the conceptual framework of decision-making capacity and discuss its application to medical decision-making. We will review selected developments in capacity assessment and recommend an approach to assessing decision-making capacity. We will discuss the unique challenges posed by end-of-life care, including determining capacity, identifying surrogate decision-makers, and working with surrogate decision-makers. We will discuss clinical and legal approaches to incapacity, including advance directives, surrogate decision-makers, and guardians. We will discuss the legal standards based on which surrogates make medical decisions and outline options for resolving disagreements between clinical staff and surrogate decision-makers. We will offer recommendations for approaching decision-making capacity assessments. © 2015 S. Karger AG, Basel.

Plan Execution Interchange Language (PLEXIL)

NASA Technical Reports Server (NTRS)

Estlin, Tara; Jonsson, Ari; Pasareanu, Corina; Simmons, Reid; Tso, Kam; Verma, Vandi

2006-01-01

Plan execution is a cornerstone of spacecraft operations, irrespective of whether the plans to be executed are generated on board the spacecraft or on the ground. Plan execution frameworks vary greatly, due to both different capabilities of the execution systems, and relations to associated decision-making frameworks. The latter dependency has made the reuse of execution and planning frameworks more difficult, and has all but precluded information sharing between different execution and decision-making systems. As a step in the direction of addressing some of these issues, a general plan execution language, called the Plan Execution Interchange Language (PLEXIL), is being developed. PLEXIL is capable of expressing concepts used by many high-level automated planners and hence provides an interface to multiple planners. PLEXIL includes a domain description that specifies command types, expansions, constraints, etc., as well as feedback to the higher-level decision-making capabilities. This document describes the grammar and semantics of PLEXIL. It includes a graphical depiction of this grammar and illustrative rover scenarios. It also outlines ongoing work on implementing a universal execution system, based on PLEXIL, using state-of-the-art rover functional interfaces and planners as test cases.

Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

PubMed Central

2014-01-01

Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women. PMID:24884597

Exploring the oxygen supply and demand framework as a learning tool in undergraduate nursing education.

PubMed

Gillespie, Mary; Shackell, Eileen

2017-11-01

In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education. A pretest/post-test assessment and reflective journal were used to gather data. Findings indicated the Oxygen Supply and Demand Framework guided the development of pattern recognition and thinking processes and supported knowledge development, knowledge application and clinical decision-making. The Oxygen Supply and Demand Framework supports undergraduate students learning to provide safe and effective nursing care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making.

PubMed

Shrier, Ian

2015-10-01

The sport medicine clinician is faced with return-to-play (RTP) decisions for every patient who wants to return to activity. The complex interaction of factors related to history, physical examination, testing, activity and baseline characteristics can make RTP decision-making challenging. Further, when reasoning is not explicit, unnecessary conflict can arise among clinicians themselves, or among clinicians and patients. This conflict can have negative health consequences for the patient. In 2010, a transparent framework for RTP decisions was proposed. However, some have identified limitations to the framework and found difficulties in its implementation. This paper presents a revised framework that addresses the limitations, and provides concrete examples of how to apply it in simple and complex cases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

PubMed

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

2015-01-01

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

Integrated Risk-Informed Decision-Making for an ALMR PRISM

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

Muhlheim, Michael David; Belles, Randy; Denning, Richard S.

Decision-making is the process of identifying decision alternatives, assessing those alternatives based on predefined metrics, selecting an alternative (i.e., making a decision), and then implementing that alternative. The generation of decisions requires a structured, coherent process, or a decision-making process. The overall objective for this work is that the generalized framework is adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or no human intervention. The overriding goal of automation is to replace ormore » supplement human decision makers with reconfigurable decision-making modules that can perform a given set of tasks rationally, consistently, and reliably. Risk-informed decision-making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The probabilistic portion of the decision-making engine of the supervisory control system is based on the control actions associated with an ALMR PRISM. Newly incorporated into the probabilistic models are the prognostic/diagnostic models developed by Pacific Northwest National Laboratory. These allow decisions to incorporate the health of components into the decision–making process. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic portion of the decision-making engine uses thermal-hydraulic modeling and components for an advanced liquid-metal reactor Power Reactor Inherently Safe Module. The deterministic multi-attribute decision-making framework uses various sensor data (e.g., reactor outlet temperature, steam generator drum level) and calculates its position within the challenge state, its trajectory, and its margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. The metrics that are evaluated are based on reactor trip set points. The integration of the deterministic calculations using multi-physics analyses and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermalhydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies, and developing a user interface to mimic display panels at a modern nuclear power plant.« less

European Qualifications Framework: Weighing Some Pros and Cons out of a French Perspective

ERIC Educational Resources Information Center

Bouder, Annie

2008-01-01

Purpose: The purpose of this paper is to question the appropriateness of a proposal for a new European Qualifications Framework. The framework has three perspectives: historical; analytical; and national. Design/methodology/approach: The approaches are diverse since the first insists on the institutional and decision-making processes at European…

An analytical procedure to assist decision-making in a government research organization

Treesearch

H. Dean Claxton; Giuseppe Rensi

1972-01-01

An analytical procedure to help management decision-making in planning government research is described. The objectives, activities, and restrictions of a government research organization are modeled in a consistent analytical framework. Theory and methodology is drawn from economics and mathe-matical programing. The major analytical aspects distinguishing research...

Leadership in a Performative Context: A Framework for Decision-Making

ERIC Educational Resources Information Center

Chitpin, Stephanie; Jones, Ken

2015-01-01

This paper examines a model of decision-making within the context of current and emerging regimes of accountability being proposed and implemented for school systems in a number of jurisdictions. These approaches to accountability typically involve the use of various measurable student learning outcomes as well as other measures of performance to…

Principals' Moral Agency and Ethical Decision-Making: Toward a Transformational Ethics

ERIC Educational Resources Information Center

Cherkowski, Sabre; Walker, Keith D.; Kutsyuruba, Benjamin

2015-01-01

This descriptive study provides a rich portrait of moral agency and ethical decision-making processes among a sample of Canadian school principals. Using an ethical responsibility framework linking moral agency and transformational leadership, the researchers found that (1) modeling moral agency is important for encouraging others to engage their…

Decisions Matter: Using a Decision-Making Framework with Contemporary Student Affairs Case Studies

ERIC Educational Resources Information Center

Vaccaro, Annemarie; McCoy, Brian; Champagne, Delight; Siegel, Michael

2013-01-01

"Decisions Matter" is an innovative guide designed to help novice student affairs professionals develop effective decision-making skills. Written by seasoned student affairs educators and practitioners, this book contains a systematic method for solving a wide range of complex problems. In this exceptional instructional tool, the authors…

The Structure of Knowledge and Departmental Social Organization.

ERIC Educational Resources Information Center

Adkinson, Judith

1979-01-01

This case study of three university departments was designed to generate substantive theory about decision-making in academic departments. Homans' social systems theory was used as a framework, and it is shown that the rate of interaction affects the crystallization of norm structures and processes of influence and decision-making. (Author/LBH)

Data and information integration framework for highway project decision making.

DOT National Transportation Integrated Search

2013-08-01

This report presents a three-tiered framework to integrate data, information, and decision-making in highway projects. The study uses the Jurans Triple Role concept and context graph to illustrate the relationship between data, information, and de...

Systems identification and the adaptive management of waterfowl in the United States

USGS Publications Warehouse

Williams, B.K.; Nichols, J.D.

2001-01-01

Waterfowl management in the United States is one of the more visible conservation success stories in the United States. It is authorized and supported by appropriate legislative authorities, based on large-scale monitoring programs, and widely accepted by the public. The process is one of only a limited number of large-scale examples of effective collaboration between research and management, integrating scientific information with management in a coherent framework for regulatory decision-making. However, harvest management continues to face some serious technical problems, many of which focus on sequential identification of the resource system in a context of optimal decision-making. The objective of this paper is to provide a theoretical foundation of adaptive harvest management, the approach currently in use in the United States for regulatory decision-making. We lay out the legal and institutional framework for adaptive harvest management and provide a formal description of regulatory decision-making in terms of adaptive optimization. We discuss some technical and institutional challenges in applying adaptive harvest management and focus specifically on methods of estimating resource states for linear resource systems.

Modelling risk aversion to support decision-making for controlling zoonotic livestock diseases.

PubMed

van Asseldonk, M A P M; Bergevoet, R H M; Ge, L

2013-12-01

Zoonotic infectious livestock diseases are becoming a significant burden for both animal and human health and are rapidly gaining the attention of decision-makers who manage public health programmes. If control decisions have only monetary components, governments are generally regarded as being risk-neutral and the intervention strategy with the highest expected benefit (lowest expected net costs) should be preferred. However, preferences will differ and alternative intervention plans will prevail if (human) life and death outcomes are involved. A rational decision framework must therefore consider risk aversion in the decision-maker and controversial values related to public health. In the present study, risk aversion and its impact on both the utility for the monetary component and the utility for the non-monetary component is shown to be an important element when dealing with emerging zoonotic infectious livestock diseases and should not be ignored in the understanding and support of decision-making. The decision framework was applied to several control strategies for the reduction of human cases of brucellosis (Brucella melitensis) originating from sheep in Turkey.

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

PubMed Central

Menychtas, Andreas; Tsanakas, Panayiotis

2016-01-01

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

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

PubMed

Menychtas, Andreas; Tsanakas, Panayiotis; Maglogiannis, Ilias

2016-03-01

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

Conceptual framework for nutrition surveillance systems.

PubMed

Mock, N B; Bertrand, W E

1993-01-01

This article describes the evolution of nutrition surveillance as an intervention strategy and presents a framework for improving the usefulness of nutrition surveillance programs. It seems clear that such programs' impact on nutritional well-being will depend increasingly on their ability to reach and influence decision-makers. Therefore, it is important to consider political and social forces, and also to realize that if a program is too decentralized or too far removed from key decision-makers, its ability to influence resource flows may be limited. It is of course important that the surveillance information provided be appropriate and of good quality. Therefore, the data collected should be analyzed to ensure they are accurate and representative. Once that has been done, relevant findings should be presented in a readily understandable form designed to meet the intended recipients' information needs. Such findings should also be disseminated to all important decision-maker constituencies, including external donors of nutrition assistance and the general public.

Integrative evaluation for sustainable decisions of urban wastewater system management under uncertainty

NASA Astrophysics Data System (ADS)

Hadjimichael, A.; Corominas, L.; Comas, J.

2017-12-01

With sustainable development as their overarching goal, urban wastewater system (UWS) managers need to take into account multiple social, economic, technical and environmental facets related to their decisions. In this complex decision-making environment, uncertainty can be formidable. It is present both in the ways the system is interpreted stochastically, but also in its natural ever-shifting behavior. This inherent uncertainty suggests that wiser decisions would be made under an adaptive and iterative decision-making regime. No decision-support framework has been presented in the literature to effectively addresses all these needs. The objective of this work is to describe such a conceptual framework to evaluate and compare alternative solutions for various UWS challenges within an adaptive management structure. Socio-economic aspects such as externalities are taken into account, along with other traditional criteria as necessary. Robustness, reliability and resilience analyses test the performance of the system against present and future variability. A valuation uncertainty analysis incorporates uncertain valuation assumptions in the decision-making process. The framework is demonstrated with an application to a case study presenting a typical problem often faced by managers: poor river water quality, increasing population, and more stringent water quality legislation. The application of the framework made use of: i) a cost-benefit analysis including monetized environmental benefits and damages; ii) a robustness analysis of system performance against future conditions; iii) reliability and resilience analyses of the system given contextual variability; and iv) a valuation uncertainty analysis of model parameters. The results suggest that the installation of bigger volumes would give rise to increased benefits despite larger capital costs, as well as increased robustness and resilience. Population numbers appear to affect the estimated benefits most, followed by electricity prices and climate change projections. The presented framework is expected to be a valuable tool for the next generation of UWS decision-making and the application demonstrates a novel and valuable integration of metrics and methods for UWS analysis.

Policy analysis for deciding on a malaria vaccine RTS,S in Tanzania.

PubMed

Romore, Idda; Njau, Ritha J A; Semali, Innocent; Mwisongo, Aziza; Ba Nguz, Antoinette; Mshinda, Hassan; Tanner, Marcel; Abdulla, Salim

2016-03-08

Traditionally, it has taken decades to introduce new interventions in low-income countries. Several factors account for these delays, one of which is the absence of a framework to facilitate comprehensive understanding of policy process to inform policy makers and stimulate the decision-making process. In the case of the proposed introduction of malaria vaccines in Tanzania, a specific framework for decision-making will speed up the administrative process and shorten the time until the vaccine is made available to the target population. Qualitative research was used as a basis for developing the Policy Framework. Interviews were conducted with government officials, bilateral and multilateral partners and other stakeholders in Tanzania to assess malaria treatment policy changes and to draw lessons for malaria vaccine adoption. The decision-making process for adopting malaria interventions and new vaccines in general takes years, involving several processes: meetings and presentations of scientific data from different studies with consistent results, packaging and disseminating evidence and getting approval for use by the Ministry of Health and Social Welfare (MOHSW). It is influenced by contextual factors; Promoting factors include; epidemiological and intervention characteristics, country experiences of malaria treatment policy change, presentation and dissemination of evidence, coordination and harmonization of the process, use of international scientific evidence. Barriers factors includes; financial sustainability, competing health and other priorities, political will and bureaucratic procedures, costs related to the adoption and implementations of interventions, supply and distribution and professional compliance with anti-malarial drugs. The framework facilitates the synthesis of information in a coherent way, enabling a clearer understanding of the policy process, thereby speeding up the policy decision-making process and shortening the time for a malaria vaccine to become available.

The Employment of Ethical Decision-Making Frameworks in Educational Change

ERIC Educational Resources Information Center

Horn, Raymond A., Jr.

2004-01-01

In this article, the author provides a prefacing narrative that examines the work of Simpson et al. (2004, this issue), situating the reader as the importance of a framework for curriculum design. Importantly, the author illuminates a set a democratic values that animate the framework, and which work to instruct a democratic ethic of curriculum…

Situation awareness and documentation of changes that affect patient outcomes in progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy

2014-05-01

To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. © 2013 John Wiley & Sons Ltd.

Teaching Behavioral Ethics: Overcoming the Key Impediments to Ethical Behavior

ERIC Educational Resources Information Center

Schwartz, Mark S.

2017-01-01

To better understand the ethical decision-making process and why individuals fail to act ethically, the aim of this article is to explore what are seen as the key impediments to ethical behavior and their pedagogical implications. Using the ethical decision-making process proposed by Rest as an overarching framework, the article examines the…

Reframing and the Liberal Arts: Creative Decision-Making in the Global Marketplace. Working Paper/3.

ERIC Educational Resources Information Center

Barnett, Steve

In order to understand creative decisionmaking in the rapidly changing global marketplace, business executives must view, interpret, and analyze events with new vision. A framework for understanding old thought patterns is provided along with suggestions on ways in which the humanities and social sciences (and other liberal arts) can help the…

The Impact of Research on Decision-Making by Practitioners and Managers.

ERIC Educational Resources Information Center

Smith, Chris Selby

The impact of research and development (R&D) on decision making and managers in vocational education and training (VET) was examined through a review of recent Australian studies in VET and health care. The framework adopted to analyze the relationships between R&D and decision making distinguished between the decision-making domain, the…

Anarchist, Neoliberal, & Democratic Decision-Making: Deepening the Joy in Learning and Teaching

ERIC Educational Resources Information Center

Briscoe, Felecia M.

2012-01-01

Using a critical postmodern framework, this article analyzes the relationship of the decision-making processes of anarchism and neoliberalism to that of deep democracy. Anarchist processes are found to share common core principals with deep democracy; but neoliberal processes are found to be antithetical to deep democracy. To increase the joy in…

An Examination of Factors Influencing Students Selection of Business Majors Using TRA Framework

ERIC Educational Resources Information Center

Kumar, Anil; Kumar, Poonam

2013-01-01

Making decisions regarding the selection of a business major is both very important and challenging for students. An understanding of this decision-making process can be valuable for students, parents, and university programs. The current study applies the Theory of Reasoned Action (TRA) consumer decision-making model to examine factors that…

Decision Support Framework (DSF) Team Research Implementation Plan

EPA Science Inventory

The mission of ORD's Ecosystem Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...

Evaluating the substantive effectiveness of SEA: Towards a better understanding

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

Doren, D. van; Driessen, P.P.J., E-mail: p.driessen@uu.nl; Schijf, B.

Evaluating the substantive effectiveness of strategic environmental assessment (SEA) is vital in order to know to what extent the tool fulfills its purposes and produces expected results. However, the studies that have evaluated the substantive effectiveness of SEA produce varying outcomes as regards the tool's contribution to decision-making and have used a variety of approaches to appraise its effectiveness. The aim of this article is to discuss the theoretical concept of SEA substantive effectiveness and to present a new approach that can be applied for evaluation studies. The SEA effectiveness evaluation framework that will be presented is composed of conceptsmore » of, and approaches to, SEA effectiveness derived from SEA literature and planning theory. Lessons for evaluation can be learned from planning theory in particular, given its long history of analyzing and understanding how sources of information and decisions affect (subsequent) decision-making. Key concepts of this new approach are 'conformance' and 'performance'. In addition, this article presents a systematic overview of process and context factors that can explain SEA effectiveness, derived from SEA literature. To illustrate the practical value of our framework for the assessment and understanding of substantive effectiveness of SEA, three Dutch SEA case studies are examined. The case studies have confirmed the usefulness of the SEA effectiveness assessment framework. The framework proved helpful in order to describe the cumulative influence of the three SEAs on decision-making and the ultimate plan. - Highlights: Black-Right-Pointing-Pointer A new framework to evaluate the substantive effectiveness of SEA is presented. Black-Right-Pointing-Pointer The framework is based on two key concepts: 'conformance' and 'performance.' Black-Right-Pointing-Pointer The practical applicability of the framework is demonstrated by three Dutch cases. Black-Right-Pointing-Pointer The framework allows for a more systematic understanding of SEA effectiveness. Black-Right-Pointing-Pointer Finally, this paper presents explanations for SEA effectiveness.« less

Helping Health Care Providers and Clinical Scientists Understand Apparently Irrational Policy Decisions.

PubMed

Demeter, Sandor J

2016-12-21

Health care providers (HCP) and clinical scientists (CS) are generally most comfortable using evidence-based rational decision-making models. They become very frustrated when policymakers make decisions that, on the surface, seem irrational and unreasonable. However, such decisions usually make sense when analysed properly. The goal of this paper to provide a basic theoretical understanding of major policy models, to illustrate which models are most prevalent in publicly funded health care systems, and to propose a policy analysis framework to better understand the elements that drive policy decision-making. The proposed policy framework will also assist HCP and CS achieve greater success with their own proposals.

Decision support in vaccination policies.

PubMed

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

How to use multi-criteria decision analysis methods for reimbursement decision-making in healthcare: a step-by-step guide.

PubMed

Diaby, Vakaramoko; Goeree, Ron

2014-02-01

In recent years, the quest for more comprehensiveness, structure and transparency in reimbursement decision-making in healthcare has prompted the research into alternative decision-making frameworks. In this environment, multi-criteria decision analysis (MCDA) is arising as a valuable tool to support healthcare decision-making. In this paper, we present the main MCDA decision support methods (elementary methods, value-based measurement models, goal programming models and outranking models) using a case study approach. For each family of methods, an example of how an MCDA model would operate in a real decision-making context is presented from a critical perspective, highlighting the parameters setting, the selection of the appropriate evaluation model as well as the role of sensitivity and robustness analyses. This study aims to provide a step-by-step guide on how to use MCDA methods for reimbursement decision-making in healthcare.

Emotion and decision-making: affect-driven belief systems in anxiety and depression.

PubMed

Paulus, Martin P; Yu, Angela J

2012-09-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach. Copyright © 2012. Published by Elsevier Ltd.

Emotion and decision-making: affect-driven belief systems in anxiety and depression

PubMed Central

Paulus, Martin P.; Yu, Angela J.

2012-01-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches to the link between emotion and decision-making, and focus on research with anxious or depressed individuals that reveals how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We then discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression and outline the broader implications of this approach. PMID:22898207

A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2017-11-01

This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.

A Moral (Normative) Framework for the Judgment of Actions and Decisions in the Construction Industry and Engineering: Part II.

PubMed

Alkhatib, Omar J

2017-12-01

The construction industry is typically characterized as a fragmented, multi-organizational setting in which members from different technical backgrounds and moral values join together to develop a particular business or project. The most challenging obstacle in the construction process is to achieve a successful practice and to identify and apply an ethical framework to manage the behavior of involved specialists and contractors and to ensure the quality of all completed construction activities. The framework should reflect a common moral ground for myriad people involved in this process to survive and compete ethically in today's turbulent construction market. This study establishes a framework for moral judgment of behavior and actions conducted in the construction process. The moral framework provides the basis of judging actions as "moral" or "immoral" based on three levels of moral accountability: personal, professional, and social. The social aspect of the proposed framework is developed primarily from the essential attributes of normative business decision-making models identified in the literature review and subsequently incorporates additional attributes related to professional and personal moral values. The normative decision-making models reviewed are based primarily on social attributes as related to moral theories (e.g., utilitarianism, duty, rights, virtue, etc.). The professional and moral attributes are established by identifying a set of common moral values recognized by professionals in the construction industry and required to prevent common construction breaches. The moral framework presented here is the complementary part of the ethical framework developed in Part I of this article and is based primarily on the personal behavior or the moral aspect of professional responsibility. The framework can be implemented as a form of preventive personal ethics, which would help avoid ethical dilemmas and moral implications in the first place. Furthermore, the moral framework can be considered as a decision-making model to guide actions and improve the moral reasoning process, which would help individuals think through possible implications and the consequences of ethical and moral issues in the construction industry.

Neuroeconomics: The neurobiology of value-based decision-making

PubMed Central

Rangel, Antonio; Camerer, Colin; Montague, P. Read

2015-01-01

Neuroeconomics studies the neurobiological and computational basis of value-based decision-making. Its goal is to provide a biologically-based account of human behavior that can be applied in both the natural and the social sciences. In this review we propose a framework for thinking about decision-making that allows us to bring together recent findings in the field, highlight some of the most important outstanding problems, define a common lexicon that bridges the different disciplines that inform neuroeconomics, and point the way to future applications. PMID:18545266

An Application of the Impact Evaluation Process for Designing a Performance Measurement and Evaluation Framework in K-12 Environments

ERIC Educational Resources Information Center

Guerra-Lopez, Ingrid; Toker, Sacip

2012-01-01

This article illustrates the application of the Impact Evaluation Process for the design of a performance measurement and evaluation framework for an urban high school. One of the key aims of this framework is to enhance decision-making by providing timely feedback about the effectiveness of various performance improvement interventions. The…

A Planning and Decision-Making Framework for Ecological Restoration.

ERIC Educational Resources Information Center

Wyant, James G.; And Others

1995-01-01

Provides a definition for restoration ecology that is suitable for extensive terrestrial applications and presents a decision framework to help organize different phases of the decision process. Encourages a wider spectrum of participants and decisions than have been traditionally employed for restoration planning. (AIM)

Informing the Gestalt: An Ethical Framework for Allocating Scarce Federal Public Health and Medical Resources to States During Disasters

PubMed Central

Knebel, Ann R.; Sharpe, Virginia A.; Danis, Marion; Toomey, Lauren M.; Knickerbocker, Deborah K.

2017-01-01

During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters. PMID:24612854

Reason, emotion and decision-making: risk and reward computation with feeling.

PubMed

Quartz, Steven R

2009-05-01

Many models of judgment and decision-making posit distinct cognitive and emotional contributions to decision-making under uncertainty. Cognitive processes typically involve exact computations according to a cost-benefit calculus, whereas emotional processes typically involve approximate, heuristic processes that deliver rapid evaluations without mental effort. However, it remains largely unknown what specific parameters of uncertain decision the brain encodes, the extent to which these parameters correspond to various decision-making frameworks, and their correspondence to emotional and rational processes. Here, I review research suggesting that emotional processes encode in a precise quantitative manner the basic parameters of financial decision theory, indicating a reorientation of emotional and cognitive contributions to risky choice.

Robustness Metrics: How Are They Calculated, When Should They Be Used and Why Do They Give Different Results?

NASA Astrophysics Data System (ADS)

McPhail, C.; Maier, H. R.; Kwakkel, J. H.; Giuliani, M.; Castelletti, A.; Westra, S.

2018-02-01

Robustness is being used increasingly for decision analysis in relation to deep uncertainty and many metrics have been proposed for its quantification. Recent studies have shown that the application of different robustness metrics can result in different rankings of decision alternatives, but there has been little discussion of what potential causes for this might be. To shed some light on this issue, we present a unifying framework for the calculation of robustness metrics, which assists with understanding how robustness metrics work, when they should be used, and why they sometimes disagree. The framework categorizes the suitability of metrics to a decision-maker based on (1) the decision-context (i.e., the suitability of using absolute performance or regret), (2) the decision-maker's preferred level of risk aversion, and (3) the decision-maker's preference toward maximizing performance, minimizing variance, or some higher-order moment. This article also introduces a conceptual framework describing when relative robustness values of decision alternatives obtained using different metrics are likely to agree and disagree. This is used as a measure of how "stable" the ranking of decision alternatives is when determined using different robustness metrics. The framework is tested on three case studies, including water supply augmentation in Adelaide, Australia, the operation of a multipurpose regulated lake in Italy, and flood protection for a hypothetical river based on a reach of the river Rhine in the Netherlands. The proposed conceptual framework is confirmed by the case study results, providing insight into the reasons for disagreements between rankings obtained using different robustness metrics.

Improvements to Strategic Planning and Implementation through Enhanced Correlation with Decision-Making Frameworks

ERIC Educational Resources Information Center

McCready, John W.

2010-01-01

The purpose of this study was to examine use of decision-making tools and feedback in strategic planning in order to develop a rigorous process that would promote the efficiency of strategic planning for acquisitions in the United States Coast Guard (USCG). Strategic planning is critical to agencies such as the USCG in order to be effective…

Developing and Validating a Tool to Assess Ethical Decision-Making Ability of Nursing Students, Using Rubrics

ERIC Educational Resources Information Center

Indhraratana, Apinya; Kaemkate, Wannee

2012-01-01

The aim of this paper is to develop a reliable and valid tool to assess ethical decision-making ability of nursing students using rubrics. A proposed ethical decision making process, from reviewing related literature was used as a framework for developing the rubrics. Participants included purposive sample of 86 nursing students from the Royal…

Measurement and Modelling: Sequential Use of Analytical Techniques in a Study of Risk-Taking in Decision-Making by School Principals

ERIC Educational Resources Information Center

Trimmer, Karen

2016-01-01

This paper investigates reasoned risk-taking in decision-making by school principals using a methodology that combines sequential use of psychometric and traditional measurement techniques. Risk-taking is defined as when decisions are made that are not compliant with the regulatory framework, the primary governance mechanism for public schools in…

Creating a System for Data-Driven Decision-Making: Applying the Principal-Agent Framework

ERIC Educational Resources Information Center

Wohlstetter, Priscilla; Datnow, Amanda; Park, Vicki

2008-01-01

The purpose of this article is to improve our understanding of data-driven decision-making strategies that are initiated at the district or system level. We apply principal-agent theory to the analysis of qualitative data gathered in a case study of 4 urban school systems. Our findings suggest educators at the school level need not only systemic…

Beyond Bioethics: A Child Rights-Based Approach to Complex Medical Decision-Making.

PubMed

Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

2016-01-01

This analysis adopts a child rights approach-based on the principles, standards, and norms of child rights and the U.N. Convention on the Rights of the Child (CRC)-to explore how decisions could be made with regard to treatment of a severely impaired infant (Baby G). While a child rights approach does not provide neat answers to ethically complex issues, it does provide a framework for decision-making in which the infant is viewed as an independent rights-holder. The state has obligations to develop the capacity of those who make decisions for infants in such situations to meet their obligations to respect, protect, and fulfill their rights as delineated in the CRC. Furthermore, a child rights approach requires procedural clarity and transparency in decision-making processes. As all rights in the CRC are interdependent and indivisible, all must be considered in the process of ethical decision-making, and the reasons for decisions must be delineated by reference to how these rights were considered. It is also important that decisions that are made in this context be monitored and reviewed to ensure consistency. A rights-based framework ensures decision-making is child-centered and that there are transparent criteria and legitimate procedures for making decisions regarding the child's most basic human right: the right to life, survival, and development.

Translational studies of goal-directed action as a framework for classifying deficits across psychiatric disorders

PubMed Central

Griffiths, Kristi R.; Morris, Richard W.; Balleine, Bernard W.

2014-01-01

The ability to learn contingencies between actions and outcomes in a dynamic environment is critical for flexible, adaptive behavior. Goal-directed actions adapt to changes in action-outcome contingencies as well as to changes in the reward-value of the outcome. When networks involved in reward processing and contingency learning are maladaptive, this fundamental ability can be lost, with detrimental consequences for decision-making. Impaired decision-making is a core feature in a number of psychiatric disorders, ranging from depression to schizophrenia. The argument can be developed, therefore, that seemingly disparate symptoms across psychiatric disorders can be explained by dysfunction within common decision-making circuitry. From this perspective, gaining a better understanding of the neural processes involved in goal-directed action, will allow a comparison of deficits observed across traditional diagnostic boundaries within a unified theoretical framework. This review describes the key processes and neural circuits involved in goal-directed decision-making using evidence from animal studies and human neuroimaging. Select studies are discussed to outline what we currently know about causal judgments regarding actions and their consequences, action-related reward evaluation, and, most importantly, how these processes are integrated in goal-directed learning and performance. Finally, we look at how adaptive decision-making is impaired across a range of psychiatric disorders and how deepening our understanding of this circuitry may offer insights into phenotypes and more targeted interventions. PMID:24904322

An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach.

PubMed

Callon, Wynne; Beach, Mary Catherine; Links, Anne R; Wasserman, Carly; Boss, Emily F

2018-03-11

We aimed to develop a comprehensive, descriptive framework to measure shared decision making (SDM) in clinical encounters. We combined a top-down (theoretical) approach with a bottom-up approach based on audio-recorded dialogue to identify all communication processes related to decision making. We coded 55 pediatric otolaryngology visits using the framework and report interrater reliability. We identified 14 clinician behaviors and 5 patient behaviors that have not been previously described, and developed a new SDM framework that is descriptive (what does happen) rather than normative (what should happen). Through the bottom-up approach we identified three broad domains not present in other SDM frameworks: socioemotional support, understandability of clinician dialogue, and recommendation-giving. We also specify the ways in which decision-making roles are assumed implicitly rather than discussed explicitly. Interrater reliability was >75% for 92% of the coded behaviors. This SDM framework allows for a more expansive understanding and analysis of how decision making takes place in clinical encounters, including new domains and behaviors not present in existing measures. We hope that this new framework will bring attention to a broader conception of SDM and allow researchers to further explore the new domains and behaviors identified. Copyright © 2018. Published by Elsevier B.V.

Application of the adverse outcome pathway framework - advances and challenges

EPA Science Inventory

The adverse outcome pathway (AOP) framework, while not new in concept, has gained attention in recent years as a set of organizing principles and tools that can help facilitate greater use of mechanistic or pathway-based data in risk assessment and regulatory decision-making. Reg...

The Best Interest Standard: Same Name but Different Roles in Pediatric Bioethics and Child Rights Frameworks.

PubMed

Ross, Lainie Friedman; Swota, Alissa Hurwitz

2017-01-01

This article explores the intersection of pediatric bioethics and child rights by examining the best interest standard as it operates within the pediatric bioethics framework in the United States and the child rights framework based on the UN 1989 Convention on the Rights of the Child (CRC). While the "best interest of the child" standard is central to both pediatric bioethics and the child rights community, it operates only as a guidance principle, and not as an intervention principle, in decision-making within U.S. pediatric bioethics, whereas it operates as both a guidance and intervention principle in the child rights community. The differences in how the best interest standard is operationalized lead to different roles for the family, the state, and the minor in decision-making processes and outcomes. We examine the recent case of Charlie Gard to illustrate some of these differences.

A framework to support human factors of automation in railway intelligent infrastructure.

PubMed

Dadashi, Nastaran; Wilson, John R; Golightly, David; Sharples, Sarah

2014-01-01

Technological and organisational advances have increased the potential for remote access and proactive monitoring of the infrastructure in various domains and sectors - water and sewage, oil and gas and transport. Intelligent Infrastructure (II) is an architecture that potentially enables the generation of timely and relevant information about the state of any type of infrastructure asset, providing a basis for reliable decision-making. This paper reports an exploratory study to understand the concepts and human factors associated with II in the railway, largely drawing from structured interviews with key industry decision-makers and attachment to pilot projects. Outputs from the study include a data-processing framework defining the key human factors at different levels of the data structure within a railway II system and a system-level representation. The framework and other study findings will form a basis for human factors contributions to systems design elements such as information interfaces and role specifications.

A deliberative framework to identify the need for real-life evidence building of new cancer drugs after interim funding decision.

PubMed

Leung, Leanne; de Lemos, Mário L; Kovacic, Laurel

2017-01-01

Background With the rising cost of new oncology treatments, it is no longer sustainable to base initial drug funding decisions primarily on prospective clinical trials as their performance in real-life populations are often difficult to determine. In British Columbia, an approach in evidence building is to retrospectively analyse patient outcomes using observational research on an ad hoc basis. Methods The deliberative framework was constructed in three stages: framework design, framework validation and treatment programme characterization, and key informant interview. Framework design was informed through a literature review and analyses of provincial and national decision-making processes. Treatment programmes funded between 2010 and 2013 were used for framework validation. A selection concordance rate of 80% amongst three reviewers was considered to be a validation of the framework. Key informant interviews were conducted to determine the utility of this deliberative framework. Results A multi-domain deliberative framework with 15 assessment parameters was developed. A selection concordance rate of 84.2% was achieved for content validation of the framework. Nine treatment programmes from five different tumour groups were selected for retrospective outcomes analysis. Five contributory factors to funding uncertainties were identified. Key informants agreed that the framework is a comprehensive tool that targets the key areas involved in the funding decision-making process. Conclusions The oncology-based deliberative framework can be routinely used to assess treatment programmes from the major tumour sites for retrospective outcomes analysis. Key informants indicate this is a value-added tool and will provide insight to the current prospective funding model.

Is the Tenure Process Fair? What Faculty Think

ERIC Educational Resources Information Center

Lawrence, Janet H.; Celis, Sergio; Ott, Molly

2014-01-01

A conceptual framework grounded on procedural justice theory was created to explain how judgments about the fairness of tenure decision-making evolved among faculty who had not yet undergone the review. The framework posits that faculty beliefs about fairness are influenced directly by their workplace experiences and both directly and indirectly…

Web Tutorials on Systems Thinking Using the Driver-Pressure-State-Impact-Response (DPSIR) Framework

EPA Science Inventory

This set of tutorials provides an overview of incorporating systems thinking into decision-making, an introduction to the DPSIR framework as one approach that can assist in the decision analysis process, and an overview of DPSIR tools, including concept mapping and keyword lists,...

Leaching Environmental Assessment Framework (LEAF) How-To Guide - Understanding the LEAF Approach and How and When to Use It

EPA Science Inventory

This document is intended to present the reader with important technical and decision-making information in a user-friendly format for implementation of the Leaching Environmental Assessment Framework (LEAF)test methods 1313, 1314, 1315, and 1316 for inorganic constituents. The ...

An integrated, ethically driven environmental model of clinical decision making in emergency settings.

PubMed

Wolf, Lisa

2013-02-01

To explore the relationship between multiple variables within a model of critical thinking and moral reasoning. A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis. The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy. A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making. © 2012, The Author. International Journal of Nursing Knowledge © 2012, NANDA International.

A formal framework for scenario development in support of environmental decision-making

USGS Publications Warehouse

Mahmoud, M.; Liu, Yajing; Hartmann, H.; Stewart, S.; Wagener, T.; Semmens, D.; Stewart, R.; Gupta, H.; Dominguez, D.; Dominguez, F.; Hulse, D.; Letcher, R.; Rashleigh, Brenda; Smith, C.; Street, R.; Ticehurst, J.; Twery, M.; van, Delden H.; Waldick, R.; White, D.; Winter, L.

2009-01-01

Scenarios are possible future states of the world that represent alternative plausible conditions under different assumptions. Often, scenarios are developed in a context relevant to stakeholders involved in their applications since the evaluation of scenario outcomes and implications can enhance decision-making activities. This paper reviews the state-of-the-art of scenario development and proposes a formal approach to scenario development in environmental decision-making. The discussion of current issues in scenario studies includes advantages and obstacles in utilizing a formal scenario development framework, and the different forms of uncertainty inherent in scenario development, as well as how they should be treated. An appendix for common scenario terminology has been attached for clarity. Major recommendations for future research in this area include proper consideration of uncertainty in scenario studies in particular in relation to stakeholder relevant information, construction of scenarios that are more diverse in nature, and sharing of information and resources among the scenario development research community. ?? 2008 Elsevier Ltd.

Adaptive Management: From More Talk to Real Action

NASA Astrophysics Data System (ADS)

Williams, Byron K.; Brown, Eleanor D.

2014-02-01

The challenges currently facing resource managers are large-scale and complex, and demand new approaches to balance development and conservation goals. One approach that shows considerable promise for addressing these challenges is adaptive management, which by now is broadly seen as a natural, intuitive, and potentially effective way to address decision-making in the face of uncertainties. Yet the concept of adaptive management continues to evolve, and its record of success remains limited. In this article, we present an operational framework for adaptive decision-making, and describe the challenges and opportunities in applying it to real-world problems. We discuss the key elements required for adaptive decision-making, and their integration into an iterative process that highlights and distinguishes technical and social learning. We illustrate the elements and processes of the framework with some successful on-the-ground examples of natural resource management. Finally, we address some of the difficulties in applying learning-based management, and finish with a discussion of future directions and strategic challenges.

How Adults in Developmental Reading Courses Describe Their Educational Life Experiences: A Phenomenological Case Study Examining Whether Experiences Influence Reading Attitudes and Decision-Making Processes

ERIC Educational Resources Information Center

Reece Armour, Ashley

2017-01-01

The purpose of this phenomenological case study is to explore the reading attitudes and decision-making skills of college freshmen enrolled in remedial language arts courses. The theoretical framework guiding this study is qualitative phenomenology explained by Baxter and Jack (2008). This specific type of research "provides tools for…

Living "a Life like Ours": Support Workers' Accounts of Substitute Decision-Making in Residential Care Homes for Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Dunn, M. C.; Clare, I. C. H.; Holland, A. J.

2010-01-01

Background: In England and Wales, the "Mental Capacity Act 2005" (MCA) provides a new legal framework to regulate substitute decision-making relating to the welfare of adults who lack the capacity to make one or more autonomous decisions about their care and support. Any substitute decision made on behalf of an adult lacking capacity…

Values based practice: a framework for thinking with.

PubMed

Mohanna, Kay

2017-07-01

Values are those principles that govern behaviours, and values-based practice has been described as a theory and skills base for effective healthcare decision-making where different (and hence potentially conflicting) values are in play. The emphasis is on good process rather than pre-set right outcomes, aiming to achieve balanced decision-making. In this article we will consider the utility of this model by looking at leadership development, a current area of much interest and investment in healthcare. Copeland points out that 'values based leadership behaviors are styles with a moral, authentic and ethical dimension', important qualities in healthcare decision-making.

Application of construal level and value-belief norm theories to undergraduate decision-making on a wildlife socio-scientific issue

NASA Astrophysics Data System (ADS)

Sutter, A. McKinzie; Dauer, Jenny M.; Forbes, Cory T.

2018-06-01

One aim of science education is to develop scientific literacy for decision-making in daily life. Socio-scientific issues (SSI) and structured decision-making frameworks can help students reach these objectives. This research uses value belief norm (VBN) theory and construal level theory (CLT) to explore students' use of personal values in their decision-making processes and the relationship between abstract and concrete problematization and their decision-making. Using mixed methods, we conclude that the level of abstraction with which students problematise a prairie dog agricultural production and ecosystem preservation issue has a significant relationship to the values students used in the decision-making process. However, neither abstraction of the problem statement nor students' surveyed value orientations were significantly related to students' final decisions. These results may help inform teachers' understanding of students and their use of a structured-decision making tool in a classroom, and aid researchers in understanding if these tools help students remain objective in their analyses of complex SSIs.

District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia.

PubMed

Avan, Bilal Iqbal; Berhanu, Della; Umar, Nasir; Wickremasinghe, Deepthi; Schellenberg, Joanna

2016-09-01

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India's extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Improved monitoring framework for local planning in the water, sanitation and hygiene sector: From data to decision-making.

PubMed

Garriga, Ricard Giné; de Palencia, Alejandro Jiménez Fdez; Foguet, Agustí Pérez

2015-09-01

Today, a vast proportion of people still lack a simple pit latrine and a source of safe drinking water. To help end this appalling state of affairs, there is a pressing need to provide policymakers with evidences which may be the basis of effective planning, targeting and prioritization. Two major challenges often hinder this process: i) lack of reliable data to identify which areas are most in need; and ii) inadequate instruments for decision-making support. In tackling previous shortcomings, this paper proposes a monitoring framework to compile, analyze, interpret and disseminate water, sanitation and hygiene information. In an era of decentralization, where decision-making moves to local governments, we apply such framework at the local level. The ultimate goal is to develop appropriate tools for decentralized planning support. To this end, the study first implements a methodology for primary data collection, which combines the household and the waterpoint as information sources. In doing so, we provide a complete picture of the context in which domestic WASH services are delivered. Second, the collected data are analyzed to underline the emerging development challenges. The use of simple planning indicators serves as the basis to i) reveal which areas require policy attention, and to ii) identify the neediest. Third, a classification process is proposed to prioritize among various populations. Three different case studies from East and Southern African countries are presented. Results indicate that accurate and comprehensive data, if adequately exploited through simple instruments, may be the basis of effective targeting and prioritization, which are central to sector planning. The application of the proposed framework in the real world, however, is to a certain extent elusive; and we point out to conclude two specific challenges that remain unaddressed, namely the upgrade of existing decision-making processes to enhance transparency and inclusiveness, and the development of data updating mechanisms. Copyright © 2015 Elsevier B.V. All rights reserved.

District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia

PubMed Central

Avan, Bilal Iqbal; Berhanu, Della; Umar, Nasir; Wickremasinghe, Deepthi; Schellenberg, Joanna

2016-01-01

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India’s extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step. PMID:27591204

Judgment under uncertainty; a probabilistic evaluation framework for decision-making about sanitation systems in low-income countries.

PubMed

Malekpour, Shirin; Langeveld, Jeroen; Letema, Sammy; Clemens, François; van Lier, Jules B

2013-03-30

This paper introduces the probabilistic evaluation framework, to enable transparent and objective decision-making in technology selection for sanitation solutions in low-income countries. The probabilistic framework recognizes the often poor quality of the available data for evaluations. Within this framework, the evaluations will be done based on the probabilities that the expected outcomes occur in practice, considering the uncertainties in evaluation parameters. Consequently, the outcome of evaluations will not be single point estimates; but there exists a range of possible outcomes. A first trial application of this framework for evaluation of sanitation options in the Nyalenda settlement in Kisumu, Kenya, showed how the range of values that an evaluation parameter may obtain in practice would influence the evaluation outcomes. In addition, as the probabilistic evaluation requires various site-specific data, sensitivity analysis was performed to determine the influence of each data set quality on the evaluation outcomes. Based on that, data collection activities could be (re)directed, in a trade-off between the required investments in those activities and the resolution of the decisions that are to be made. Copyright © 2013 Elsevier Ltd. All rights reserved.

The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki; Epstein, Ronald; Juraskova, Ilona

2017-11-01

Family caregivers are regularly involved in cancer consultations and treatment decision-making (DM). Yet there is limited conceptual description of caregiver influence/involvement in DM. To address this, an empirically-grounded conceptual framework of triadic DM (TRIO Framework) and corresponding graphical aid (TRIO Triangle) were developed. Jabareen's model for conceptual framework development informed multiple phases of development/validation, incorporation of empirical research and theory, and iterative revisions by an expert advisory group. Findings coalesced into six empirically-grounded conceptual insights: i) Caregiver influence over a decision is variable amongst different groups; ii) Caregiver influence is variable within the one triad over time; iii) Caregivers are involved in various ways in the wider DM process; iv) DM is not only amongst three, but can occur among wider social networks; v) Many factors may affect the form and extent of caregiver involvement in DM; vi) Caregiver influence over, and involvement in, DM is linked to their everyday involvement in illness care/management. The TRIO Framework/Triangle may serve as a useful guide for future empirical, ethical and/or theoretical work. This Framework can deepen clinicians's and researcher's understanding of the diverse and varying scope of caregiver involvement and influence in DM. Copyright © 2017 Elsevier B.V. All rights reserved.

Conceptual Frameworks for Child Care Decision-Making. White Paper

ERIC Educational Resources Information Center

Chaudry, Ajay; Henly, Julia; Meyers, Marcia

2010-01-01

This working paper is one in a series of projects initiated by the Administration for Children and Families (ACF) to improve knowledge for child care researchers and policy makers about parental child care decision making. In this paper, the authors identify three distinct conceptual frameworks for understanding child care decisions--a rational…

Making a Good Group Decision (Low Risk) in Singapore Under an Environment That Has Time and Cost Constraints

DTIC Science & Technology

2014-09-01

decision-making framework to eliminate bias and promote effective communication. Using a collaborative approach built on systems engineering and...framework to eliminate bias and promote effective communication. Using a collaborative approach built on systems engineering and decision-making...Organization .......................................................................................61 2. Bias

Individuals' interpretation of constraints: a new perspective on existing theory

Treesearch

Po-Ju Chen; Deborah Kerstetter; Linda Caldwell

2001-01-01

The travel decision-making process is influenced by a number of factors. One of the most important yet infrequently studied factors is "perceived constraints." Nearly a decade ago Crawford, Jackson and Godbey (1991) developed a framework to guide constraints research. Numerous authors have utilized this framework but results have suggested that individuals...

A framework for sustainable nanomaterial selection and design based on performance, hazard, and economic considerations.

PubMed

Falinski, Mark M; Plata, Desiree L; Chopra, Shauhrat S; Theis, Thomas L; Gilbertson, Leanne M; Zimmerman, Julie B

2018-04-30

Engineered nanomaterials (ENMs) and ENM-enabled products have emerged as potentially high-performance replacements to conventional materials and chemicals. As such, there is an urgent need to incorporate environmental and human health objectives into ENM selection and design processes. Here, an adapted framework based on the Ashby material selection strategy is presented as an enhanced selection and design process, which includes functional performance as well as environmental and human health considerations. The utility of this framework is demonstrated through two case studies, the design and selection of antimicrobial substances and conductive polymers, including ENMs, ENM-enabled products and their alternatives. Further, these case studies consider both the comparative efficacy and impacts at two scales: (i) a broad scale, where chemical/material classes are readily compared for primary decision-making, and (ii) within a chemical/material class, where physicochemical properties are manipulated to tailor the desired performance and environmental impact profile. Development and implementation of this framework can inform decision-making for the implementation of ENMs to facilitate promising applications and prevent unintended consequences.

A Framework to Determine New System Requirements Under Design Parameter and Demand Uncertainties

DTIC Science & Technology

2015-04-30

relegates quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the...quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the approach...play a critical role in determining new system requirements. Scope and Method of Approach The early stages of the design process have substantial

Should I Stay at Home or Should I Go Back to Work? Workforce Reentry Influences on a Mother's Decision-Making Process

ERIC Educational Resources Information Center

Ericksen, Kirsten S.; Jurgens, Jill C.; Garrett, Michael Tlanusta; Swedburg, Randy B.

2008-01-01

The authors examine the literature pertaining to women's life transitions and the difficult decision-making process some women encounter when reentering the workforce after a period of staying at home with young children. On the basis of the unique challenges faced by this population, the authors created a conceptual framework (i.e., the Mother's…

Clarity versus complexity: land-use modeling as a practical tool for decision-makers

USGS Publications Warehouse

Sohl, Terry L.; Claggett, Peter

2013-01-01

The last decade has seen a remarkable increase in the number of modeling tools available to examine future land-use and land-cover (LULC) change. Integrated modeling frameworks, agent-based models, cellular automata approaches, and other modeling techniques have substantially improved the representation of complex LULC systems, with each method using a different strategy to address complexity. However, despite the development of new and better modeling tools, the use of these tools is limited for actual planning, decision-making, or policy-making purposes. LULC modelers have become very adept at creating tools for modeling LULC change, but complicated models and lack of transparency limit their utility for decision-makers. The complicated nature of many LULC models also makes it impractical or even impossible to perform a rigorous analysis of modeling uncertainty. This paper provides a review of land-cover modeling approaches and the issues causes by the complicated nature of models, and provides suggestions to facilitate the increased use of LULC models by decision-makers and other stakeholders. The utility of LULC models themselves can be improved by 1) providing model code and documentation, 2) through the use of scenario frameworks to frame overall uncertainties, 3) improving methods for generalizing key LULC processes most important to stakeholders, and 4) adopting more rigorous standards for validating models and quantifying uncertainty. Communication with decision-makers and other stakeholders can be improved by increasing stakeholder participation in all stages of the modeling process, increasing the transparency of model structure and uncertainties, and developing user-friendly decision-support systems to bridge the link between LULC science and policy. By considering these options, LULC science will be better positioned to support decision-makers and increase real-world application of LULC modeling results.

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care.

PubMed

Burke, Robert E; Jones, Jacqueline; Lawrence, Emily; Ladebue, Amy; Ayele, Roman; Leonard, Chelsea; Lippmann, Brandi; Matlock, Daniel D; Allyn, Rebecca; Cumbler, Ethan

2018-05-01

Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization. We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF. Qualitative inquiry using the Ottawa Decision Support Framework (ODSF), a conceptual framework that describes key components of high-quality decision-making. Thirty-two previously community-dwelling older adults (≥ 65 years old) and 22 caregivers interviewed at three different hospitals and three skilled nursing facilities. We used key components of the ODSF to identify elements of context and process that affected decision-making and to what extent the outcome was characteristic of a high-quality decision: informed, values based, and not associated with regret or blame. The most important contextual themes were the presence of active medical conditions in the hospital that made decision-making difficult, prior experiences with hospital readmission or SNF, relative level of caregiver support, and pressure to make a decision quickly for which participants felt unprepared. Patients described playing a passive role in the decision-making process and largely relying on recommendations from the medical team. Patients commonly expressed resignation and a perceived lack of choice or autonomy, leading to dissatisfaction with the outcome. Understanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential.

Assessing the capacity of ministries of health to use research in decision-making: conceptual framework and tool.

PubMed

Rodríguez, Daniela C; Hoe, Connie; Dale, Elina M; Rahman, M Hafizur; Akhter, Sadika; Hafeez, Assad; Irava, Wayne; Rajbangshi, Preety; Roman, Tamlyn; Ţîrdea, Marcela; Yamout, Rouham; Peters, David H

2017-08-01

The capacity to demand and use research is critical for governments if they are to develop policies that are informed by evidence. Existing tools designed to assess how government officials use evidence in decision-making have significant limitations for low- and middle-income countries (LMICs); they are rarely tested in LMICs and focus only on individual capacity. This paper introduces an instrument that was developed to assess Ministry of Health (MoH) capacity to demand and use research evidence for decision-making, which was tested for reliability and validity in eight LMICs (Bangladesh, Fiji, India, Lebanon, Moldova, Pakistan, South Africa, Zambia). Instrument development was based on a new conceptual framework that addresses individual, organisational and systems capacities, and items were drawn from existing instruments and a literature review. After initial item development and pre-testing to address face validity and item phrasing, the instrument was reduced to 54 items for further validation and item reduction. In-country study teams interviewed a systematic sample of 203 MoH officials. Exploratory factor analysis was used in addition to standard reliability and validity measures to further assess the items. Thirty items divided between two factors representing organisational and individual capacity constructs were identified. South Africa and Zambia demonstrated the highest level of organisational capacity to use research, whereas Pakistan and Bangladesh were the lowest two. In contrast, individual capacity was highest in Pakistan, followed by South Africa, whereas Bangladesh and Lebanon were the lowest. The framework and related instrument represent a new opportunity for MoHs to identify ways to understand and improve capacities to incorporate research evidence in decision-making, as well as to provide a basis for tracking change.

Gatekeepers for Pragmatic Clinical Trials

PubMed Central

Whicher, Danielle M.; Miller, Jennifer E.; Dunham, Kelly M.; Joffe, Steven

2015-01-01

To successfully implement a pragmatic clinical trial, investigators need access to numerous resources, including financial support, institutional infrastructure (e.g., clinics, facilities, staff), eligible patients, and patient data. Gatekeepers are people or entities who have the ability to allow or deny access to the resources required to support the conduct of clinical research. Based on this definition, gatekeepers relevant to the United States clinical research enterprise include research sponsors, regulatory agencies, payers, health system and other organizational leadership, research team leadership, human research protections programs, advocacy and community groups, and clinicians. This manuscript provides a framework to help guide gatekeepers’ decision-making related to the use of resources for pragmatic clinical trials. These include (1) concern for the interests of individuals, groups, and communities affected by the gatekeepers’ decisions, including protection from harm and maximization of benefits, (2) advancement of organizational mission and values, and (3) stewardship of financial, human, and other organizational resources. Separate from these ethical considerations, gatekeepers’ actions will be guided by relevant federal, state, and local regulations. This framework also suggests that to further enhance the legitimacy of their decision-making, gatekeepers should adopt transparent processes that engage relevant stakeholders when feasible and appropriate. We apply this framework to the set of gatekeepers responsible for making decisions about resources necessary for pragmatic clinical trials in the United States, describing the relevance of the criteria in different situations and pointing out where conflicts among the criteria and relevant regulations may affect decision-making. Recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources. PMID:26374683

Developing evidence that is fit for purpose: a framework for payer and research dialogue.

PubMed

Sabharwal, Rajeev K; Graff, Jennifer S; Holve, Erin; Dubois, Robert W

2015-09-01

Matching the supply and demand of evidence requires an understanding of when more evidence is needed, as well as the type of evidence that will meet this need. This article describes efforts to develop and refine a decision-making framework that considers payers' perspectives on the utility of evidence generated by different types of research methods, including real-world evidence. Conceptual framework development with subsequent testing during a roundtable dialogue. The framework development process included a literature scan to identify existing frameworks and relevant articles on payer decision making. The framework was refined during a stand-alone roundtable in December 2013 hosted by the research team, which included representatives from public and private payers, pharmacy benefit management, the life sciences industry, and researchers. The roundtable discussion also included an application of the framework to 3 case studies. Application of the framework to the clinical scenarios and the resulting discussion provided key insights into when new evidence is needed to inform payer decision making and what questions should be addressed. Payers are not necessarily seeking more evidence about treatment efficacy; rather, they are seeking more evidence for relevant end points that illustrate the differences between treatment alternatives that can justify the resources required to change practice. In addition, payers are interested in obtaining new evidence that goes beyond efficacy, with an emphasis on effectiveness, longer-term safety, and delivery system impact. We believe that our decision-making framework is a useful tool to increase dialogue between evidence generators and payers, while also allowing for greater efficiency in the research process.

Allocation of Public Resources for Psychological Therapy between Types of Mental Health Condition: Towards Structural Balance

ERIC Educational Resources Information Center

Tustin, Don

2009-01-01

This paper addresses issues of allocating public resources efficiently between mental health conditions that are associated with different levels of disability, and presents an adaptation of an established framework to help decision-making in this area. The adapted framework refers to psychological interventions that are universal, indicated,…

Conceptual Framework To Extend Life Cycle Assessment Using Near-Field Human Exposure Modeling and High-Throughput Tools for Chemicals

EPA Science Inventory

Life Cycle Assessment (LCA) is a decision-making tool that accounts for multiple impacts across the life cycle of a product or service. This paper presents a conceptual framework to integrate human health impact assessment with risk screening approaches to extend LCA to include n...

A Framework for the Design of Computer-Assisted Simulation Training for Complex Police Situations

ERIC Educational Resources Information Center

Söderström, Tor; Åström, Jan; Anderson, Greg; Bowles, Ron

2014-01-01

Purpose: The purpose of this paper is to report progress concerning the design of a computer-assisted simulation training (CAST) platform for developing decision-making skills in police students. The overarching aim is to outline a theoretical framework for the design of CAST to facilitate police students' development of search techniques in…

Decision Support Framework (DSF) For Evaluating Planned Land And Resource Use Decisions: Hypothetical Application Of The DSF To Address Nutrient Loads In The Florida Keys

EPA Science Inventory

The mission of ORD's Ecosystme Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...

Keeping Teachers in the Center: A Framework of Data-Driven Decision-Making

ERIC Educational Resources Information Center

Light, Daniel; Wexler, Dara H.; Heinze, Juliette

2004-01-01

The Education Development Center's Center for Children and Technology (CCT) conducted a three year study of a large-scale data reporting system, developed by the Grow Network for New York City's Department of Education. This paper presents a framework based on two years of research exploring the intersection of decision-support technologies,…

Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

PubMed

Tan, Amy; Manca, Donna

2013-01-22

Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a "good death". These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths.

The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control.

PubMed

Rangel, Erica Cavalcanti; Pereira, Andre; Cavalcante, Tania Maria; Oliveira, Egléubia Andrade; Silva, Vera Luiza da Costa E

2017-09-21

Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 10: operationalising disinvestment in a conceptual framework for resource allocation.

PubMed

Harris, Claire; Green, Sally; Elshaug, Adam G

2017-09-08

This is the tenth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. After more than a decade of research, there is little published evidence of active and successful disinvestment. The paucity of frameworks, methods and tools is reported to be a factor in the lack of success. However there are clear and consistent messages in the literature that can be used to inform development of a framework for operationalising disinvestment. This paper, along with the conceptual review of disinvestment in Paper 9 of this series, aims to integrate the findings of the SHARE Program with the existing disinvestment literature to address the lack of information regarding systematic organisation-wide approaches to disinvestment at the local health service level. A framework for disinvestment in a local healthcare setting is proposed. Definitions for essential terms and key concepts underpinning the framework have been made explicit to address the lack of consistent terminology. Given the negative connotations of the word 'disinvestment' and the problems inherent in considering disinvestment in isolation, the basis for the proposed framework is 'resource allocation' to address the spectrum of decision-making from investment to disinvestment. The focus is positive: optimising healthcare, improving health outcomes, using resources effectively. The framework is based on three components: a program for decision-making, projects to implement decisions and evaluate outcomes, and research to understand and improve the program and project activities. The program consists of principles for decision-making and settings that provide opportunities to introduce systematic prompts and triggers to initiate disinvestment. The projects follow the steps in the disinvestment process. Potential methods and tools are presented, however the framework does not stipulate project design or conduct; allowing application of any theories, methods or tools at each step. Barriers are discussed and examples illustrating constituent elements are provided. The framework can be employed at network, institutional, departmental, ward or committee level. It is proposed as an organisation-wide application, embedded within existing systems and processes, which can be responsive to needs and priorities at the level of implementation. It can be used in policy, management or clinical contexts.

Reaching a Consensus on the Definition of Genetic Literacy that Is Required from a Twenty-First-Century Citizen

NASA Astrophysics Data System (ADS)

Boerwinkel, Dirk Jan; Yarden, Anat; Waarlo, Arend Jan

2017-12-01

To determine what knowledge of genetics is needed for decision-making on genetic-related issues, a consensus-reaching approach was used. An international group of 57 experts, involved in teaching, studying, or developing genetic education and communication or working with genetic applications in medicine, agriculture, or forensics, answered the questions: "What knowledge of genetics is relevant to those individuals not professionally involved in science?" and "Why is this knowledge relevant?" The answers were classified in different knowledge components following the PISA 2015 science framework. During a workshop with the participants, the results were discussed and applied to seven cases in which genetic knowledge is relevant for decision-making. The analysis of these discussions resulted in a revised framework consisting of nine conceptual knowledge components, three sociocultural components, and four epistemic components. The framework can be used in curricular decisions; its open character allows for including new technologies and applications and facilitates comparisons of different cases.

Risk-based decision-making framework for the selection of sediment dredging option.

PubMed

Manap, Norpadzlihatun; Voulvoulis, Nikolaos

2014-10-15

The aim of this study was to develop a risk-based decision-making framework for the selection of sediment dredging option. Descriptions using case studies of the newly integrated, holistic and staged framework were followed. The first stage utilized the historical dredging monitoring data and the contamination level in media data into Ecological Risk Assessment phases, which have been altered for benefits in cost, time and simplicity. How Multi-Criteria Decision Analysis (MCDA) can be used to analyze and prioritize dredging areas based on environmental, socio-economic and managerial criteria was described for the next stage. The results from MCDA will be integrated into Ecological Risk Assessment to characterize the degree of contamination in the prioritized areas. The last stage was later described using these findings and analyzed using MCDA, in order to identify the best sediment dredging option, accounting for the economic, environmental and technical aspects of dredging, which is beneficial for dredging and sediment management industries. Copyright © 2014 Elsevier B.V. All rights reserved.

Evaluating the effectiveness of the Emergency Neurological Life Support educational framework in low-income countries

PubMed Central

McCredie, Victoria A; Shrestha, Gentle S; Acharya, Subhash; Bellini, Antonio; Singh, Jeffrey M; Hemphill, J Claude; Goffi, Alberto

2018-01-01

Abstract Background The Emergency Neurological Life Support (ENLS) is an educational initiative designed to improve the acute management of neurological injuries. However, the applicability of the course in low-income countries in unknown. We evaluated the impact of the course on knowledge, decision-making skills and preparedness to manage neurological emergencies in a resource-limited country. Methods A prospective cohort study design was implemented for the first ENLS course held in Asia. Knowledge and decision-making skills for neurological emergencies were assessed at baseline, post-course and at 6 months following course completion. To determine perceived knowledge and preparedness, data were collected using surveys administered immediately post-course and 6 months later. Results A total of 34 acute care physicians from across Nepal attended the course. Knowledge and decision-making skills significantly improved following the course (p=0.0008). Knowledge and decision-making skills remained significantly improved after 6 months, compared with before the course (p=0.02), with no significant loss of skills immediately following the course to the 6-month follow-up (p=0.16). At 6 months, the willingness to participate in continuing medical education activities remained evident, with 77% (10/13) of participants reporting a change in their clinical practice and decision-making, with the repeated use of ENLS protocols as the main driver of change. Conclusions Using the ENLS framework, neurocritical care education can be delivered in low-income countries to improve knowledge uptake, with evidence of knowledge retention up to 6 months. PMID:29506188

Sustaining life or prolonging dying? Appropriate choice of conservative care for children in end-stage renal disease: an ethical framework.

PubMed

Dionne, Janis M; d'Agincourt-Canning, Lori

2015-10-01

Due to technological advances, an increasing number of infants and children are surviving with multi-organ system dysfunction, and some are reaching end-stage renal disease (ESRD). Many have quite limited life expectancies and may not be eligible for kidney transplantation but families request dialysis as alternative. In developed countries where resources are available there is often uncertainty by the medical team as to what should be done. After encountering several of these scenarios, we developed an ethical decision-making framework for the appropriate choice of conservative care or renal replacement therapy in infants and children with ESRD. The framework is a practical tool to help determine if the burdens of dialysis would outweigh the benefits for a particular patient and family. It is based on the four topics approach of medical considerations, quality-of-life determinants, patient and family preferences and contextual features tailored to pediatric ESRD. In this article we discuss the basis of the criteria, provide a practical framework to guide these difficult conversations, and illustrate use of the framework with a case example. While further research is needed, through this approach we hope to reduce the moral distress of care providers and staff as well as potential conflict with the family in these complex decision-making situations.

Expectations Do Not Alter Early Sensory Processing during Perceptual Decision-Making.

PubMed

Rungratsameetaweemana, Nuttida; Itthipuripat, Sirawaj; Salazar, Annalisa; Serences, John T

2018-06-13

Two factors play important roles in shaping perception: the allocation of selective attention to behaviorally relevant sensory features, and prior expectations about regularities in the environment. Signal detection theory proposes distinct roles of attention and expectation on decision-making such that attention modulates early sensory processing, whereas expectation influences the selection and execution of motor responses. Challenging this classic framework, recent studies suggest that expectations about sensory regularities enhance the encoding and accumulation of sensory evidence during decision-making. However, it is possible, that these findings reflect well documented attentional modulations in visual cortex. Here, we tested this framework in a group of male and female human participants by examining how expectations about stimulus features (orientation and color) and expectations about motor responses impacted electroencephalography (EEG) markers of early sensory processing and the accumulation of sensory evidence during decision-making (the early visual negative potential and the centro-parietal positive potential, respectively). We first demonstrate that these markers are sensitive to changes in the amount of sensory evidence in the display. Then we show, counter to recent findings, that neither marker is modulated by either feature or motor expectations, despite a robust effect of expectations on behavior. Instead, violating expectations about likely sensory features and motor responses impacts posterior alpha and frontal theta oscillations, signals thought to index overall processing time and cognitive conflict. These findings are inconsistent with recent theoretical accounts and suggest instead that expectations primarily influence decisions by modulating post-perceptual stages of information processing. SIGNIFICANCE STATEMENT Expectations about likely features or motor responses play an important role in shaping behavior. Classic theoretical frameworks posit that expectations modulate decision-making by biasing late stages of decision-making including the selection and execution of motor responses. In contrast, recent accounts suggest that expectations also modulate decisions by improving the quality of early sensory processing. However, these effects could instead reflect the influence of selective attention. Here we examine the effect of expectations about sensory features and motor responses on a set of electroencephalography (EEG) markers that index early sensory processing and later post-perceptual processing. Counter to recent empirical results, expectations have little effect on early sensory processing but instead modulate EEG markers of time-on-task and cognitive conflict. Copyright © 2018 the authors 0270-6474/18/385632-17$15.00/0.

The interrogation decision-making model: A general theoretical framework for confessions.

PubMed

Yang, Yueran; Guyll, Max; Madon, Stephanie

2017-02-01

This article presents a new model of confessions referred to as the interrogation decision-making model . This model provides a theoretical umbrella with which to understand and analyze suspects' decisions to deny or confess guilt in the context of a custodial interrogation. The model draws upon expected utility theory to propose a mathematical account of the psychological mechanisms that not only underlie suspects' decisions to deny or confess guilt at any specific point during an interrogation, but also how confession decisions can change over time. Findings from the extant literature pertaining to confessions are considered to demonstrate how the model offers a comprehensive and integrative framework for organizing a range of effects within a limited set of model parameters. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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

PubMed

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

2006-12-01

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

Expert decision-making strategies

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.

1991-01-01

A recognition-primed decisions (RPD) model is employed as a framework to investigate crew decision-making processes. The quality of information transfer, a critical component of the team RPD model and an indicator of the team's 'collective consciouness', is measured and analyzed with repect to crew performance. As indicated by the RPD model, timing and patterns of information search transfer were expected to reflect extensive and continual situation assessment, and serial evaluation of alternative states of the world or decision response options.

Evidence-based management - healthcare manager viewpoints.

PubMed

Janati, Ali; Hasanpoor, Edris; Hajebrahimi, Sakineh; Sadeghi-Bazargani, Homayoun

2018-06-11

Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making.

PubMed

Knight, Gwenan M; Dharan, Nila J; Fox, Gregory J; Stennis, Natalie; Zwerling, Alice; Khurana, Renuka; Dowdy, David W

2016-01-01

The dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy), the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively re-evaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Strategies to improve healthcare websites.

PubMed

Johnson, Constance; Peterson, Susan K; Turley, James P; Ensor, Joe; Amos, Christopher; Spitz, Margaret; Levin, Bernard; Berry, Donald

2006-01-01

Healthcare websites that are influential in healthcare decision-making must be evaluated for accuracy, readability and understandability by the average population. Most existing frameworks for designing and evaluating interactive websites focus on the utility and usability of the site. Although these are significant to the design of the basic site, they are not sufficient. We have developed an iterative framework that considers additional attributes.

Acquisition and production of skilled behavior in dynamic decision-making tasks

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1993-01-01

Summaries of the four projects completed during the performance of this research are included. The four projects described are: Perceptual Augmentation Aiding for Situation Assessment, Perceptual Augmentation Aiding for Dynamic Decision-Making and Control, Action Advisory Aiding for Dynamic Decision-Making and Control, and Display Design to Support Time-Constrained Route Optimization. Papers based on each of these projects are currently in preparation. The theoretical framework upon which the first three projects are based, Ecological Task Analysis, was also developed during the performance of this research, and is described in a previous report. A project concerned with modeling strategies in human control of a dynamic system was also completed during the performance of this research.

Distributed decision-making in electric power system transmission maintenance scheduling using multi-agent systems (MAS)

NASA Astrophysics Data System (ADS)

Zhang, Zhong

In this work, motivated by the need to coordinate transmission maintenance scheduling among a multiplicity of self-interested entities in restructured power industry, a distributed decision support framework based on multiagent negotiation systems (MANS) is developed. An innovative risk-based transmission maintenance optimization procedure is introduced. Several models for linking condition monitoring information to the equipment's instantaneous failure probability are presented, which enable quantitative evaluation of the effectiveness of maintenance activities in terms of system cumulative risk reduction. Methodologies of statistical processing, equipment deterioration evaluation and time-dependent failure probability calculation are also described. A novel framework capable of facilitating distributed decision-making through multiagent negotiation is developed. A multiagent negotiation model is developed and illustrated that accounts for uncertainty and enables social rationality. Some issues of multiagent negotiation convergence and scalability are discussed. The relationships between agent-based negotiation and auction systems are also identified. A four-step MAS design methodology for constructing multiagent systems for power system applications is presented. A generic multiagent negotiation system, capable of inter-agent communication and distributed decision support through inter-agent negotiations, is implemented. A multiagent system framework for facilitating the automated integration of condition monitoring information and maintenance scheduling for power transformers is developed. Simulations of multiagent negotiation-based maintenance scheduling among several independent utilities are provided. It is shown to be a viable alternative solution paradigm to the traditional centralized optimization approach in today's deregulated environment. This multiagent system framework not only facilitates the decision-making among competing power system entities, but also provides a tool to use in studying competitive industry relative to monopolistic industry.

A decision-making framework for sediment contamination.

PubMed

Chapman, Peter M; Anderson, Janette

2005-07-01

A decision-making framework for determining whether or not contaminated sediments are polluted is described. This framework is intended to be sufficiently prescriptive to standardize the decision-making process but without using "cook book" assessments. It emphasizes 4 guidance "rules": (1) sediment chemistry data are only to be used alone for remediation decisions when the costs of further investigation outweigh the costs of remediation and there is agreement among all stakeholders to act; (2) remediation decisions are based primarily on biology; (3) lines of evidence (LOE), such as laboratory toxicity tests and models that contradict the results of properly conducted field surveys, are assumed incorrect; and (4) if the impacts of a remedial alternative will cause more environmental harm than good, then it should not be implemented. Sediments with contaminant concentrations below sediment quality guidelines (SQGs) that predict toxicity toless than 5% of sediment-dwelling infauna and that contain no quantifiable concentrations of substances capable of biomagnifying are excluded from further consideration, as are sediments that do not meet these criteria but have contaminant concentrations equal to or below reference concentrations. Biomagnification potential is initially addressed by conservative (worst case) modeling based on benthos and sediments and, subsequently, by additional food chain data and more realistic assumptions. Toxicity (acute and chronic) and alterations to resident communities are addressed by, respectively, laboratory studies and field observations. The integrative decision point for sediments is a weight of evidence (WOE) matrix combining up to 4 main LOE: chemistry, toxicity, community alteration, and biomagnification potential. Of 16 possible WOE scenarios, 6 result in definite decisions, and 10 require additional assessment. Typically, this framework will be applied to surficial sediments. The possibility that deeper sediments may be uncovered as a result of natural or other processes must also be investigated and may require similar assessment.

A Bayesian paradigm for decision-making in proof-of-concept trials.

PubMed

Pulkstenis, Erik; Patra, Kaushik; Zhang, Jianliang

2017-01-01

Decision-making is central to every phase of drug development, and especially at the proof of concept stage where risk and evidence must be weighed carefully, often in the presence of significant uncertainty. The decision to proceed or not to large expensive Phase 3 trials has significant implications to both patients and sponsors alike. Recent experience has shown that Phase 3 failure rates remain high. We present a flexible Bayesian quantitative decision-making paradigm that evaluates evidence relative to achieving a multilevel target product profile. A framework for operating characteristics is provided that allows the drug developer to design a proof-of-concept trial in light of its ability to support decision-making rather than merely achieve statistical significance. Operating characteristics are shown to be superior to traditional p-value-based methods. In addition, discussion related to sample size considerations, application to interim futility analysis and incorporation of prior historical information is evaluated.

Contralateral prophylactic mastectomy: A qualitative approach to exploring the decision making process.

PubMed

Greener, Judith R; Bass, Sarah Bauerle; Lepore, Stephen J

2018-01-01

The proportion of women with unilateral breast cancer and no familial or genetic risk factors who elect contralateral prophylactic mastectomy (CPM) has grown dramatically, even in the absence of clear data demonstrating improved outcomes. To further extend the literature that addresses treatment decision-making, qualitative interviews were conducted with eleven women who considered CPM. A social ecological model of breast cancer treatment decision-making provided the conceptual framework, and grounded theory was used to identify the cognitive, psychosocial, and emotional influences motivating treatment choice. This research identified five themes that give context to women's decision-making experience: (1) variability in physician communication, (2) immediacy of the decision, (3) meaning of being proactive about treatment, (4) meaning of risk, and (5) women's relationship with their breasts. The results suggest that greater emphasis should be placed on a more nuanced understanding of patients' emotional reaction to breast cancer and managing the decision-making environment.

Key elements of optimal treatment decision-making for surgeons and older patients with colorectal or pancreatic cancer: A qualitative study.

PubMed

Geessink, Noralie H; Schoon, Yvonne; van Herk, Hanneke C P; van Goor, Harry; Olde Rikkert, Marcel G M

2017-03-01

To identify key elements of optimal treatment decision-making for surgeons and older patients with colorectal (CRC) or pancreatic cancer (PC). Six focus groups with different participants were performed: three with older CRC/PC patients and relatives, and three with physicians. Supplementary in-depth interviews were conducted in another seven patients. Framework analysis was used to identify key elements in decision-making. 23 physicians, 22 patients and 14 relatives participated. Three interacting components were revealed: preconditions, content and facilitators of decision-making. To provide optimal information about treatments' impact on an older patient's daily life, physicians should obtain an overall picture and take into account patients' frailty. Depending on patients' preferences and capacities, dividing decision-making into more sessions will be helpful and simultaneously emphasize patients' own responsibility. GPs may have a valuable contribution because of their background knowledge and supportive role. Stakeholders identified several crucial elements in the complex surgical decision-making of older CRC/PC patients. Structured qualitative research may also be of great help in optimizing other treatment directed decision-making processes. Surgeons should be trained in examining preconditions and useful facilitators in decision-making in older CRC/PC patients to optimize its content and to improve the quality of shared care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance

PubMed Central

Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

2017-01-01

The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning. PMID:28529491

Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance.

PubMed

Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

2017-01-01

The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning.

Theoretical aspects of cellular decision-making and information-processing.

PubMed

Kobayashi, Tetsuya J; Kamimura, Atsushi

2012-01-01

Microscopic biological processes have extraordinary complexity and variety at the sub-cellular, intra-cellular, and multi-cellular levels. In dealing with such complex phenomena, conceptual and theoretical frameworks are crucial, which enable us to understand seemingly different intra- and inter-cellular phenomena from unified viewpoints. Decision-making is one such concept that has attracted much attention recently. Since a number of cellular behavior can be regarded as processes to make specific actions in response to external stimuli, decision-making can cover and has been used to explain a broad range of different cellular phenomena [Balázsi et al. (Cell 144(6):910, 2011), Zeng et al. (Cell 141(4):682, 2010)]. Decision-making is also closely related to cellular information-processing because appropriate decisions cannot be made without exploiting the information that the external stimuli contain. Efficiency of information transduction and processing by intra-cellular networks determines the amount of information obtained, which in turn limits the efficiency of subsequent decision-making. Furthermore, information-processing itself can serve as another concept that is crucial for understanding of other biological processes than decision-making. In this work, we review recent theoretical developments on cellular decision-making and information-processing by focusing on the relation between these two concepts.

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

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

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

How We Assess Risks to Pollinators

EPA Pesticide Factsheets

EPA's pollinator risk assessment framework is part of its regulatory decision-making process for all pesticides, relying on a tiered process and focusing on major routes of exposure while distinguishing different types of pesticide treatment.

A Communication Framework for Dialysis Decision-Making for Frail Elderly Patients

PubMed Central

Cohen, Robert A.

2014-01-01

Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented. The role of uncertainty is highlighted, and the concept of a goal-directed care plan is introduced. This plan incorporates a time-limited trial that promotes frequent opportunities for reassessment. Using the communication skills presented, the clinician can prepare and guide patients for the dialysis trajectory as it unfolds. PMID:24970868

Group long-term care insurance: decision-making factors and implications for financing long-term care.

PubMed

Stum, Marlene S

2008-01-01

This study proposes and tests a systemic family decision-making framework to understand group long-term care insurance (LTCI) enrollment decisions. A random sample of public employees who were offered group LTCI as a workplace benefit were examined. Findings reveal very good predictive efficacy for the overall conceptual framework with a pseudo R2 value of .687, and reinforced the contributions of factors within the family system. Enrollees were more likely to have discussed the decision with others, used information sources, and had prior experience when compared to non-enrollees. Perceived health status, financial knowledge, attitudes regarding the role of private insurance, risk taking, and coverage features were additional factors related to enrollment decisions. The findings help to inform policymakers about the potential of LTCI as one strategy for financing long-term care.

A method for studying decision-making by guideline development groups.

PubMed

Gardner, Benjamin; Davidson, Rosemary; McAteer, John; Michie, Susan

2009-08-05

Multidisciplinary guideline development groups (GDGs) have considerable influence on UK healthcare policy and practice, but previous research suggests that research evidence is a variable influence on GDG recommendations. The Evidence into Recommendations (EiR) study has been set up to document social-psychological influences on GDG decision-making. In this paper we aim to evaluate the relevance of existing qualitative methodologies to the EiR study, and to develop a method best-suited to capturing influences on GDG decision-making. A research team comprised of three postdoctoral research fellows and a multidisciplinary steering group assessed the utility of extant qualitative methodologies for coding verbatim GDG meeting transcripts and semi-structured interviews with GDG members. A unique configuration of techniques was developed to permit data reduction and analysis. Our method incorporates techniques from thematic analysis, grounded theory analysis, content analysis, and framework analysis. Thematic analysis of individual interviews conducted with group members at the start and end of the GDG process defines discrete problem areas to guide data extraction from GDG meeting transcripts. Data excerpts are coded both inductively and deductively, using concepts taken from theories of decision-making, social influence and group processes. These codes inform a framework analysis to describe and explain incidents within GDG meetings. We illustrate the application of the method by discussing some preliminary findings of a study of a National Institute for Health and Clinical Excellence (NICE) acute physical health GDG. This method is currently being applied to study the meetings of three of NICE GDGs. These cover topics in acute physical health, mental health and public health, and comprise a total of 45 full-day meetings. The method offers potential for application to other health care and decision-making groups.

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.

Building Bridges between Perceptual and Economic Decision-Making: Neural and Computational Mechanisms.

PubMed

Summerfield, Christopher; Tsetsos, Konstantinos

2012-01-01

Investigation into the neural and computational bases of decision-making has proceeded in two parallel but distinct streams. Perceptual decision-making (PDM) is concerned with how observers detect, discriminate, and categorize noisy sensory information. Economic decision-making (EDM) explores how options are selected on the basis of their reinforcement history. Traditionally, the sub-fields of PDM and EDM have employed different paradigms, proposed different mechanistic models, explored different brain regions, disagreed about whether decisions approach optimality. Nevertheless, we argue that there is a common framework for understanding decisions made in both tasks, under which an agent has to combine sensory information (what is the stimulus) with value information (what is it worth). We review computational models of the decision process typically used in PDM, based around the idea that decisions involve a serial integration of evidence, and assess their applicability to decisions between good and gambles. Subsequently, we consider the contribution of three key brain regions - the parietal cortex, the basal ganglia, and the orbitofrontal cortex (OFC) - to perceptual and EDM, with a focus on the mechanisms by which sensory and reward information are integrated during choice. We find that although the parietal cortex is often implicated in the integration of sensory evidence, there is evidence for its role in encoding the expected value of a decision. Similarly, although much research has emphasized the role of the striatum and OFC in value-guided choices, they may play an important role in categorization of perceptual information. In conclusion, we consider how findings from the two fields might be brought together, in order to move toward a general framework for understanding decision-making in humans and other primates.

Building Bridges between Perceptual and Economic Decision-Making: Neural and Computational Mechanisms

PubMed Central

Summerfield, Christopher; Tsetsos, Konstantinos

2012-01-01

Investigation into the neural and computational bases of decision-making has proceeded in two parallel but distinct streams. Perceptual decision-making (PDM) is concerned with how observers detect, discriminate, and categorize noisy sensory information. Economic decision-making (EDM) explores how options are selected on the basis of their reinforcement history. Traditionally, the sub-fields of PDM and EDM have employed different paradigms, proposed different mechanistic models, explored different brain regions, disagreed about whether decisions approach optimality. Nevertheless, we argue that there is a common framework for understanding decisions made in both tasks, under which an agent has to combine sensory information (what is the stimulus) with value information (what is it worth). We review computational models of the decision process typically used in PDM, based around the idea that decisions involve a serial integration of evidence, and assess their applicability to decisions between good and gambles. Subsequently, we consider the contribution of three key brain regions – the parietal cortex, the basal ganglia, and the orbitofrontal cortex (OFC) – to perceptual and EDM, with a focus on the mechanisms by which sensory and reward information are integrated during choice. We find that although the parietal cortex is often implicated in the integration of sensory evidence, there is evidence for its role in encoding the expected value of a decision. Similarly, although much research has emphasized the role of the striatum and OFC in value-guided choices, they may play an important role in categorization of perceptual information. In conclusion, we consider how findings from the two fields might be brought together, in order to move toward a general framework for understanding decision-making in humans and other primates. PMID:22654730

Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years.

PubMed

Dunn, Jennifer A; Hay-Smith, E Jean; Keeling, Sally; Sinnott, K Anne

2016-06-01

To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. Quantitative-qualitative mixed-methods study. Community based in New Zealand. People (N=9) living with tetraplegia for >10 years. Not applicable. An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Applying a multi-replication framework to support dynamic situation assessment and predictive capabilities

NASA Astrophysics Data System (ADS)

Lammers, Craig; McGraw, Robert M.; Steinman, Jeffrey S.

2005-05-01

Technological advances and emerging threats reduce the time between target detection and action to an order of a few minutes. To effectively assist with the decision-making process, C4I decision support tools must quickly and dynamically predict and assess alternative Courses Of Action (COAs) to assist Commanders in anticipating potential outcomes. These capabilities can be provided through the faster-than-real-time predictive simulation of plans that are continuously re-calibrating with the real-time picture. This capability allows decision-makers to assess the effects of re-tasking opportunities, providing the decision-maker with tremendous freedom to make time-critical, mid-course decisions. This paper presents an overview and demonstrates the use of a software infrastructure that supports DSAP capabilities. These DSAP capabilities are demonstrated through the use of a Multi-Replication Framework that supports (1) predictivie simulations using JSAF (Joint Semi-Automated Forces); (2) real-time simulation, also using JSAF, as a state estimation mechanism; and, (3) real-time C4I data updates through TBMCS (Theater Battle Management Core Systems). This infrastructure allows multiple replications of a simulation to be executed simultaneously over a grid faster-than-real-time, calibrated with live data feeds. A cost evaluator mechanism analyzes potential outcomes and prunes simulations that diverge from the real-time picture. In particular, this paper primarily serves to walk a user through the process for using the Multi-Replication Framework providing an enhanced decision aid.

Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient.

PubMed

Patterson, Christopher; Procter, Nicholas; Toffoli, Luisa

2016-09-01

This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made. The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice. Discussion paper. A search of terms related to situation awareness and mental health nursing was conducted in the period 2000 - present. Exploring nurses decision-making using a situation awareness framework provides for a more nuanced understanding of nurses knowledge and skill when deciding to admit or not a person as an involuntary patient. The concept of situation awareness provides a framework to better understand the decision-making process associated with the involuntary admission decision. © 2016 John Wiley & Sons Ltd.

Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

PubMed Central

Smith, Neale; Mitton, Craig; Peacock, Stuart; Cornelissen, Evelyn; MacLeod, Stuart

2009-01-01

Background To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation. Methods The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes. Results Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation. Conclusion We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is likely that the results are broadly applicable to other healthcare contexts. The implementation of this research agenda in British Columbia will depend upon the ability of the researchers and decision-makers to develop particular projects that fit within the constraints of existing funding opportunities. The process of engagement itself had benefits in terms of connecting decision-makers with their peers and sparking increased interest in the use and refinement of priority setting frameworks. PMID:19754969

A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations.

PubMed

Dotson, G Scott; Hudson, Naomi L; Maier, Andrew

2015-01-01

Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management.

A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations

PubMed Central

Dotson, G. Scott; Hudson, Naomi L.; Maier, Andrew

2016-01-01

Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management. PMID:26312660

The Assisted Decision-Making (Capacity) Bill 2013: content, commentary, controversy.

PubMed

Kelly, B D

2015-03-01

Ireland's Assisted Decision-Making (Capacity) Bill (2013) aims to reform the law relating to persons who require assistance exercising their decision-making capacity. When finalised, the Bill will replace Ireland's outdated Ward of Court system which has an all-or-nothing approach to capacity; does not adequately define capacity; is poorly responsive to change; makes unwieldy provision for appointing decision-makers; and has insufficient provision for review. To explore the content and implications of the Assisted Decision-Making (Capacity) Bill. Review of the content of the Assisted Decision-Making (Capacity) Bill and related literature. The new Bill includes a presumption of capacity and defines lack of capacity. All interventions must minimise restriction of rights and freedom, and have due regard for "dignity, bodily integrity, privacy and autonomy". The Bill proposes legal frameworks for "assisted decision-making" (where an individual voluntarily appoints someone to assist with specific decisions relating to personal welfare or property and affairs, by, among other measures, assisting the individual to communicate his or her "will and preferences"); "co-decision-making" (where the Circuit Court declares the individual's capacity is reduced but he or she can make specific decisions with a co-decision-maker to share authority); "decision-making representatives" (substitute decision-making); "enduring power of attorney"; and "informal decision-making on personal welfare matters" (without apparent oversight). These measures, if implemented, will shift Ireland's capacity laws away from an approach based on "best interests" to one based on "will and preferences", and increase compliance with the United Nations' Convention on the Rights of Persons with Disabilities.

Contrasting models of driver behaviour in emergencies using retrospective verbalisations and network analysis.

PubMed

Banks, Victoria A; Stanton, Neville A

2015-01-01

Automated assistance in driving emergencies aims to improve the safety of our roads by avoiding or mitigating the effects of accidents. However, the behavioural implications of such systems remain unknown. This paper introduces the driver decision-making in emergencies (DDMiEs) framework to investigate how the level and type of automation may affect driver decision-making and subsequent responses to critical braking events using network analysis to interrogate retrospective verbalisations. Four DDMiE models were constructed to represent different levels of automation within the driving task and its effects on driver decision-making. Findings suggest that whilst automation does not alter the decision-making pathway (e.g. the processes between hazard detection and response remain similar), it does appear to significantly weaken the links between information-processing nodes. This reflects an unintended yet emergent property within the task network that could mean that we may not be improving safety in the way we expect. This paper contrasts models of driver decision-making in emergencies at varying levels of automation using the Southampton University Driving Simulator. Network analysis of retrospective verbalisations indicates that increasing the level of automation in driving emergencies weakens the link between information-processing nodes essential for effective decision-making.

Quantum stochastic walks on networks for decision-making.

PubMed

Martínez-Martínez, Ismael; Sánchez-Burillo, Eduardo

2016-03-31

Recent experiments report violations of the classical law of total probability and incompatibility of certain mental representations when humans process and react to information. Evidence shows promise of a more general quantum theory providing a better explanation of the dynamics and structure of real decision-making processes than classical probability theory. Inspired by this, we show how the behavioral choice-probabilities can arise as the unique stationary distribution of quantum stochastic walkers on the classical network defined from Luce's response probabilities. This work is relevant because (i) we provide a very general framework integrating the positive characteristics of both quantum and classical approaches previously in confrontation, and (ii) we define a cognitive network which can be used to bring other connectivist approaches to decision-making into the quantum stochastic realm. We model the decision-maker as an open system in contact with her surrounding environment, and the time-length of the decision-making process reveals to be also a measure of the process' degree of interplay between the unitary and irreversible dynamics. Implementing quantum coherence on classical networks may be a door to better integrate human-like reasoning biases in stochastic models for decision-making.

Quantum stochastic walks on networks for decision-making

NASA Astrophysics Data System (ADS)

Martínez-Martínez, Ismael; Sánchez-Burillo, Eduardo

2016-03-01

Recent experiments report violations of the classical law of total probability and incompatibility of certain mental representations when humans process and react to information. Evidence shows promise of a more general quantum theory providing a better explanation of the dynamics and structure of real decision-making processes than classical probability theory. Inspired by this, we show how the behavioral choice-probabilities can arise as the unique stationary distribution of quantum stochastic walkers on the classical network defined from Luce’s response probabilities. This work is relevant because (i) we provide a very general framework integrating the positive characteristics of both quantum and classical approaches previously in confrontation, and (ii) we define a cognitive network which can be used to bring other connectivist approaches to decision-making into the quantum stochastic realm. We model the decision-maker as an open system in contact with her surrounding environment, and the time-length of the decision-making process reveals to be also a measure of the process’ degree of interplay between the unitary and irreversible dynamics. Implementing quantum coherence on classical networks may be a door to better integrate human-like reasoning biases in stochastic models for decision-making.

Quantum stochastic walks on networks for decision-making

PubMed Central

Martínez-Martínez, Ismael; Sánchez-Burillo, Eduardo

2016-01-01

Recent experiments report violations of the classical law of total probability and incompatibility of certain mental representations when humans process and react to information. Evidence shows promise of a more general quantum theory providing a better explanation of the dynamics and structure of real decision-making processes than classical probability theory. Inspired by this, we show how the behavioral choice-probabilities can arise as the unique stationary distribution of quantum stochastic walkers on the classical network defined from Luce’s response probabilities. This work is relevant because (i) we provide a very general framework integrating the positive characteristics of both quantum and classical approaches previously in confrontation, and (ii) we define a cognitive network which can be used to bring other connectivist approaches to decision-making into the quantum stochastic realm. We model the decision-maker as an open system in contact with her surrounding environment, and the time-length of the decision-making process reveals to be also a measure of the process’ degree of interplay between the unitary and irreversible dynamics. Implementing quantum coherence on classical networks may be a door to better integrate human-like reasoning biases in stochastic models for decision-making. PMID:27030372

A tool for the consensual analysis of decision-making scenarios.

PubMed

Hunt, Geoffrey; Merzeder, Christine; Bischofberger, Iren

2018-05-01

The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4-12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework's five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.

Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review.

PubMed

Soltani, Atousa; Hewage, Kasun; Reza, Bahareh; Sadiq, Rehan

2015-01-01

Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, and finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies. Copyright © 2014 Elsevier Ltd. All rights reserved.

The solution of target assignment problem in command and control decision-making behaviour simulation

NASA Astrophysics Data System (ADS)

Li, Ni; Huai, Wenqing; Wang, Shaodan

2017-08-01

C2 (command and control) has been understood to be a critical military component to meet an increasing demand for rapid information gathering and real-time decision-making in a dynamically changing battlefield environment. In this article, to improve a C2 behaviour model's reusability and interoperability, a behaviour modelling framework was proposed to specify a C2 model's internal modules and a set of interoperability interfaces based on the C-BML (coalition battle management language). WTA (weapon target assignment) is a typical C2 autonomous decision-making behaviour modelling problem. Different from most WTA problem descriptions, here sensors were considered to be available resources of detection and the relationship constraints between weapons and sensors were also taken into account, which brought it much closer to actual application. A modified differential evolution (MDE) algorithm was developed to solve this high-dimension optimisation problem and obtained an optimal assignment plan with high efficiency. In case study, we built a simulation system to validate the proposed C2 modelling framework and interoperability interface specification. Also, a new optimisation solution was used to solve the WTA problem efficiently and successfully.

Emergency material allocation with time-varying supply-demand based on dynamic optimization method for river chemical spills.

PubMed

Liu, Jie; Guo, Liang; Jiang, Jiping; Jiang, Dexun; Wang, Peng

2018-04-13

Aiming to minimize the damage caused by river chemical spills, efficient emergency material allocation is critical for an actual emergency rescue decision-making in a quick response. In this study, an emergency material allocation framework based on time-varying supply-demand constraint is developed to allocate emergency material, minimize the emergency response time, and satisfy the dynamic emergency material requirements in post-accident phases dealing with river chemical spills. In this study, the theoretically critical emergency response time is firstly obtained for the emergency material allocation system to select a series of appropriate emergency material warehouses as potential supportive centers. Then, an enumeration method is applied to identify the practically critical emergency response time, the optimum emergency material allocation and replenishment scheme. Finally, the developed framework is applied to a computational experiment based on south-to-north water transfer project in China. The results illustrate that the proposed methodology is a simple and flexible tool for appropriately allocating emergency material to satisfy time-dynamic demands during emergency decision-making. Therefore, the decision-makers can identify an appropriate emergency material allocation scheme in a balance between time-effective and cost-effective objectives under the different emergency pollution conditions.

Trial-by-trial fluctuations in CNV amplitude reflect anticipatory adjustment of response caution.

PubMed

Boehm, Udo; van Maanen, Leendert; Forstmann, Birte; van Rijn, Hedderik

2014-08-01

The contingent negative variation, a slow cortical potential, occurs when humans are warned by a stimulus about an upcoming task. The cognitive processes that give rise to this EEG potential are not yet well understood. To explain these processes, we adopt a recently developed theoretical framework from the area of perceptual decision-making. This framework assumes that the basal ganglia control the tradeoff between fast and accurate decision-making in the cortex. It suggests that an increase in cortical excitability serves to lower response caution, which results in faster but more error prone responding. We propose that the CNV reflects this increased cortical excitability. To test this hypothesis, we conducted an EEG experiment in which participants performed the random dot motion task either under speed or under accuracy stress. Our results show that trial-by-trial fluctuations in participants' response speed as well as model-based estimates of response caution correlated with single-trial CNV amplitude under conditions of speed but not accuracy stress. We conclude that the CNV might reflect adjustments of response caution, which serves to enhance quick decision-making. Copyright © 2014 Elsevier Inc. All rights reserved.

How stakeholder roles, power, and negotiation impact natural resource policy: A political economy view

USGS Publications Warehouse

Caughlan, L.

2002-01-01

Natural resource management decisions are complicated by multiple property rights, management objectives, and stakeholders with varying degrees of influence over the decision making process. In order to make efficient decisions, managers must incorporate the opinions and values of the involved stakeholders as well as understand the complex institutional constraints and opportunities that influence the decision-making process. Often this type of information is not understood until after a decision has been made, which can result in wasted time and effort.The purpose of my dissertation was to show how institutional frameworks and stakeholder involvement influence the various phases of the resource management decision-making process in a public choice framework. The intent was to assist decision makers and stakeholders by developing a methodology for formally incorporating stakeholders'' objectives and influence into the resource management planning process and to predict the potential success of rent-seeking activity based on stakeholder preferences and level of influence. Concepts from decision analysis, institutional analysis, and public choice economics were used in designing this interdisciplinary framework. The framework was then applied to an actual case study concerning elk and bison management on the National Elk Refuge and Grand Teton National Park near Jackson, Wyoming. The framework allowed for the prediction of the level of support and conflict for all relevant policy decisions, and the identification of each stakeholder''s level of support or opposition for each management decision.

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

Finding common ground to achieve a “good death”: family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study

PubMed Central

2013-01-01

Background Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a “bad death” experience for the patient and family. We aim to describe Canadian family physicians’ experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Methods Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Results Eleven family physicians with a range of 3 to 40 years in clinical practice participated. The family physicians expressed a desire to achieve a “good death” and described their role in positively influencing the experience of death. Finding Common Ground to Achieve a “Good Death” for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. Conclusions A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a “good death”. These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths. PMID:23339822

Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Brooke, Vanessa

2017-05-09

This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies. There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service.

A heuristic framework for understanding the role of participatory decision making in community-based non-profits.

PubMed

Bess, Kimberly D; Perkins, Douglas D; Cooper, Daniel G; Jones, Diana L

2011-06-01

This paper explores the role of member participation in decision-making (PDM) from an organizational learning (OL) perspective. Community-based organizations (CBOs) serve as mediators between the individual and the local community, often providing the means for community member participation and benefiting organizationally from members' input. Community psychologists have recognized these benefits; however, the field has paid less attention to the role participation plays in increasing CBOs' capacity to meet community needs. We present a framework for exploring how CBO contextual factors influence the use of participatory decision-making structures and practices, and how these affect OL. We then use the framework to examine PDM in qualitative case study analysis of four CBOs: a youth development organization, a faith-based social action coalition, a low-income neighborhood organization, and a large human service agency. We found that organizational form, energy, and culture each had a differential impact on participation in decision making within CBOs. We highlight how OL is constrained in CBOs and document how civic aims and voluntary membership enhanced participation and learning.

A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples

PubMed Central

Crankshaw, Tamaryn L.; Matthews, Lynn T.; Giddy, Janet; Kaida, Angela; Ware, Norma C.; Smit, Jennifer A.; Bangsberg, David R.

2013-01-01

Integrated reproductive health services for people living with HIV must address their fertility intentions. For HIV-serodiscordant couples who want to conceive, attempted conception confers a substantial risk of HIV transmission to the uninfected partner. Behavioral and pharmacologic strategies may reduce HIV transmission risk among HIV-serodiscordant couples who seek to conceive. In order to develop effective pharmaco-behavioral programs, it is important to understand and address the contexts surrounding reproductive decision-making; perceived periconception HIV transmission risk; and periconception risk behaviors. We present a conceptual framework to describe the dynamics involved in periconception HIV risk behaviors in a South African setting. We adapt the Information-Motivation-Behavioral Skill Model of HIV Preventative Behavior to address the structural, individual and couple-level determinants of safer conception behavior. The framework is intended to identify factors that influence periconception HIV risk behavior among serodiscordant couples, and therefore to guide design and implementation of integrated and effective HIV, reproductive health and family planning services that support reproductive decision-making. PMID:23177680

Not a Humbug: the evolution of patient-centred medical decision-making.

PubMed

Trump, Benjamin D; Linkov, Faina; Edwards, Robert P; Linkov, Igor

2015-12-01

This 'Christmas Issue'-type paper uses the framework of 'A Christmas Carol' to tell about the evolution of decision-making in evidence-based medicine (EBM). The Ghost of the Past represents paternalistic medicine, the Ghost of the Present symbolises EBM, while the Ghost of the Future serves as a patient-centred system where research data and tools of decision science are jointly used to make optimal medical decisions for individual patients. We argue that this shift towards a patient-centred approach to EBM and medical care is the next step in the evolution of medical decision-making, which would help to empower patients with the capability to make educated decisions throughout the course of their medical treatment.

Hybrid Optimization in Urban Traffic Networks

DOT National Transportation Integrated Search

1979-04-01

The hybrid optimization problem is formulated to provide a general theoretical framework for the analysis of a class of traffic control problems which takes into account the role of individual drivers as independent decisionmakers. Different behavior...

Taking the prudent path. Best practices for not-for-profit boards.

PubMed

Peregrine, Michael W; Schwartz, James R

2003-01-01

A direct outgrowth of the Sarbanes-Oxley Act, best practices in corporate governance strengthen board independence, provide a framework for ethical decision-making and enhance compliance with state and national regulations.

Expanding the base for teaching of percutaneous coronary interventions: the explicit approach.

PubMed

Lanzer, Peter; Prechelt, Lutz

2011-02-15

Accelerate and improve the training and learning process of operators performing percutaneous coronary interventions (PCI). Operator cognitive, in particular decision-making skills and technical skills are a major factor for the success of coronary interventions. Currently, cognitive skills are commonly developed by three methods: (1) Cognitive learning of rules for which statistical evidence is available. This is very incomprehensive and isolates cognitive learning from skill acquisition. (2) Informal tutoring received from experienced operators, and (3) personal experience by trial-and-error are both very slow. We propose in this concept article a conceptual framework to elicit, capture, and transfer expert PCI skills to complement the current approach. This includes the development of an in-depth understanding of the nature of PCI skills, terminology, and nomenclature needed to streamline communication, propensity of reproducible performance assessment, and in particular an explication of intervention planning and intra-intervention decision-making. We illustrate the impact of improved decision-making by simulation results based on a stochastic model of intervention risk. We identify several key concepts that form the basis of this conceptual framework, in particular different risk types and the notions of strategy, interventional module, and tactic. The increasing complexity of cases have brought PCI to the point where the decision-making skills of master operators need to be made explicit to make them systematically learnable such that the skills of beginner and intermediate operators can be improved much faster than is currently possible. Copyright © 2010 Wiley-Liss, Inc.

Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework.

PubMed

Nicolini, Marie; Vandenberghe, Joris; Gastmans, Chris

2017-11-29

In the era of deinstitutionalisation of psychiatric patients, steady or even increasing rates of compulsory commitment to care (CCC) are an intriguing phenomenon to analyse. From a clinical, legal and ethical perspective, CCC continues to be a controversial practice in psychiatry, and perhaps even more so when applied to patients with severe substance use disorder (SUD). Several reasons make it controversial. The lack of consensus about the benefits of CCC and professional disagreement about what mental illness and autonomy mean in the case of SUD make it difficult to apply ethically sound clinical decision-making in CCC. Also, the medico-legal framework underlying CCC use sometimes appears to foster the use of reductionist clinical evaluation. Layered on top of these issues is how stakeholders view coercion. There is a discrepancy between clinicians' and patients' perception of coercion, which leads to clinician-patient differences on whether CCC is necessary. Moreover, the way in which the evaluation is typically carried out influences patients' perception of coercion and subsequently their motivation for participating fully in treatment. In this article, we explore the value of care ethics, often applied to care practices such as nursing, when applied to more procedural medical practices, such as decision-making regarding CCC. The care-ethical approach views decision-making as part of a dynamic care process, within which the lived experience, interpretative dialogue and promotion of dignity are core features. Embracing this new framework means a paradigm shift in when the therapeutic relationship begins, namely, investing in it occurs while conducting an evaluation for a possible CCC procedure. Unlike in current typical evaluations, early cultivation of the therapeutic relationship enables the patient to participate in the definition of his needs, reduces perceived coercion and negative emotions and enhances treatment motivation. Finally, implications of this novel approach for clinical practice are formulated and discussed. © 2017 Nordic College of Caring Science.

Linking Theoretical Decision-making Mechanisms in the Simon Task with Electrophysiological Data: A Model-based Neuroscience Study in Humans.

PubMed

Servant, Mathieu; White, Corey; Montagnini, Anna; Burle, Borís

2016-10-01

A current challenge for decision-making research is in extending models of simple decisions to more complex and ecological choice situations. Conflict tasks (e.g., Simon, Stroop, Eriksen flanker) have been the focus of much interest, because they provide a decision-making context representative of everyday life experiences. Modeling efforts have led to an elaborated drift diffusion model for conflict tasks (DMC), which implements a superimposition of automatic and controlled decision activations. The DMC has proven to capture the diversity of behavioral conflict effects across various task contexts. This study combined DMC predictions with EEG and EMG measurements to test a set of linking propositions that specify the relationship between theoretical decision-making mechanisms involved in the Simon task and brain activity. Our results are consistent with a representation of the superimposed decision variable in the primary motor cortices. The decision variable was also observed in the EMG activity of response agonist muscles. These findings provide new insight into the neurophysiology of human decision-making. In return, they provide support for the DMC model framework.

POLE.VAULT: A Semantic Framework for Health Policy Evaluation and Logical Testing.

PubMed

Shaban-Nejad, Arash; Okhmatovskaia, Anya; Shin, Eun Kyong; Davis, Robert L; Buckeridge, David L

2017-01-01

The major goal of our study is to provide an automatic evaluation framework that aligns the results generated through semantic reasoning with the best available evidence regarding effective interventions to support the logical evaluation of public health policies. To this end, we have designed the POLicy EVAlUation & Logical Testing (POLE.VAULT) Framework to assist different stakeholders and decision-makers in making informed decisions about different health-related interventions, programs and ultimately policies, based on the contextual knowledge and the best available evidence at both individual and aggregate levels.

Using structured decision making to manage disease risk for Montana wildlife

USGS Publications Warehouse

Mitchell, Michael S.; Gude, Justin A.; Anderson, Neil J.; Ramsey, Jennifer M.; Thompson, Michael J.; Sullivan, Mark G.; Edwards, Victoria L.; Gower, Claire N.; Cochrane, Jean Fitts; Irwin, Elise R.; Walshe, Terry

2013-01-01

We used structured decision-making to develop a 2-part framework to assist managers in the proactive management of disease outbreaks in Montana, USA. The first part of the framework is a model to estimate the probability of disease outbreak given field observations available to managers. The second part of the framework is decision analysis that evaluates likely outcomes of management alternatives based on the estimated probability of disease outbreak, and applies managers' values for different objectives to indicate a preferred management strategy. We used pneumonia in bighorn sheep (Ovis canadensis) as a case study for our approach, applying it to 2 populations in Montana that differed in their likelihood of a pneumonia outbreak. The framework provided credible predictions of both probability of disease outbreaks, as well as biological and monetary consequences of management actions. The structured decision-making approach to this problem was valuable for defining the challenges of disease management in a decentralized agency where decisions are generally made at the local level in cooperation with stakeholders. Our approach provides local managers with the ability to tailor management planning for disease outbreaks to local conditions. Further work is needed to refine our disease risk models and decision analysis, including robust prediction of disease outbreaks and improved assessment of management alternatives.

A Temporal Mining Framework for Classifying Un-Evenly Spaced Clinical Data: An Approach for Building Effective Clinical Decision-Making System.

PubMed

Jane, Nancy Yesudhas; Nehemiah, Khanna Harichandran; Arputharaj, Kannan

2016-01-01

Clinical time-series data acquired from electronic health records (EHR) are liable to temporal complexities such as irregular observations, missing values and time constrained attributes that make the knowledge discovery process challenging. This paper presents a temporal rough set induced neuro-fuzzy (TRiNF) mining framework that handles these complexities and builds an effective clinical decision-making system. TRiNF provides two functionalities namely temporal data acquisition (TDA) and temporal classification. In TDA, a time-series forecasting model is constructed by adopting an improved double exponential smoothing method. The forecasting model is used in missing value imputation and temporal pattern extraction. The relevant attributes are selected using a temporal pattern based rough set approach. In temporal classification, a classification model is built with the selected attributes using a temporal pattern induced neuro-fuzzy classifier. For experimentation, this work uses two clinical time series dataset of hepatitis and thrombosis patients. The experimental result shows that with the proposed TRiNF framework, there is a significant reduction in the error rate, thereby obtaining the classification accuracy on an average of 92.59% for hepatitis and 91.69% for thrombosis dataset. The obtained classification results prove the efficiency of the proposed framework in terms of its improved classification accuracy.

A Markovian state-space framework for integrating flexibility into space system design decisions

NASA Astrophysics Data System (ADS)

Lafleur, Jarret M.

The past decades have seen the state of the art in aerospace system design progress from a scope of simple optimization to one including robustness, with the objective of permitting a single system to perform well even in off-nominal future environments. Integrating flexibility, or the capability to easily modify a system after it has been fielded in response to changing environments, into system design represents a further step forward. One challenge in accomplishing this rests in that the decision-maker must consider not only the present system design decision, but also sequential future design and operation decisions. Despite extensive interest in the topic, the state of the art in designing flexibility into aerospace systems, and particularly space systems, tends to be limited to analyses that are qualitative, deterministic, single-objective, and/or limited to consider a single future time period. To address these gaps, this thesis develops a stochastic, multi-objective, and multi-period framework for integrating flexibility into space system design decisions. Central to the framework are five steps. First, system configuration options are identified and costs of switching from one configuration to another are compiled into a cost transition matrix. Second, probabilities that demand on the system will transition from one mission to another are compiled into a mission demand Markov chain. Third, one performance matrix for each design objective is populated to describe how well the identified system configurations perform in each of the identified mission demand environments. The fourth step employs multi-period decision analysis techniques, including Markov decision processes from the field of operations research, to find efficient paths and policies a decision-maker may follow. The final step examines the implications of these paths and policies for the primary goal of informing initial system selection. Overall, this thesis unifies state-centric concepts of flexibility from economics and engineering literature with sequential decision-making techniques from operations research. The end objective of this thesis’ framework and its supporting tools is to enable selection of the next-generation space systems today, tailored to decision-maker budget and performance preferences, that will be best able to adapt and perform in a future of changing environments and requirements. Following extensive theoretical development, the framework and its steps are applied to space system planning problems of (1) DARPA-motivated multiple- or distributed-payload satellite selection and (2) NASA human space exploration architecture selection.

Life Cycle Costing as an Aid in Decision Making

ERIC Educational Resources Information Center

Blake, Robert

1973-01-01

Within an accepted process and measures framework, total program cost over the life of the program, including the life of facility(ies) that house the program, provides a rational decisionmaking environment for the accountable managers. (Author)

"Nuclear Deterrence" as an Adaptive Game Frame for Crisis Decision-Making.

ERIC Educational Resources Information Center

Sorenson, David S.

1981-01-01

Describes the simulation game "Nuclear Deterrence," which was developed to model an international relations crisis situation involving a bargaining framework potentially applicable to crisis modeling in other disciplines. Eight references are listed. (Author/LLS)

A Framework for Modeling Emerging Diseases to Inform Management

PubMed Central

Katz, Rachel A.; Richgels, Katherine L.D.; Walsh, Daniel P.; Grant, Evan H.C.

2017-01-01

The rapid emergence and reemergence of zoonotic diseases requires the ability to rapidly evaluate and implement optimal management decisions. Actions to control or mitigate the effects of emerging pathogens are commonly delayed because of uncertainty in the estimates and the predicted outcomes of the control tactics. The development of models that describe the best-known information regarding the disease system at the early stages of disease emergence is an essential step for optimal decision-making. Models can predict the potential effects of the pathogen, provide guidance for assessing the likelihood of success of different proposed management actions, quantify the uncertainty surrounding the choice of the optimal decision, and highlight critical areas for immediate research. We demonstrate how to develop models that can be used as a part of a decision-making framework to determine the likelihood of success of different management actions given current knowledge. PMID:27983501

Developing a Legal Framework for Advance Healthcare Planning: Comparing England & Wales and Ireland.

PubMed

Donnelly, Mary

2017-03-01

This article examines the legislative frameworks for advance healthcare planning in England & Wales (the Mental Capacity Act 2005) and in Ireland (the Assisted Decision-Making (Capacity) Act 2015), undertaking a comparative analysis of each measure, with particular focus on the detail of the approaches taken. It is only through this kind of detailed focus that the normative choices made by legislation can fully be understood and evaluated. The article argues that, in several respects, possibly because the drafters were able to reflect lessons learned from other jurisdictions, the Assisted Decision-Making (Capacity) Act 2015 provides a more rounded and complete form of advance healthcare planning than that provided by the Mental Capacity Act. This is on the basis that it provides more protection for patient choice; better potential for delivery on the choices made; and a more appropriate balance between formalities and enforceability.

A Framework for Modeling Emerging Diseases to Inform Management.

PubMed

Russell, Robin E; Katz, Rachel A; Richgels, Katherine L D; Walsh, Daniel P; Grant, Evan H C

2017-01-01

The rapid emergence and reemergence of zoonotic diseases requires the ability to rapidly evaluate and implement optimal management decisions. Actions to control or mitigate the effects of emerging pathogens are commonly delayed because of uncertainty in the estimates and the predicted outcomes of the control tactics. The development of models that describe the best-known information regarding the disease system at the early stages of disease emergence is an essential step for optimal decision-making. Models can predict the potential effects of the pathogen, provide guidance for assessing the likelihood of success of different proposed management actions, quantify the uncertainty surrounding the choice of the optimal decision, and highlight critical areas for immediate research. We demonstrate how to develop models that can be used as a part of a decision-making framework to determine the likelihood of success of different management actions given current knowledge.

A framework for modeling emerging diseases to inform management

USGS Publications Warehouse

Russell, Robin E.; Katz, Rachel A.; Richgels, Katherine L. D.; Walsh, Daniel P.; Grant, Evan H. Campbell

2017-01-01

The rapid emergence and reemergence of zoonotic diseases requires the ability to rapidly evaluate and implement optimal management decisions. Actions to control or mitigate the effects of emerging pathogens are commonly delayed because of uncertainty in the estimates and the predicted outcomes of the control tactics. The development of models that describe the best-known information regarding the disease system at the early stages of disease emergence is an essential step for optimal decision-making. Models can predict the potential effects of the pathogen, provide guidance for assessing the likelihood of success of different proposed management actions, quantify the uncertainty surrounding the choice of the optimal decision, and highlight critical areas for immediate research. We demonstrate how to develop models that can be used as a part of a decision-making framework to determine the likelihood of success of different management actions given current knowledge.

How to control the costs of health care services--an inventory of strategic options.

PubMed

Dionne, Francois; Mitton, Craig; Shoveller, Jean; Peacock, Stuart; Barer, Morris

2009-01-01

This paper has two objectives: (1) to provide an inventory of popular strategies for cost reduction or cost containment in the health services research literature and (2) to propose a coherent framework to organize this inventory. The purpose of this framework is to inform decision-makers when grappling with the opposing forces they face in choosing a cost reduction strategy. The trade-off is clear: to access progressively more possible strategies, the decision-maker must be ready to expose the population and patients to more significant changes in services provided. On one hand, more choices are preferable because each strategy attacks the problem from a different angle and being restricted to fewer "angles" increases the likelihood that a specific "well" may have dried up. On the other hand, we know that change is often viewed, a priori, negatively in health care management, so there are pressures to limit the impact on services.

Decision-making in Swiss home-like childbirth: A grounded theory study.

PubMed

Meyer, Yvonne; Frank, Franziska; Schläppy Muntwyler, Franziska; Fleming, Valerie; Pehlke-Milde, Jessica

2017-12-01

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

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

PubMed

Samsi, Kritika; Manthorpe, Jill

2013-06-01

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

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.

Strategic Directions Within Health Care Institutions: The Role of the Physician

PubMed Central

McDaniel, Reuben R.; Ashmos, Donde P.

1986-01-01

The nature of the strategic problem faced by health care institutions is identified. Physicians are urged to be involved in the strategic decision-making process and are offered several alternative roles that they might play in strategy development. A set of conceptual frameworks from the generic management decision-making literature is used to organize the analysis in addition to the literature of health care management. This combination affords a different perspective into the nature of the problems and new insights into these critical issues. PMID:3746932

General Matthew B. Ridgway: Attributes of Battle Command and Decision-Making

DTIC Science & Technology

1998-02-13

information dominance require the attributes of future battle commanders be different than those of the past? This paper focuses on the intellectual and personality traits of General Matthew B. Ridgway as they apply to operational command and decision-making. These traits are considered essential for analysis and serve as a framework in which to examine their applicability to future command. The essential qualities of an operational commander are divided into two categories: intellect and personality. Each category is further divided into elemental traits. The application

Decision-making in schizophrenia: A predictive-coding perspective.

PubMed

Sterzer, Philipp; Voss, Martin; Schlagenhauf, Florian; Heinz, Andreas

2018-05-31

Dysfunctional decision-making has been implicated in the positive and negative symptoms of schizophrenia. Decision-making can be conceptualized within the framework of hierarchical predictive coding as the result of a Bayesian inference process that uses prior beliefs to infer states of the world. According to this idea, prior beliefs encoded at higher levels in the brain are fed back as predictive signals to lower levels. Whenever these predictions are violated by the incoming sensory data, a prediction error is generated and fed forward to update beliefs encoded at higher levels. Well-documented impairments in cognitive decision-making support the view that these neural inference mechanisms are altered in schizophrenia. There is also extensive evidence relating the symptoms of schizophrenia to aberrant signaling of prediction errors, especially in the domain of reward and value-based decision-making. Moreover, the idea of altered predictive coding is supported by evidence for impaired low-level sensory mechanisms and motor processes. We review behavioral and neural findings from these research areas and provide an integrated view suggesting that schizophrenia may be related to a pervasive alteration in predictive coding at multiple hierarchical levels, including cognitive and value-based decision-making processes as well as sensory and motor systems. We relate these findings to decision-making processes and propose that varying degrees of impairment in the implicated brain areas contribute to the variety of psychotic experiences. Copyright © 2018 Elsevier Inc. All rights reserved.

Ensemble modelling and structured decision-making to support Emergency Disease Management.

PubMed

Webb, Colleen T; Ferrari, Matthew; Lindström, Tom; Carpenter, Tim; Dürr, Salome; Garner, Graeme; Jewell, Chris; Stevenson, Mark; Ward, Michael P; Werkman, Marleen; Backer, Jantien; Tildesley, Michael

2017-03-01

Epidemiological models in animal health are commonly used as decision-support tools to understand the impact of various control actions on infection spread in susceptible populations. Different models contain different assumptions and parameterizations, and policy decisions might be improved by considering outputs from multiple models. However, a transparent decision-support framework to integrate outputs from multiple models is nascent in epidemiology. Ensemble modelling and structured decision-making integrate the outputs of multiple models, compare policy actions and support policy decision-making. We briefly review the epidemiological application of ensemble modelling and structured decision-making and illustrate the potential of these methods using foot and mouth disease (FMD) models. In case study one, we apply structured decision-making to compare five possible control actions across three FMD models and show which control actions and outbreak costs are robustly supported and which are impacted by model uncertainty. In case study two, we develop a methodology for weighting the outputs of different models and show how different weighting schemes may impact the choice of control action. Using these case studies, we broadly illustrate the potential of ensemble modelling and structured decision-making in epidemiology to provide better information for decision-making and outline necessary development of these methods for their further application. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Variation in clinical decision-making for induction of labour: a qualitative study.

PubMed

Nippita, Tanya A; Porter, Maree; Seeho, Sean K; Morris, Jonathan M; Roberts, Christine L

2017-09-22

Unexplained variation in induction of labour (IOL) rates exist between hospitals, even after accounting for casemix and hospital differences. We aimed to explore factors that influence clinical decision-making for IOL that may be contributing to the variation in IOL rates between hospitals. We undertook a qualitative study involving semi-structured, audio-recorded interviews with obstetricians and midwives. Using purposive sampling, participants known to have diverse opinions on IOL were selected from ten Australian maternity hospitals (based on differences in hospital IOL rate, size, location and case-mix complexities). Transcripts were indexed, coded, and analysed using the Framework Approach to identify main themes and subthemes. Forty-five participants were interviewed (21 midwives, 24 obstetric medical staff). Variations in decision-making for IOL were based on the obstetrician's perception of medical risk in the pregnancy (influenced by the obstetrician's personality and knowledge), their care relationship with the woman, how they involved the woman in decision-making, and resource availability. The role of a 'gatekeeper' in the procedural aspects of arranging an IOL also influenced decision-making. There was wide variation in the clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with a high IOL rate, with the converse occurring in hospitals with low IOL rates. Improved communication, standardised risk assessment and accountability for IOL offer potential for reducing variation in hospital IOL rates.

Surrogate Motherhood and Abortion for Fetal Abnormality.

PubMed

Walker, Ruth; van Zyl, Liezl

2015-10-01

A diagnosis of fetal abnormality presents parents with a difficult - even tragic - moral dilemma. Where this diagnosis is made in the context of surrogate motherhood there is an added difficulty, namely that it is not obvious who should be involved in making decisions about abortion, for the person who would normally have the right to decide - the pregnant woman - does not intend to raise the child. This raises the question: To what extent, if at all, should the intended parents be involved in decision-making? In commercial surrogacy it is thought that as part of the contractual agreement the intended parents acquire the right to make this decision. By contrast, in altruistic surrogacy the pregnant woman retains the right to make these decisions, but the intended parents are free to decide not to adopt the child. We argue that both these strategies are morally unsound, and that the problems encountered serve to highlight more fundamental defects within the commercial and altruistic models, as well as in the legal and institutional frameworks that support them. We argue in favour of the professional model, which acknowledges the rights and responsibilities of both parties and provides a legal and institutional framework that supports good decision-making. In particular, the professional model acknowledges the surrogate's right to decide whether to undergo an abortion, and the intended parents' obligation to accept legal custody of the child. While not solving all the problems that arise in surrogacy, the model provides a framework that supports good decision-making. © 2015 John Wiley & Sons Ltd.

Value Assessment Frameworks for HTA Agencies: The Organization of Evidence-Informed Deliberative Processes.

PubMed

Baltussen, Rob; Jansen, Maarten Paul Maria; Bijlmakers, Leon; Grutters, Janneke; Kluytmans, Anouck; Reuzel, Rob P; Tummers, Marcia; der Wilt, Gert Jan van

2017-02-01

Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness. Evidence-informed deliberative processes are, on one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making through evidence-informed evaluation of the identified values. The framework has important implications for how HTA agencies should ideally organize their processes. First, HTA agencies should take the responsibility of organizing stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phases, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria and to provide argumentation for how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal. The framework should not be considered a blueprint for HTA agencies but rather an aspirational goal-agencies can take incremental steps toward achieving this goal. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

PubMed

Chambers, Duncan; Wilson, Paul

2012-07-09

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

Decision support framework for evaluating the operational environment of forest bioenergy production and use: Case of four European countries.

PubMed

Pezdevšek Malovrh, Špela; Kurttila, Mikko; Hujala, Teppo; Kärkkäinen, Leena; Leban, Vasja; Lindstad, Berit H; Peters, Dörte Marie; Rhodius, Regina; Solberg, Birger; Wirth, Kristina; Zadnik Stirn, Lidija; Krč, Janez

2016-09-15

Complex policy-making situations around bioenergy production and use require examination of the operational environment of the society and a participatory approach. This paper presents and demonstrates a three-phase decision-making framework for analysing the operational environment of strategies related to increased forest bioenergy targets. The framework is based on SWOT (strengths, weaknesses, opportunities and threats) analysis and the Simple Multi-Attribute Rating Technique (SMART). Stakeholders of four case countries (Finland, Germany, Norway and Slovenia) defined the factors that affect the operational environments, classified in four pre-set categories (Forest Characteristics and Management, Policy Framework, Technology and Science, and Consumers and Society). The stakeholders participated in weighting of SWOT items for two future scenarios with SMART technique. The first scenario reflected the current 2020 targets (the Business-as-Usual scenario), and the second scenario contained a further increase in the targets (the Increase scenario). This framework can be applied to various problems of environmental management and also to other fields where public decision-making is combined with stakeholders' engagement. The case results show that the greatest differences between the scenarios appear in Germany, indicating a notably negative outlook for the Increase scenario, while the smallest differences were found in Finland. Policy Framework was a highly rated category across the countries, mainly with respect to weaknesses and threats. Intensified forest bioenergy harvesting and utilization has potentially wide country-specific impacts which need to be anticipated and considered in national policies and public dialogue. Copyright © 2016 Elsevier Ltd. All rights reserved.

Decision-making by experienced rugby referees: use of perceptual information and episodic memory.

PubMed

MacMahon, Clare; Ste-Marie, Diane M

2002-10-01

The expertise paradigm was used in two studies to examine decision-making by rugby referees. Videoclips were used to assess infraction detection and knowledge base, or sources of information used. In Study 1, referees of high and low experience were compared, and in Study 2 referees and players were compared. Analysis by signal detection used a framework to classify types of information. Study 1 yielded no differences in detection of infractions as a function of experience, however, referees of high experience used significantly more sources of information than the group with low experience across all categories of information. In Study 2, there were no significant differences between referees and players, with the exception that referees displayed greater use of episodic memory information in decision-making.

Summary: Ecosystem Services and Human Welfare

EPA Science Inventory

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

Adverse outcome pathway (AOP) development: Guiding principles and best practices

EPA Science Inventory

Adverse outcome pathways (AOPs) represent a conceptual framework that can support greater application of mechanistic data in regulatory decision-making. However, in order for the scientific community to collectively address the daunting challenge of describing relevant toxicologi...

Understanding driver behavior at grade crossings through signal detection theory.

DOT National Transportation Integrated Search

2013-01-31

This report uses signal detection theory (SDT) to model motorists decisionmaking strategies at grade crossings in order to understand the factors that influence such decisions and to establish a framework for evaluating the impact of proposed coun...

Understanding driver behavior at grade crossings through signal detection theory.

DOT National Transportation Integrated Search

2013-01-01

This report uses signal detection theory (SDT) to model motorists decisionmaking strategies at grade crossings in order to understand the factors that influence such decisions and to establish a framework for evaluating the impact of proposed coun...

On policies to regulate long-term risks from hazardous waste disposal sites under both intergenerational equity and intragenerational equity

NASA Astrophysics Data System (ADS)

Shu, Zhongbin

In recent years, it has been recognized that there is a need for a general philosophic policy to guide the regulation of societal activities that involve long-term and very long-term risks. Theses societal activities not only include the disposal of high-level radioactive wastes and global warming, but also include the disposal of non-radioactive carcinogens that never decay, such as arsenic, nickel, etc. In the past, attention has been focused on nuclear wastes. However, there has been international recognition that large quantities of non-radioactive wastes are being disposed of with little consideration of their long-term risks. The objectives of this dissertation are to present the significant long-term risks posed by non-radioactive carcinogens through case studies; develop the conceptual decision framework for setting the long-term risk policy; and illustrate that certain factors, such as discount rate, can significantly influence the results of long-term risk analysis. Therefore, the proposed decision-making framework can be used to systematically study the important policy questions on long-term risk regulations, and then subsequently help the decision-maker to make informed decisions. Regulatory disparities between high-level radioactive wastes and non-radioactive wastes are summarized. Long-term risk is rarely a consideration in the regulation of disposal of non-radioactive hazardous chemicals; and when it is, the matter has been handled in a somewhat perfunctory manner. Case studies of long-term risks are conducted for five Superfund sites that are contaminated with one or more non-radioactive carcinogens. Under the same assumptions used for the disposal of high-level radioactive wastes, future subsistence farmers would be exposed to significant individual risks, in some cases with lifetime fatality risk equal to unity. The important policy questions on long-term risk regulation are identified, and the conceptual decision-making framework to regulate long-term risk is presented. The results of decision tree analysis of cleanup alternatives for the Crystal Chemical site indicate that discount rate has profound impact on the results of the analysis and significant implication with regard to intergenerational equity. It is expected that other policy factors could have similar impacts. There is a need to use the proposed decision-making framework to systemically study those factors and make rational policy decisions accordingly.

Fuzzy bilevel programming with multiple non-cooperative followers: model, algorithm and application

NASA Astrophysics Data System (ADS)

Ke, Hua; Huang, Hu; Ralescu, Dan A.; Wang, Lei

2016-04-01

In centralized decision problems, it is not complicated for decision-makers to make modelling technique selections under uncertainty. When a decentralized decision problem is considered, however, choosing appropriate models is no longer easy due to the difficulty in estimating the other decision-makers' inconclusive decision criteria. These decision criteria may vary with different decision-makers because of their special risk tolerances and management requirements. Considering the general differences among the decision-makers in decentralized systems, we propose a general framework of fuzzy bilevel programming including hybrid models (integrated with different modelling methods in different levels). Specially, we discuss two of these models which may have wide applications in many fields. Furthermore, we apply the proposed two models to formulate a pricing decision problem in a decentralized supply chain with fuzzy coefficients. In order to solve these models, a hybrid intelligent algorithm integrating fuzzy simulation, neural network and particle swarm optimization based on penalty function approach is designed. Some suggestions on the applications of these models are also presented.

Informing clinical policy decision-making practices in ambulance services.

PubMed

Muecke, Sandy; Curac, Nada; Binks, Darryn

2013-12-01

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

Shared decision-making in dementia care planning: barriers and facilitators in two European countries.

PubMed

Mariani, Elena; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne; Chattat, Rabih

2017-01-01

Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands. Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data. Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents' cognitive status that influenced their degree of involvement. Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.

Classifying clinical decision making: a unifying approach.

PubMed

Buckingham, C D; Adams, A

2000-10-01

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

The Montreal Protocol treaty and its illuminating history of science-policy decision-making

NASA Astrophysics Data System (ADS)

Grady, C.

2017-12-01

The Montreal Protocol on Substances that Deplete the Ozone Layer, hailed as one of the most effective environmental treaties of all time, has a thirty year history of science-policy decision-making. The partnership between Parties to the Montreal Protocol and its technical assessment panels serve as a basis for understanding successes and evaluating stumbles of global environmental decision-making. Real-world environmental treaty negotiations can be highly time-sensitive, politically motivated, and resource constrained thus scientists and policymakers alike are often unable to confront the uncertainties associated with the multitude of choices. The science-policy relationship built within the framework of the Montreal Protocol has helped constrain uncertainty and inform policy decisions but has also highlighted the limitations of the use of scientific understanding in political decision-making. This talk will describe the evolution of the scientist-policymaker relationship over the history of the Montreal Protocol. Examples will illustrate how the Montreal Protocol's technical panels inform decisions of the country governments and will characterize different approaches pursued by different countries with a particular focus on the recently adopted Kigali Amendment. In addition, this talk will take a deeper dive with an analysis of the historic technical panel assessments on estimating financial resources necessary to enable compliance to the Montreal Protocol compared to the political financial decisions made through the Protocol's Multilateral Fund replenishment negotiation process. Finally, this talk will describe the useful lessons and challenges from these interactions and how they may be applicable in other environmental management frameworks across multiple scales under changing climatic conditions.

Improving the Slum Planning Through Geospatial Decision Support System

NASA Astrophysics Data System (ADS)

Shekhar, S.

2014-11-01

In India, a number of schemes and programmes have been launched from time to time in order to promote integrated city development and to enable the slum dwellers to gain access to the basic services. Despite the use of geospatial technologies in planning, the local, state and central governments have only been partially successful in dealing with these problems. The study on existing policies and programmes also proved that when the government is the sole provider or mediator, GIS can become a tool of coercion rather than participatory decision-making. It has also been observed that local level administrators who have adopted Geospatial technology for local planning continue to base decision-making on existing political processes. In this juncture, geospatial decision support system (GSDSS) can provide a framework for integrating database management systems with analytical models, graphical display, tabular reporting capabilities and the expert knowledge of decision makers. This assists decision-makers to generate and evaluate alternative solutions to spatial problems. During this process, decision-makers undertake a process of decision research - producing a large number of possible decision alternatives and provide opportunities to involve the community in decision making. The objective is to help decision makers and planners to find solutions through a quantitative spatial evaluation and verification process. The study investigates the options for slum development in a formal framework of RAY (Rajiv Awas Yojana), an ambitious program of Indian Government for slum development. The software modules for realizing the GSDSS were developed using the ArcGIS and Community -VIZ software for Gulbarga city.

Capacity, pressure, demand, and flow: A conceptual framework for analyzing ecosystem service provision and delivery

USGS Publications Warehouse

Villamagna, Amy M.; Angermeier, Paul L.; Bennett, Elena M.

2013-01-01

Ecosystem services provide an instinctive way to understand the trade-offs associated with natural resource management. However, despite their apparent usefulness, several hurdles have prevented ecosystem services from becoming deeply embedded in environmental decision-making. Ecosystem service studies vary widely in focal services, geographic extent, and in methods for defining and measuring services. Dissent among scientists on basic terminology and approaches to evaluating ecosystem services create difficulties for those trying to incorporate ecosystem services into decision-making. To facilitate clearer comparison among recent studies, we provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem's capacity to produce services; ecological pressures that interfere with an ecosystem's ability to provide the service; societal demand for the service; and flow of the service to people. We discuss how interpretation and measurement of these four components can differ among provisioning, regulating, and cultural services. Our flexible framework treats service capacity, ecological pressure, demand, and flow as separate but interactive entities to improve our ability to evaluate the sustainability of service provision and to help guide management decisions. We consider ecosystem service provision to be sustainable when demand is met without decreasing capacity for future provision of that service or causing undesirable declines in other services. When ecosystem service demand exceeds ecosystem capacity to provide services, society can choose to enhance natural capacity, decrease demand and/or ecological pressure, or invest in a technological substitute. Because regulating services are frequently overlooked in environmental assessments, we provide a more detailed examination of regulating services and propose a novel method for quantifying the flow of regulating services based on estimates of ecological work. We anticipate that our synthesis and framework will reduce inconsistency and facilitate coherence across analyses of ecosystem services, thereby increasing their utility in environmental decision-making.

Enrollment Projection within a Decision-Making Framework.

ERIC Educational Resources Information Center

Armstrong, David F.; Nunley, Charlene Wenckowski

1981-01-01

Two methods used to predict enrollment at Montgomery College in Maryland are compared and evaluated, and the administrative context in which they are used is considered. The two methods involve time series analysis (curve fitting) and indicator techniques (yield from components). (MSE)

An Assessment Framework for Making Compensatory Mitigation Determinations in California

EPA Science Inventory

Efficient gathering and use of assessment information will improve the ecological effectiveness of compensatory mitigation. It also will make for more efficient regulatory decision-making. Recognizing these facts, the California Water Board worked in collaboration with the USEPA...

ALTERNATIVE FUTURES ANALYSIS: A FRAMEWORK FOR COMMUNITY DECISION-MAKING

EPA Science Inventory

Alternative futures analysis is an assessment approach designed to inform community decisions about land and water use. We conducted an alternative futures analysis in Oregon's Willamette River Basin. Three alternative future landscapes for the year 2050 were depicted and compare...

A Decision-Making Framework for Cleanup of Sites Impacted with Light Non-Aqueous Phase Liquids (LNAPL)

EPA Pesticide Factsheets

This document has been prepared by the Remediation Technologies Development Forum (RTDF) NAPL Cleanup Alliance to provide a guide to practicable and reasonable approaches for management of LNAPL petroleum hydrocarbons in the subsurface.

Creative Survival in Educational Bureaucracies.

ERIC Educational Resources Information Center

Brubaker, Dale L.; Nelson, Roland H., Jr.

In order to survive creativity in and change educational organizations, the decision-maker needs to understand how these organizations presently function. Educational organizations are discussed as sociopolitical systems and a conceptual framework is proposed for analysis, planning, implementation, and evaluation. The five functions that…

Decision Making, Models of Mind, and the New Cognitive Science.

ERIC Educational Resources Information Center

Evers, Colin W.

1998-01-01

Explores implications for understanding educational decision making from a cognitive science perspective. Examines three models of mind providing the methodological framework for decision-making studies. The "absent mind" embodies the behaviorist research tradition. The "functionalist mind" underwrites traditional cognitivism…

The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?

PubMed

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

2010-06-01

Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making. Copyright 2010 Elsevier Ltd. All rights reserved.

Application of an Informatics-Based Decision-Making Framework and Process to the Assessment of Radiation Safety in Nanotechnology

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

Hoover, Mark D.; Myers, David S.; Cash, Leigh J.

The National Council on Radiation Protection and Measurements (NCRP) has established NCRP Scientific Committee 2-6 to develop a report on the current state of knowledge and guidance for radiation safety programs involved with nanotechnology. Nanotechnology is the understanding and control of matter at the nanoscale, at dimensions between approximately 1 and 100 nanometers, where unique phenomena enable novel applications. While the full report is in preparation, this article presents and applies an informatics-based decision-making framework and process through which the radiation protection community can anticipate that nano-enabled applications, processes, nanomaterials, and nanoparticles are likely to become present or are alreadymore » present in radiation-related activities; recognize specific situations where environmental and worker safety, health, well-being, and productivity may be affected by nano-related activities; evaluate how radiation protection practices may need to be altered to improve protection; control information, interpretations, assumptions, and conclusions to implement scientifically sound decisions and actions; and confirm that desired protection outcomes have been achieved. This generally applicable framework and supporting process can be continuously applied to achieve health and safety at the convergence of nanotechnology and radiation-related activities.« less

Application of an informatics-based decision-making framework and process to the assessment of radiation safety in nanotechnology.

PubMed

Hoover, Mark D; Myers, David S; Cash, Leigh J; Guilmette, Raymond A; Kreyling, Wolfgang G; Oberdörster, Günter; Smith, Rachel; Cassata, James R; Boecker, Bruce B; Grissom, Michael P

2015-02-01

The National Council on Radiation Protection and Measurements (NCRP) established NCRP Scientific Committee 2-6 to develop a report on the current state of knowledge and guidance for radiation safety programs involved with nanotechnology. Nanotechnology is the understanding and control of matter at the nanoscale, at dimensions between ∼1 and 100 nm, where unique phenomena enable novel applications. While the full report is in preparation, this paper presents and applies an informatics-based decision-making framework and process through which the radiation protection community can anticipate that nano-enabled applications, processes, nanomaterials, and nanoparticles are likely to become present or are already present in radiation-related activities; recognize specific situations where environmental and worker safety, health, well-being, and productivity may be affected by nano-related activities; evaluate how radiation protection practices may need to be altered to improve protection; control information, interpretations, assumptions, and conclusions to implement scientifically sound decisions and actions; and confirm that desired protection outcomes have been achieved. This generally applicable framework and supporting process can be continuously applied to achieve health and safety at the convergence of nanotechnology and radiation-related activities.

Putting intelligent structured intermittent auscultation (ISIA) into practice.

PubMed

Maude, Robyn M; Skinner, Joan P; Foureur, Maralyn J

2016-06-01

Fetal monitoring guidelines recommend intermittent auscultation for the monitoring of fetal wellbeing during labour for low-risk women. However, these guidelines are not being translated into practice and low-risk women birthing in institutional maternity units are increasingly exposed to continuous cardiotocographic monitoring, both on admission to hospital and during labour. When continuous fetal monitoring becomes routinised, midwives and obstetricians lose practical skills around intermittent auscultation. To support clinical practice and decision-making around auscultation modality, the intelligent structured intermittent auscultation (ISIA) framework was developed. The purpose of this discussion paper is to describe the application of intelligent structured intermittent auscultation in practice. The intelligent structured intermittent auscultation decision-making framework is a knowledge translation tool that supports the implementation of evidence into practice around the use of intermittent auscultation for fetal heart monitoring for low-risk women during labour. An understanding of the physiology of the materno-utero-placental unit and control of the fetal heart underpin the development of the framework. Intelligent structured intermittent auscultation provides midwives with a robust means of demonstrating their critical thinking and clinical reasoning and supports their understanding of normal physiological birth. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Application of an Informatics-Based Decision-Making Framework and Process to the Assessment of Radiation Safety in Nanotechnology

DOE PAGES

Hoover, Mark D.; Myers, David S.; Cash, Leigh J.; ...

2015-01-01

The National Council on Radiation Protection and Measurements (NCRP) has established NCRP Scientific Committee 2-6 to develop a report on the current state of knowledge and guidance for radiation safety programs involved with nanotechnology. Nanotechnology is the understanding and control of matter at the nanoscale, at dimensions between approximately 1 and 100 nanometers, where unique phenomena enable novel applications. While the full report is in preparation, this article presents and applies an informatics-based decision-making framework and process through which the radiation protection community can anticipate that nano-enabled applications, processes, nanomaterials, and nanoparticles are likely to become present or are alreadymore » present in radiation-related activities; recognize specific situations where environmental and worker safety, health, well-being, and productivity may be affected by nano-related activities; evaluate how radiation protection practices may need to be altered to improve protection; control information, interpretations, assumptions, and conclusions to implement scientifically sound decisions and actions; and confirm that desired protection outcomes have been achieved. This generally applicable framework and supporting process can be continuously applied to achieve health and safety at the convergence of nanotechnology and radiation-related activities.« less

A general theory of intertemporal decision-making and the perception of time.

PubMed

Namboodiri, Vijay M K; Mihalas, Stefan; Marton, Tanya M; Hussain Shuler, Marshall G

2014-01-01

Animals and humans make decisions based on their expected outcomes. Since relevant outcomes are often delayed, perceiving delays and choosing between earlier vs. later rewards (intertemporal decision-making) is an essential component of animal behavior. The myriad observations made in experiments studying intertemporal decision-making and time perception have not yet been rationalized within a single theory. Here we present a theory-Training-Integrated Maximized Estimation of Reinforcement Rate (TIMERR)-that explains a wide variety of behavioral observations made in intertemporal decision-making and the perception of time. Our theory postulates that animals make intertemporal choices to optimize expected reward rates over a limited temporal window which includes a past integration interval-over which experienced reward rate is estimated-as well as the expected delay to future reward. Using this theory, we derive mathematical expressions for both the subjective value of a delayed reward and the subjective representation of the delay. A unique contribution of our work is in finding that the past integration interval directly determines the steepness of temporal discounting and the non-linearity of time perception. In so doing, our theory provides a single framework to understand both intertemporal decision-making and time perception.

A general theory of intertemporal decision-making and the perception of time

PubMed Central

Namboodiri, Vijay M. K.; Mihalas, Stefan; Marton, Tanya M.; Hussain Shuler, Marshall G.

2014-01-01

Animals and humans make decisions based on their expected outcomes. Since relevant outcomes are often delayed, perceiving delays and choosing between earlier vs. later rewards (intertemporal decision-making) is an essential component of animal behavior. The myriad observations made in experiments studying intertemporal decision-making and time perception have not yet been rationalized within a single theory. Here we present a theory—Training-Integrated Maximized Estimation of Reinforcement Rate (TIMERR)—that explains a wide variety of behavioral observations made in intertemporal decision-making and the perception of time. Our theory postulates that animals make intertemporal choices to optimize expected reward rates over a limited temporal window which includes a past integration interval—over which experienced reward rate is estimated—as well as the expected delay to future reward. Using this theory, we derive mathematical expressions for both the subjective value of a delayed reward and the subjective representation of the delay. A unique contribution of our work is in finding that the past integration interval directly determines the steepness of temporal discounting and the non-linearity of time perception. In so doing, our theory provides a single framework to understand both intertemporal decision-making and time perception. PMID:24616677

What is on your mind? Using the perceptual cycle model and critical decision method to understand the decision-making process in the cockpit.

PubMed

Plant, Katherine L; Stanton, Neville A

2013-01-01

Aeronautical decision-making is complex as there is not always a clear coupling between the decision made and decision outcome. As such, there is a call for process-orientated decision research in order to understand why a decision made sense at the time it was made. Schema theory explains how we interact with the world using stored mental representations and forms an integral part of the perceptual cycle model (PCM); proposed here as a way to understand the decision-making process. This paper qualitatively analyses data from the critical decision method (CDM) based on the principles of the PCM. It is demonstrated that the approach can be used to understand a decision-making process and highlights how influential schemata can be at informing decision-making. The reliability of this approach is established, the general applicability is discussed and directions for future work are considered. This paper introduces the PCM, and the associated schema theory, as a framework to structure and explain data collected from the CDM. The reliability of both the method and coding scheme is addressed.

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

Modelling human decision-making in coupled human and natural systems

NASA Astrophysics Data System (ADS)

Feola, G.

2012-12-01

A solid understanding of human decision-making is essential to analyze the complexity of coupled human and natural systems (CHANS) and inform policies to promote resilience in the face of environmental change. Human decisions drive and/or mediate the interactions and feedbacks, and contribute to the heterogeneity and non-linearity that characterize CHANS. However, human decision-making is usually over-simplistically modeled, whereby human agents are represented deterministically either as dumb or clairvoyant decision-makers. Decision-making models fall short in the integration of both environmental and human behavioral drivers, and concerning the latter, tend to focus on only one category, e.g. economic, cultural, or psychological. Furthermore, these models render a linear decision-making process and therefore fail to account for the recursive co-evolutionary dynamics in CHANS. As a result, these models constitute only a weak basis for policy-making. There is therefore scope and an urgent need for better approaches to human decision-making, to produce the knowledge that can inform vulnerability reduction policies in the face of environmental change. This presentation synthesizes the current state-of-the-art of modelling human decision-making in CHANS, with particular reference to agricultural systems, and delineates how the above mentioned shortcomings can be overcome. Through examples from research on pesticide use and adaptation to climate change, both based on the integrative agent-centered framework (Feola and Binder, 2010), the approach for an improved understanding of human agents in CHANS are illustrated. This entails: integrative approach, focus on behavioral dynamics more than states, feedbacks between individual and system levels, and openness to heterogeneity.

A Rationale and Framework for Establishing a Systems Engineering Community Within the Department of the Army

DTIC Science & Technology

2011-03-01

transition into the ranks of employees. • Make contact not solely with students , but with all those who impact their decision-making: parents, teachers ...SUBTITLE A Rationale and Framework for Establishing a Systems Engineering Community Within the Department of the Army 6. AUTHOR( S ) Alan Clayton...fields the most operationally effective military force in the world. However, fielding such a force has been challenging, as seen by the multiple

A Proposed Theoretical Model Using the Work of Thomas Kuhn, David Ausubel, and Mauritz Johnson as a Basis for Curriculum and Instruction Decisions in Science Education.

ERIC Educational Resources Information Center

Bowen, Barbara Lynn

This study presents a holistic framework which can be used as a basis for decision-making at various points in the curriculum-instruction development process as described by Johnson in a work published in 1967. The proposed framework has conceptual bases in the work of Thomas S. Kuhn and David P. Ausubel and utilizes the work of several perceptual…

Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool.

PubMed

Van den Bulcke, Bo; Piers, Ruth; Jensen, Hanne Irene; Malmgren, Johan; Metaxa, Victoria; Reyners, Anna K; Darmon, Michael; Rusinova, Katerina; Talmor, Daniel; Meert, Anne-Pascale; Cancelliere, Laura; Zubek, Làszló; Maia, Paolo; Michalsen, Andrej; Decruyenaere, Johan; Kompanje, Erwin J O; Azoulay, Elie; Meganck, Reitske; Van de Sompel, Ariëlla; Vansteelandt, Stijn; Vlerick, Peter; Vanheule, Stijn; Benoit, Dominique D

2018-02-23

Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Defining and Measuring Decision-Making for the Management of Trauma Patients.

PubMed

Madani, Amin; Gips, Amanda; Razek, Tarek; Deckelbaum, Dan L; Mulder, David S; Grushka, Jeremy R

Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Protected Areas Visitor Impact Management (PAVIM) framework: A simplified process for making management decisions

USGS Publications Warehouse

Farrell, T.A.; Marion, J.L.

2002-01-01

Ecotourism and protected area visitation in Central and South America have resulted in ecological impacts, which some protected areas managers have addressed by employing visitor impact management frameworks. In this paper, we propose the Protected Area Visitor Impact Management (PAVIM) framework as an alternative to carrying capacity and other frameworks such as Limits of Acceptable Change. We use a set of evaluation criteria to compare the relative positive and negative attributes of carrying capacity, other decision-making frameworks and the new framework, within the context of their actual and potential use in Central and South America. Positive attributes of PAVIM include simplicity, flexibility, cost effectiveness, timeliness, and incorporating input from stakeholders and local residents. Negative attributes include diminished objectivity and cultural sensitivity issues. Further research and application of PAVIM are recommended.

Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

PubMed

Lin, Yanxia; Myall, Michelle; Jarrett, Nikki

2017-12-01

To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE).

PubMed

Turner, Simon; Morris, Stephen; Sheringham, Jessica; Hudson, Emma; Fulop, Naomi J

2016-04-05

A range of evidence informs healthcare decision-making, from formal research findings to 'soft intelligence' or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice. Using a multi-level framework, this project will analyse how interactions between the evidence available and processes at the micro (individual/group) and meso (organisational/system) levels influence decisions to introduce or diffuse innovations in acute and primary care within the National Health Service in the UK. This study will use a mixed methods design, combining qualitative and quantitative methods, and involves four interdependent work streams: (1) rapid evidence synthesis of relevant literature with stakeholder feedback; (2) in-depth case studies of 'real-world' decision-making in acute and primary care; (3) a national survey and discrete choice experiment; and (4) development of guidance for decision-makers and evaluators to support the use of evidence in decision-making. This study will enhance the understanding of decision-makers' use of diverse forms of evidence. The findings will provide insights into how and why some evidence does inform decisions to introduce healthcare innovations, and why barriers persist in other cases. It will also quantify decision-makers' preferences, including the 'tipping point' of evidence needed to shift stakeholders' views. Practical guidance will be shared with healthcare decision-makers and evaluators on uses of evidence to enable the introduction and diffusion of innovation.

The GRADE Evidence to Decision (EtD) framework for health system and public health decisions.

PubMed

Moberg, Jenny; Oxman, Andrew D; Rosenbaum, Sarah; Schünemann, Holger J; Guyatt, Gordon; Flottorp, Signe; Glenton, Claire; Lewin, Simon; Morelli, Angela; Rada, Gabriel; Alonso-Coello, Pablo

2018-05-29

To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

Research Using In Vivo Simulation of Meta-Organizational Shared Decision-making (SDM). Task 4: Modeling of Communication and Decision Functions within a Shared Decision-making (SDM) Framework

DTIC Science & Technology

2011-12-01

la Reine (en droit du Canada), telle que représentée par le ministre de la Défense nationale 2011, Abstract...modélisation des fonctions de communication et de prise de décision dans le cadre de la prise de décision partagée (PDP) du volet de travail « Recherche par... la simulation in-vivo sur la prise de décision partagée des méta-organisations ». Cette composante du programme

Combination of uncertainty theories and decision-aiding methods for natural risk management in a context of imperfect information

NASA Astrophysics Data System (ADS)

Tacnet, Jean-Marc; Dupouy, Guillaume; Carladous, Simon; Dezert, Jean; Batton-Hubert, Mireille

2017-04-01

In mountain areas, natural phenomena such as snow avalanches, debris-flows and rock-falls, put people and objects at risk with sometimes dramatic consequences. Risk is classically considered as a combination of hazard, the combination of the intensity and frequency of the phenomenon, and vulnerability which corresponds to the consequences of the phenomenon on exposed people and material assets. Risk management consists in identifying the risk level as well as choosing the best strategies for risk prevention, i.e. mitigation. In the context of natural phenomena in mountainous areas, technical and scientific knowledge is often lacking. Risk management decisions are therefore based on imperfect information. This information comes from more or less reliable sources ranging from historical data, expert assessments, numerical simulations etc. Finally, risk management decisions are the result of complex knowledge management and reasoning processes. Tracing the information and propagating information quality from data acquisition to decisions are therefore important steps in the decision-making process. One major goal today is therefore to assist decision-making while considering the availability, quality and reliability of information content and sources. A global integrated framework is proposed to improve the risk management process in a context of information imperfection provided by more or less reliable sources: uncertainty as well as imprecision, inconsistency and incompleteness are considered. Several methods are used and associated in an original way: sequential decision context description, development of specific multi-criteria decision-making methods, imperfection propagation in numerical modeling and information fusion. This framework not only assists in decision-making but also traces the process and evaluates the impact of information quality on decision-making. We focus and present two main developments. The first one relates to uncertainty and imprecision propagation in numerical modeling using both classical Monte-Carlo probabilistic approach and also so-called Hybrid approach using possibility theory. Second approach deals with new multi-criteria decision-making methods which consider information imperfection, source reliability, importance and conflict, using fuzzy sets as well as possibility and belief function theories. Implemented methods consider information imperfection propagation and information fusion in total aggregation methods such as AHP (Saaty, 1980) or partial aggregation methods such as the Electre outranking method (see Soft Electre Tri ) or decisions in certain but also risky or uncertain contexts (see new COWA-ER and FOWA-ER- Cautious and Fuzzy Ordered Weighted Averaging-Evidential Reasoning). For example, the ER-MCDA methodology considers expert assessment as a multi-criteria decision process based on imperfect information provided by more or less heterogeneous, reliable and conflicting sources: it mixes AHP, fuzzy sets theory, possibility theory and belief function theory using DSmT (Dezert-Smarandache Theory) framework which provides powerful fusion rules.

WHAT ARE ‘BEST INTERESTS’? A CRITICAL EVALUATION OF ‘BEST INTERESTS’ DECISION-MAKING IN CLINICAL PRACTICE

PubMed Central

Taylor, Helen J.

2016-01-01

Obtaining the patient's consent is usually a prerequisite of any clinical intervention. However, some cognitively impaired patients may not be able to give valid consent. Following years of consultation and legislative review, the Mental Capacity Act 2005 (MCA) provides a statutory framework of ‘best interests’ decision-making on behalf of incapacitated individuals. However, confusion over the meaning and application of the ‘best interests’ standard persists. This paper explores the variation in judicial interpretation of the standard and the complexities of best interests decision-making in clinical practice. Prevailing confusion and risk-aversive practices mean that the rights and interests of cognitively impaired individuals continue to be compromised, with evidence to suggest that ‘best interests’ may be conflated with the clinician's evaluation of ‘best medical interests’. PMID:26979251

Balancing the costs of mobility investments in work zones : phase 1 final report.

DOT National Transportation Integrated Search

2015-06-01

Work zone safety and mobility continue to be critical transportation concerns in Michigan and elsewhere. : Previous research has led to the development of a variety of tools, performance measures and decision-making frameworks to analyze work zone sa...

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

PubMed

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar

2017-05-05

This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign. This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them.

Service Level Decision-making in Rural Physiotherapy: Development of Conceptual Models.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2016-06-01

Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Elements of an integrated health monitoring framework

NASA Astrophysics Data System (ADS)

Fraser, Michael; Elgamal, Ahmed; Conte, Joel P.; Masri, Sami; Fountain, Tony; Gupta, Amarnath; Trivedi, Mohan; El Zarki, Magda

2003-07-01

Internet technologies are increasingly facilitating real-time monitoring of Bridges and Highways. The advances in wireless communications for instance, are allowing practical deployments for large extended systems. Sensor data, including video signals, can be used for long-term condition assessment, traffic-load regulation, emergency response, and seismic safety applications. Computer-based automated signal-analysis algorithms routinely process the incoming data and determine anomalies based on pre-defined response thresholds and more involved signal analysis techniques. Upon authentication, appropriate action may be authorized for maintenance, early warning, and/or emergency response. In such a strategy, data from thousands of sensors can be analyzed with near real-time and long-term assessment and decision-making implications. Addressing the above, a flexible and scalable (e.g., for an entire Highway system, or portfolio of Networked Civil Infrastructure) software architecture/framework is being developed and implemented. This framework will network and integrate real-time heterogeneous sensor data, database and archiving systems, computer vision, data analysis and interpretation, physics-based numerical simulation of complex structural systems, visualization, reliability & risk analysis, and rational statistical decision-making procedures. Thus, within this framework, data is converted into information, information into knowledge, and knowledge into decision at the end of the pipeline. Such a decision-support system contributes to the vitality of our economy, as rehabilitation, renewal, replacement, and/or maintenance of this infrastructure are estimated to require expenditures in the Trillion-dollar range nationwide, including issues of Homeland security and natural disaster mitigation. A pilot website (http://bridge.ucsd.edu/compositedeck.html) currently depicts some basic elements of the envisioned integrated health monitoring analysis framework.

Police Officer, Deal-Maker, or Healthcare Provider? Moving to a Patient-Centered Framework for Chronic Opioid Management

PubMed Central

Nicolaidis, Christina

2016-01-01

How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be non-judgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the APS/AAPM guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This paper discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic non-malignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. PMID:21539703

Toward a Contingency Theory of Decision Making.

ERIC Educational Resources Information Center

Tarter, C. John; Hoy, Wayne K.

1998-01-01

There is no single best decision-making approach. This article reviews and compares six contemporary models (classical, administrative, incremental, mixed-scanning, garbage-can, and political) and develops a framework and 10 propositions to match strategies with circumstances. A contingency approach suggests that administrators use satisficing (a…

Pilot testing of SHRP 2 reliability data and analytical products: Florida. [supporting datasets

DOT National Transportation Integrated Search

2014-01-01

SHRP 2 initiated the L38 project to pilot test products from five of the programs completed projects. The products support reliability estimation and use based on data analyses, analytical techniques, and decision-making framework. The L38 project...

Role of the adverse outcome pathway framework in the validation of predictive biomarkers

EPA Science Inventory

Gene expression, enzyme activities, changes in endogenous metabolite or hormone titers, altered histology, etc. are widely used as biomarkers, but rarely, if ever, used for regulatory decision-making or to define management objectives. The disconnect between the measurements comm...

Decision-making in Coastal Management and a Collaborative Governance Framework

EPA Science Inventory

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

Developing a Modeling Framework for Ecosystem Forecasting: The Lake Michigan Pilot

EPA Science Inventory

Recent multi-party efforts to coordinate modeling activities that support ecosystem management decision-making in the Great Lakes have resulted in the recommendation to convene an interagency working group that will develop a pilot approach for Lake Michigan. The process will br...

The influence of emotions on cognitive control: feelings and beliefs—where do they meet?

PubMed Central

Harlé, Katia M.; Shenoy, Pradeep; Paulus, Martin P.

2013-01-01

The influence of emotion on higher-order cognitive functions, such as attention allocation, planning, and decision-making, is a growing area of research with important clinical applications. In this review, we provide a computational framework to conceptualize emotional influences on inhibitory control, an important building block of executive functioning. We first summarize current neuro-cognitive models of inhibitory control and show how Bayesian ideal observer models can help reframe inhibitory control as a dynamic decision-making process. Finally, we propose a Bayesian framework to study emotional influences on inhibitory control, providing several hypotheses that may be useful to conceptualize inhibitory control biases in mental illness such as depression and anxiety. To do so, we consider the neurocognitive literature pertaining to how affective states can bias inhibitory control, with particular attention to how valence and arousal may independently impact inhibitory control by biasing probabilistic representations of information (i.e., beliefs) and valuation processes (e.g., speed-error tradeoffs). PMID:24065901

Multi-criteria decision-making on assessment of proposed tidal barrage schemes in terms of environmental impacts.

PubMed

Wu, Yunna; Xu, Chuanbo; Ke, Yiming; Chen, Kaifeng; Xu, Hu

2017-12-15

For tidal range power plants to be sustainable, the environmental impacts caused by the implement of various tidal barrage schemes must be assessed before construction. However, several problems exist in the current researches: firstly, evaluation criteria of the tidal barrage schemes environmental impact assessment (EIA) are not adequate; secondly, uncertainty of criteria information fails to be processed properly; thirdly, correlation among criteria is unreasonably measured. Hence the contributions of this paper are as follows: firstly, an evaluation criteria system is established from three dimensions of hydrodynamic, biological and morphological aspects. Secondly, cloud model is applied to describe the uncertainty of criteria information. Thirdly, Choquet integral with respect to λ-fuzzy measure is introduced to measure the correlation among criteria. On the above bases, a multi-criteria decision-making decision framework for tidal barrage scheme EIA is established to select the optimal scheme. Finally, a case study demonstrates the effectiveness of the proposed framework. Copyright © 2017 Elsevier Ltd. All rights reserved.

Incorporating environmental concerns into power sector decision-making: A case study of Sri Lanka. World Bank Environment Paper 6

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

Meier, P.; Munasinghe, M.; Team, S.L.S.

1994-04-01

Weighs Sri Lanka`s options for addressing environmental concerns during the planning stages of energy policymaking. Here is a holistic approach to analyzing the environmental impact of various power systems. Unlike standard impact studies that begin at the project level, this method calls for environmental assessments that start at the planning stage of a national framework for energy policymaking. The framework would take into account the energy needs of Sri Lanka`s total economy. It also would make it easier to incorporate environmental goals into power sector decisionmaking at the critical investment stage. Sri Lanka`s development options for the power sector aremore » reviewed in detail. Topics include alternative ways to assess the economic value of a power plant`s impact on biodiversity, human health, and air and water pollution. The study also assesses which energy planning options work best and recommends ways in which the Ceylon Electricity Board can improve its environmental policies.« less

When Rights Just Won't Do: Ethical Considerations When Making Decisions for Severely Disabled Newborns.

PubMed

Hester, D Micah; Lew, Cheryl D; Swota, Alissa

2016-01-01

Children born with severe handicapping conditions, where survival and quality of survival is indeterminate, present special challenges for families and health-care professionals tasked with deciding the best courses of treatment and care. The case of Baby G presents an opportunity to compare the relative effectiveness of ethical versus rights theories in providing guidance about what obligations are owed to such children at bedside and how those obligations pertain to broader societal duties in a rights framework. We review common theories of determining the "best interests standard" of newborn decision-making and the priority of families to decide on behalf of their children. We then discuss what support the rights framework of the U.N. Convention on the Rights of the Child (CRC) might lend to the best implementation of clinical ethics decision-making. Finally, we conclude that the universal nature of rights theory does not provide the particular, specific guidance needed at the bedside of the critically ill infant.

The for-profit sector in humanitarian response: integrating ethical considerations in public policy decision making.

PubMed

Huckel Schneider, Carmen; Negin, Joel

2016-01-01

The engagement of the for-profit private sector in health, social and humanitarian services has become a topic of keen interest. It is particularly contentious in those instances where for-profit organizations have become recipients of public funds, and where they become key decision-makers in terms of how, and to whom, services are provided. We put forward a framework for identifying and organizing the ethical questions to be considered when contracting government services to the for-profit sector, specifically in those areas that have traditionally remained in the public or not-for-profit spheres. The framework is designed to inform both academic debate and practical decision-making regarding the acceptability, feasibility and legitimacy of for-profit organizations carrying out humanitarian work. First, we outline the importance of posing ethical questions in government contracting for-profit vs. not-for-profit organizations. We then outline five key areas to be considered before then examining the extent to which ethics concerns are warranted and how they may be safeguarded.

Quantitative Framework and Management Expectation Tool for the Selection of Bioremediation Approaches at Chlorinated Solvent Sites

DTIC Science & Technology

2015-03-19

to Abiotic Degradation  Magnetite (FeO.Fe2O3) often occurs naturally in sediments formed by weathering of igneous or metamorphic rock  Magnetite...send questions at any time using the Q&A panel 6 SERDP & ESTCP Webinar Series (#11) SERDP & ESTCP Webinar Series SERDP and ESTCP Overview Andrea...Attenuation (MNA)  Integrate the decision-making framework into an easy to use application • Excel spreadsheet  Guide users in the selection of

A political economy analysis of decision-making on natural disaster preparedness in Kenya.

PubMed

Rono-Bett, Karen C

2018-01-01

Most deaths from natural disasters occur in low- or middle-income countries; among them, countries in the Horn of Africa - where Kenya lies. Between September 2015 and September 2016, 23.4 million people in this region faced food insecurity because of the 2015 El Niño, characterised by floods and droughts. The importance of effective government decision-making on preparedness and response are critical to saving lives during such disasters. But this decision-making process occurs in a political context which is marred by uncertainty with other factors at play. Yet, good practice requires making investments on a 'no-regrets' basis. This article looks at the factors influencing Kenya's decision-making process for natural disasters, the preparedness for the 2015 El Niño as a case study. I explored what stakeholders understand by 'no-regrets investments' and its application. I assessed financial allocations by government and donors to disaster preparedness. Based on key informant interviews, focus group discussions and financial analyses, this article presents evidence at national and subnational levels. The findings indicate that in making decisions relating to preparedness, the government seeks information primarily from sources it trusts - other government departments, its communities and the media. With no existing legal frameworks guiding Kenya's disaster preparedness, the coordination of preparedness is not strong. It appears that there is a lack of political will to prioritise these frameworks. The no-regrets approach is applied predominantly by non-state actors. Because there have been 'non-events' in the past, government has become overcautious in committing resources on a no-regrets basis. Government allocation to preparedness exceeds donor funding by almost tenfold.

Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy.

PubMed

Madani, Amin; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C; Barkun, Jeffrey S; Fried, Gerald M; Aggarwal, Rajesh

2015-11-01

Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.

PubMed

Mohan, Deepika; Alexander, Stewart C; Garrigues, Sarah K; Arnold, Robert M; Barnato, Amber E

2010-08-01

Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0-6) and at discussing end of life goals (0-16). Twenty-seven hospital-based physicians. Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p = 0.04). It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.

The value of foresight: how prospection affects decision-making.

PubMed

Pezzulo, Giovanni; Rigoli, Francesco

2011-01-01

Traditional theories of decision-making assume that utilities are based on the intrinsic value of outcomes; in turn, these values depend on associations between expected outcomes and the current motivational state of the decision-maker. This view disregards the fact that humans (and possibly other animals) have prospection abilities, which permit anticipating future mental processes and motivational and emotional states. For instance, we can evaluate future outcomes in light of the motivational state we expect to have when the outcome is collected, not (only) when we make a decision. Consequently, we can plan for the future and choose to store food to be consumed when we expect to be hungry, not immediately. Furthermore, similarly to any expected outcome, we can assign a value to our anticipated mental processes and emotions. It has been reported that (in some circumstances) human subjects prefer to receive an unavoidable punishment immediately, probably because they are anticipating the dread associated with the time spent waiting for the punishment. This article offers a formal framework to guide neuroeconomic research on how prospection affects decision-making. The model has two characteristics. First, it uses model-based Bayesian inference to describe anticipation of cognitive and motivational processes. Second, the utility-maximization process considers these anticipations in two ways: to evaluate outcomes (e.g., the pleasure of eating a pie is evaluated differently at the beginning of a dinner, when one is hungry, and at the end of the dinner, when one is satiated), and as outcomes having a value themselves (e.g., the case of dread as a cost of waiting for punishment). By explicitly accounting for the relationship between prospection and value, our model provides a framework to reconcile the utility-maximization approach with psychological phenomena such as planning for the future and dread.

The Value of Foresight: How Prospection Affects Decision-Making

PubMed Central

Pezzulo, Giovanni; Rigoli, Francesco

2011-01-01

Traditional theories of decision-making assume that utilities are based on the intrinsic value of outcomes; in turn, these values depend on associations between expected outcomes and the current motivational state of the decision-maker. This view disregards the fact that humans (and possibly other animals) have prospection abilities, which permit anticipating future mental processes and motivational and emotional states. For instance, we can evaluate future outcomes in light of the motivational state we expect to have when the outcome is collected, not (only) when we make a decision. Consequently, we can plan for the future and choose to store food to be consumed when we expect to be hungry, not immediately. Furthermore, similarly to any expected outcome, we can assign a value to our anticipated mental processes and emotions. It has been reported that (in some circumstances) human subjects prefer to receive an unavoidable punishment immediately, probably because they are anticipating the dread associated with the time spent waiting for the punishment. This article offers a formal framework to guide neuroeconomic research on how prospection affects decision-making. The model has two characteristics. First, it uses model-based Bayesian inference to describe anticipation of cognitive and motivational processes. Second, the utility-maximization process considers these anticipations in two ways: to evaluate outcomes (e.g., the pleasure of eating a pie is evaluated differently at the beginning of a dinner, when one is hungry, and at the end of the dinner, when one is satiated), and as outcomes having a value themselves (e.g., the case of dread as a cost of waiting for punishment). By explicitly accounting for the relationship between prospection and value, our model provides a framework to reconcile the utility-maximization approach with psychological phenomena such as planning for the future and dread. PMID:21747755

Patients Should Define Value in Health Care: A Conceptual Framework.

PubMed

Kamal, Robin N; Lindsay, Sarah E; Eppler, Sara L

2018-05-10

The main tenet of value-based health care is delivering high-quality care that is centered on the patient, improving health, and minimizing cost. Collaborative decision-making frameworks have been developed to help facilitate delivering care based on patient preferences (patient-centered care). The current value-based health care model, however, focuses on improving population health and overlooks the individuality of patients and their preferences for care. We highlight the importance of eliciting patient preferences in collaborative decision making and describe a conceptual framework that incorporates individual patients' preferences when defining value. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Toward a synthesis of cognitive biases: how noisy information processing can bias human decision making.

PubMed

Hilbert, Martin

2012-03-01

A single coherent framework is proposed to synthesize long-standing research on 8 seemingly unrelated cognitive decision-making biases. During the past 6 decades, hundreds of empirical studies have resulted in a variety of rules of thumb that specify how humans systematically deviate from what is normatively expected from their decisions. Several complementary generative mechanisms have been proposed to explain those cognitive biases. Here it is suggested that (at least) 8 of these empirically detected decision-making biases can be produced by simply assuming noisy deviations in the memory-based information processes that convert objective evidence (observations) into subjective estimates (decisions). An integrative framework is presented to show how similar noise-based mechanisms can lead to conservatism, the Bayesian likelihood bias, illusory correlations, biased self-other placement, subadditivity, exaggerated expectation, the confidence bias, and the hard-easy effect. Analytical tools from information theory are used to explore the nature and limitations that characterize such information processes for binary and multiary decision-making exercises. The ensuing synthesis offers formal mathematical definitions of the biases and their underlying generative mechanism, which permits a consolidated analysis of how they are related. This synthesis contributes to the larger goal of creating a coherent picture that explains the relations among the myriad of seemingly unrelated biases and their potential psychological generative mechanisms. Limitations and research questions are discussed.

Simulation of Optimal Decision-Making Under the Impacts of Climate Change.

PubMed

Møller, Lea Ravnkilde; Drews, Martin; Larsen, Morten Andreas Dahl

2017-07-01

Climate change causes transformations to the conditions of existing agricultural practices appointing farmers to continuously evaluate their agricultural strategies, e.g., towards optimising revenue. In this light, this paper presents a framework for applying Bayesian updating to simulate decision-making, reaction patterns and updating of beliefs among farmers in a developing country, when faced with the complexity of adapting agricultural systems to climate change. We apply the approach to a case study from Ghana, where farmers seek to decide on the most profitable of three agricultural systems (dryland crops, irrigated crops and livestock) by a continuous updating of beliefs relative to realised trajectories of climate (change), represented by projections of temperature and precipitation. The climate data is based on combinations of output from three global/regional climate model combinations and two future scenarios (RCP4.5 and RCP8.5) representing moderate and unsubstantial greenhouse gas reduction policies, respectively. The results indicate that the climate scenario (input) holds a significant influence on the development of beliefs, net revenues and thereby optimal farming practices. Further, despite uncertainties in the underlying net revenue functions, the study shows that when the beliefs of the farmer (decision-maker) opposes the development of the realised climate, the Bayesian methodology allows for simulating an adjustment of such beliefs, when improved information becomes available. The framework can, therefore, help facilitating the optimal choice between agricultural systems considering the influence of climate change.

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 2. Introduction and Framework for Analysis.

DOT National Transportation Integrated Search

1979-09-01

The study represents the first systematic attempt to estimate the potential impacts of a wide range of IP options in different settings. The output of this study should provide local decision-makers with a better understanding of the varied impacts a...

A computational framework for supporting environmental-climate-energy decision-making

EPA Science Inventory

GLIMPSE is a effort in which the U.S. EPA Office of Research and Development is developing tools to support long-term, coordinated environmental, climate, and energy planning. The purpose of this presentation is to discuss the underlying science questions; provide an overview of ...

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

ERIC Educational Resources Information Center

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

2016-01-01

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

Ethics for Fundraisers.

ERIC Educational Resources Information Center

Anderson, Albert

Intended for professionals and others in the field of philanthropy, this book applies ethics and ethical decision-making to fund raising. Its primary aim is to enhance the level of ethical fund raising throughout the nonprofit sector by equipping those involved with frameworks for understanding and taking principled actions and preventing…

Framework for Site Characterization for Monitored Natural Attenuation of Volatile Organic Compounds in Ground Water

EPA Science Inventory

Monitored Natural Attenuation (MNA) is unique among remedial technologies in relying entirely on natural processes to achieve site-specific objectives. Site characterization is essential to provide site-specific data and interpretations for the decision-making process (i.e., to ...

A Framework Incorporating Community Preferences in Use Attainment and Related Water Quality Decision-Making (2010 Final)

EPA Science Inventory

The report is intended to assist water quality officials, watershed managers, members of stakeholder groups, and other interested individuals in fully evaluating ecological and socioeconomic objectives and the gains and losses that often are involved in use attainment decisions. ...

Decision Analysis for a Sustainable Environment, Economy, and Society: A Participatory Framework for Ecosystem Services-Based Decision-Making

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. The vast majority of environmenta...

The role of conviction and narrative in decision-making under radical uncertainty.

PubMed

Tuckett, David; Nikolic, Milena

2017-08-01

We propose conviction narrative theory (CNT) to broaden decision-making theory in order to better understand and analyse how subjectively means-end rational actors cope in contexts in which the traditional assumptions in decision-making models fail to hold. Conviction narratives enable actors to draw on their beliefs, causal models, and rules of thumb to identify opportunities worth acting on, to simulate the future outcome of their actions, and to feel sufficiently convinced to act. The framework focuses on how narrative and emotion combine to allow actors to deliberate and to select actions that they think will produce the outcomes they desire. It specifies connections between particular emotions and deliberative thought, hypothesising that approach and avoidance emotions evoked during narrative simulation play a crucial role. Two mental states, Divided and Integrated, in which narratives can be formed or updated, are introduced and used to explain some familiar problems that traditional models cannot.

Finding audiences, changing beliefs: the structure of research use in Canadian health policy.

PubMed

Lomas, J

1990-01-01

The impact of research information depends on its ability to change beliefs or policy assumptions within the relevant audiences. As a hybrid of American and British systems, Canada's chosen decision-making structure for policy-making and its legislative framework for health insurance make these audiences unclear and not readily accessible. This factor and historical characteristics of the research community which made them only partially responsive to the values of decisionmakers provide an explanation for the limited past use of research information in Canadian health policy. More recently, improved responsiveness by researchers and an emerging definition of the audiences by legislative policymakers are bringing about a gradual increase in the potential impact of research at the levels of administrative and clinical policy. Because of continuing decision-making constraints on legislative policy, however, impact at this level is predicted to remain diffuse, with only cautious acceptance of the changes in beliefs implied by research.

The role of conviction and narrative in decision-making under radical uncertainty

PubMed Central

Tuckett, David; Nikolic, Milena

2017-01-01

We propose conviction narrative theory (CNT) to broaden decision-making theory in order to better understand and analyse how subjectively means–end rational actors cope in contexts in which the traditional assumptions in decision-making models fail to hold. Conviction narratives enable actors to draw on their beliefs, causal models, and rules of thumb to identify opportunities worth acting on, to simulate the future outcome of their actions, and to feel sufficiently convinced to act. The framework focuses on how narrative and emotion combine to allow actors to deliberate and to select actions that they think will produce the outcomes they desire. It specifies connections between particular emotions and deliberative thought, hypothesising that approach and avoidance emotions evoked during narrative simulation play a crucial role. Two mental states, Divided and Integrated, in which narratives can be formed or updated, are introduced and used to explain some familiar problems that traditional models cannot. PMID:28804217

Health professionals' decision-making in wound management: a grounded theory.

PubMed

Gillespie, Brigid M; Chaboyer, Wendy; St John, Winsome; Morley, Nicola; Nieuwenhoven, Paul

2015-06-01

To develop a conceptual understanding of the decision-making processes used by healthcare professionals in wound care practice. With the global move towards using an evidence-base in standardizing wound care practices and the need to reduce hospital wound care costs, it is important to understand health professionals' decision-making in this important yet under-researched area. A grounded theory approach was used to explore clinical decision-making of healthcare professionals in wound care practice. Interviews were conducted with 20 multi-disciplinary participants from nursing, surgery, infection control and wound care who worked at a metropolitan hospital in Australia. Data were collected during 2012-2013. Constant comparative analysis underpinned by Strauss and Corbin's framework was used to identify clinical decision-making processes. The core category was 'balancing practice-based knowledge with evidence-based knowledge'. Participants' clinical practice and actions embedded the following processes: 'utilizing the best available information', 'using a consistent approach in wound assessment' and 'using a multidisciplinary approach'. The substantive theory explains how practice and evidence knowledge was balanced and the variation in use of intuitive practice-based knowledge versus evidence-based knowledge. Participants considered patients' needs and preferences, costs, outcomes, technologies, others' expertise and established practices. Participants' decision-making tended to be more heavily weighted towards intuitive practice-based processes. These findings offer a better understanding of the processes used by health professionals' in their decision-making in wound care. Such an understanding may inform the development of evidence-based interventions that lead to better patient outcomes. © 2014 John Wiley & Sons Ltd.

Integrated consensus-based frameworks for unmanned vehicle routing and targeting assignment

NASA Astrophysics Data System (ADS)

Barnawi, Waleed T.

Unmanned aerial vehicles (UAVs) are increasingly deployed in complex and dynamic environments to perform multiple tasks cooperatively with other UAVs that contribute to overarching mission effectiveness. Studies by the Department of Defense (DoD) indicate future operations may include anti-access/area-denial (A2AD) environments which limit human teleoperator decision-making and control. This research addresses the problem of decentralized vehicle re-routing and task reassignments through consensus-based UAV decision-making. An Integrated Consensus-Based Framework (ICF) is formulated as a solution to the combined single task assignment problem and vehicle routing problem. The multiple assignment and vehicle routing problem is solved with the Integrated Consensus-Based Bundle Framework (ICBF). The frameworks are hierarchically decomposed into two levels. The bottom layer utilizes the renowned Dijkstra's Algorithm. The top layer addresses task assignment with two methods. The single assignment approach is called the Caravan Auction Algorithm (CarA) Algorithm. This technique extends the Consensus-Based Auction Algorithm (CBAA) to provide awareness for task completion by agents and adopt abandoned tasks. The multiple assignment approach called the Caravan Auction Bundle Algorithm (CarAB) extends the Consensus-Based Bundle Algorithm (CBBA) by providing awareness for lost resources, prioritizing remaining tasks, and adopting abandoned tasks. Research questions are investigated regarding the novelty and performance of the proposed frameworks. Conclusions regarding the research questions will be provided through hypothesis testing. Monte Carlo simulations will provide evidence to support conclusions regarding the research hypotheses for the proposed frameworks. The approach provided in this research addresses current and future military operations for unmanned aerial vehicles. However, the general framework implied by the proposed research is adaptable to any unmanned vehicle. Civil applications that involve missions where human observability would be limited could benefit from the independent UAV task assignment, such as exploration and fire surveillance are also notable uses for this approach.

GIS-assisted spatial analysis for urban regulatory detailed planning: designer's dimension in the Chinese code system

NASA Astrophysics Data System (ADS)

Yu, Yang; Zeng, Zheng

2009-10-01

By discussing the causes behind the high amendments ratio in the implementation of urban regulatory detailed plans in China despite its law-ensured status, the study aims to reconcile conflict between the legal authority of regulatory detailed planning and the insufficient scientific support in its decision-making and compilation by introducing into the process spatial analysis based on GIS technology and 3D modeling thus present a more scientific and flexible approach to regulatory detailed planning in China. The study first points out that the current compilation process of urban regulatory detailed plan in China employs mainly an empirical approach which renders it constantly subjected to amendments; the study then discusses the need and current utilization of GIS in the Chinese system and proposes the framework of a GIS-assisted 3D spatial analysis process from the designer's perspective which can be regarded as an alternating processes between the descriptive codes and physical design in the compilation of regulatory detailed planning. With a case study of the processes and results from the application of the framework, the paper concludes that the proposed framework can be an effective instrument which provides more rationality, flexibility and thus more efficiency to the compilation and decision-making process of urban regulatory detailed plan in China.

Evidence-based librarianship: an overview.

PubMed

Eldredge, J D

2000-10-01

To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

Evidence-based librarianship: an overview

PubMed Central

Eldredge, Jonathan D.

2000-01-01

Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism

PubMed Central

Khan, Mohammad J.; Chelliah, Shankar; Haron, Mahmod S.; Ahmed, Sahrish

2017-01-01

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation. PMID:28417022

Acquisition and production of skilled behavior in dynamic decision-making tasks

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1992-01-01

Detailed summaries of two NASA-funded research projects are provided. The first project was an ecological task analysis of the Star Cruiser model. Star Cruiser is a psychological model designed to test a subject's level of cognitive activity. Ecological task analysis is used as a framework to predict the types of cognitive activity required to achieve productive behavior and to suggest how interfaces can be manipulated to alleviate certain types of cognitive demands. The second project is presented in the form of a thesis for the Masters Degree. The thesis discusses the modeling of decision-making through the use of neural network and genetic-algorithm machine learning technologies.

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism: Theoretical model.

PubMed

Khan, Mohammad J; Chelliah, Shankar; Haron, Mahmod S; Ahmed, Sahrish

2017-02-01

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.

DECISION-COMPONENTS OF NICE'S TECHNOLOGY APPRAISALS ASSESSMENT FRAMEWORK.

PubMed

de Folter, Joost; Trusheim, Mark; Jonsson, Pall; Garner, Sarah

2018-01-01

Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way. A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors. We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created. This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

Cultivating Peace through Design Thinking: Problem Solving with PAST Foundation

ERIC Educational Resources Information Center

Deaner, Kat; McCreery-Kellert, Heather

2018-01-01

Design thinking is a methodology that emphasizes reasoning and decision-making as part of the problem-solving process. It is a structured framework for identifying challenges, gathering information, generating potential solutions, refining ideas, and testing solutions. Design thinking offers valuable skills that will serve students well as they…

Making Predictions about Chemical Reactivity: Assumptions and Heuristics

ERIC Educational Resources Information Center

Maeyer, Jenine; Talanquer, Vicente

2013-01-01

Diverse implicit cognitive elements seem to support but also constrain reasoning in different domains. Many of these cognitive constraints can be thought of as either implicit assumptions about the nature of things or reasoning heuristics for decision-making. In this study we applied this framework to investigate college students' understanding of…

A social-ecological impact assessment for public land management: application of a conceptual and methodological framework

USDA-ARS?s Scientific Manuscript database

According to the U.S. National Environmental Policy Act of 1969 (NEPA), federal action to manipulate habitat for species conservation requires an environmental impact statement (EIS), which should integrate natural and social sciences in planning and decision-making. Nonetheless, most impact assessm...

Decision-Making Styles of Russian School Principals

ERIC Educational Resources Information Center

Kasprzhak, A. G.; Bysik, N. V.

2015-01-01

This work discusses the results of a pilot project performed in 2013-14 within the framework of the Asian Leadership Project international comparative study, which continues research of school leadership in Europe and America since years 2006-2008. Alongside with Russia, the pilot project also included Australia, Hong Kong, Indonesia, Malaysia,…

LIFE CYCLE IMPACT ASSESSMENT FOR THE BUILDING DESIGN AND CONSTRUCTION INDUSTRY

EPA Science Inventory

The most effective way to achieve long-term environmental results is through the use of a consistent set of metrics within a decision-making framework. This paper describes the role of Life Cycle Impact Assessment (LCIA) and details its use within two tools available to this indu...

A Set of Web-based Tools for Integrating Scientific Research and Decision-Making through Systems Thinking

EPA Science Inventory

Currently, many policy and management decisions are made without considering the goods and services humans derive from ecosystems and the costs associated with protecting them. This approach is unlikely to be sustainable. Conceptual frameworks provide a tool for capturing, visual...

Moral Pluralism in Business Ethics Education: It Is about Time

ERIC Educational Resources Information Center

Burton, Brian K.; Dunn, Craig P.; Goldsby, Michael

2006-01-01

The teaching of business ethics is almost inherently pluralistic, but little evidence of explicitly pluralistic approaches exists in teaching materials besides the available decision-making frameworks. In this article, it is argued that the field needs to acknowledge and adopt pluralism as the standard pedagogical approach, whether the individual…

Assess. Instruct. Repeat.

ERIC Educational Resources Information Center

Demski, Jennifer

2009-01-01

Response to Intervention, or RTI, is a framework for using data to establish the nature and degree of the help a student needs, and then applying strategies targeting those areas. It is a carefully drawn, systematic form of data-driven decision-making that establishes multiple stages of interventions for varying degrees of problems. Though some…

Key Elements of a Successful Drive toward Marketing Strategy Making

ERIC Educational Resources Information Center

Cann, Cynthia W.; George, Marie A.

2003-01-01

A conceptual model is presented that depicts the relationship between an internal marketing function and an organization's readiness to learn. Learning and marketing orientations are identified as components to marketing strategy making. Key organizational functions, including communication and decision-making, are utilized in a framework for…

The Relevance of Theories of the Policy Process to Educational Decision-Making.

ERIC Educational Resources Information Center

Ryan, R. J.

1985-01-01

Two case studies of educational decision making are used to test the utility of some current theories of the policy-formation process; a framework for the application of these theories is proposed; and the merits of applying existing theories before seeking new paradigms are stressed. (MSE)

Promoting Effective Science Teacher Education and Science Teaching: A Framework for Teacher Decision-Making

ERIC Educational Resources Information Center

Clough, Michael P.; Berg, Craig A.; Olson, Joanne K.

2009-01-01

Learning and effective teaching are both complicated acts. However, many administrators, teachers, parents, and policymakers appear not to recognize those complexities and their significance for practice. Fueling this perception, recommendations from "isolated" research findings often neglect the complexities in learning and teaching, and when…

Assessment and Decision-Making in Early Childhood Education and Intervention

ERIC Educational Resources Information Center

Strand, Paul S.; Cerna, Sandra; Skucy, Jim

2007-01-01

Assessment within the fields of early childhood education and early childhood intervention is guided by the "deductive-psychometric model", which is a framework for legitimizing constructs that arise from theories. An alternative approach, termed the "inductive-experimental model", places significantly more restrictions on what constitutes a…

An assessment of frameworks useful for public land recreation planning.

Treesearch

Stephen F. McCool; Roger N. Clark; George Stankey

2007-01-01

Public land managers are confronted with an ever-growing and diversifying set of demands for providing recreation opportunities. Coupled with a variety of trends (devolution of governance and decisionmaking, population growth, technological innovation, shifts in public values, economic restructuring) and reduced organizational capacity, these demands represent a...

Quantitative AOP linking aromatase inhibition to impaired reproduction: A case study in predictive ecotoxicology

EPA Science Inventory

The adverse outcome pathway (AOP) framework is intended to help support greater use of mechanistic toxicology data as a basis for risk assessment and/or regulatory decision-making. While there have been clear advances in the ability to rapidly generate mechanistically-oriented da...

Exploring Investor Decisions in a Behavioral Finance Framework

ERIC Educational Resources Information Center

Hayes, Suzanne K.

2010-01-01

The first objective of this article is to increase awareness and understanding of individual decision-making biases. The second is to provide FCS professionals with strategies to improve consumer financial decisions. Individual decision biases are presented within the context of a seven-stage decision process. Proactive consumer educators using a…

Weight of evidence evaluation of adverse outcome pathways converging at impaired vitellogenin synthesis leading to reproductive impairment

EPA Science Inventory

Adverse outcome pathways (AOPs) provide a framework that supports greater use of mechanistic data measured at lower levels of biological organization as a basis for regulatory decision-making. However, it is recognized that different types of regulatory applications and decisions...

Solid Waste Management Planning--A Methodology

ERIC Educational Resources Information Center

Theisen, Hilary M.; And Others

1975-01-01

This article presents a twofold solid waste management plan consisting of a basic design methodology and a decision-making methodology. The former provides a framework for the developing plan while the latter builds flexibility into the design so that there is a model for use during the planning process. (MA)

Differential Diagnosis of Specific Learning Disability within a Response to Intervention Framework

ERIC Educational Resources Information Center

Boneshefski, Michael J.

2017-01-01

The purpose of this study was to determine to what extent two major specific learning disability (SLD) criteria, including a student's level of academic achievement and rate of improvement (ROI), predict multidisciplinary evaluation teams' decision-making regarding referral for special education evaluation and special education eligibility.…

Merging Information Literacy and Evidence-Based Practice in an Undergraduate Health Sciences Curriculum Map

ERIC Educational Resources Information Center

Franzen, Susan; Bannon, Colleen M.

2016-01-01

The ACRL's "Framework for Information Literacy for Higher Education" offers the opportunity to rethink information literacy teaching and curriculum. However, the ACRL's rescinded "Information Literacy Competency Standards for Higher Education" correlate with the preferred research and decision-making model of the health…

Problem Seeking. New Directions in Architectural Programming.

ERIC Educational Resources Information Center

Pena, William M.; Focke, John W.

The rationale, principles, and methods of pre-design architectural programing are explained for those responsible for overall policy decision-making in the area of facility planning. This programing process provides an orderly framework that aids the architect in defining a client's total problem. A general background is given on data collection,…

School-Based Decision Making: A Principal-Agent Perspective.

ERIC Educational Resources Information Center

Ferris, James M.

1992-01-01

A principal-agent framework is used to examine potential gains in educational performance and potential threats to public accountability that school-based decision-making proposals pose. Analysis underscores the need to tailor the design of decentralized decision making to the sources of poor educational performance and threats to school…

The Acceptance of Computer Technology by Teachers in Early Childhood Education

ERIC Educational Resources Information Center

Jeong, Hye In; Kim, Yeolib

2017-01-01

This study investigated kindergarten teachers' decision-making process regarding the acceptance of computer technology. We incorporated the Technology Acceptance Model framework, in addition to computer self-efficacy, subjective norm, and personal innovativeness in education technology as external variables. The data were obtained from 160…

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

The Role of Cooperation and Information Exchange in Transnational River Basins: the Zambezi River case

NASA Astrophysics Data System (ADS)

Castelletti, A.; Giuliani, M.; Soncini-Sessa, R.

2012-12-01

The presence of multiple, institutionally independent but physically interconnected decision-makers is a distinctive features of many water resources systems, especially of transnational river basins. The adoption of a centralized approach to study the optimal operation of these systems, as mostly done in the water resources literature, is conceptually interesting to quantify the best achievable performance, but of little practical impact given the real political and institutional setting. Centralized management indeed assumes a cooperative attitude and full information exchange by the involved parties. However, when decision-makers belong to different countries or institutions, it is very likely that they act considering only their local objectives, producing global externalities that negatively impact on other objectives. In this work we adopt a Multi-Agent Systems framework, which naturally allows to represent a set of self-interested agents (decision-makers and/or stakeholders) acting in a distributed decision-making process. According to this agent-based approach, each agent represents a decision-maker, whose decisions are defined by an explicit optimization problem considering only the agent's local interests. In particular, this work assesses the role of information exchange and increasing level of cooperation among originally non-cooperative agents. The Zambezi River basin is used to illustrate the methodology: the four largest reservoirs in the basin (Ithezhithezhi, Kafue-Gorge, Kariba and Cahora Bassa) are mainly operated for maximizing the economic revenue from hydropower energy production with considerably negative effects on the aquatic ecosystem in the Zambezi delta due to the alteration of the natural flow regime. We comparatively analyse the ideal centralized solution and the current situation where all the decision-makers act independently and non-cooperatively. Indeed, although a new basin-level institution called Zambezi Watercourse Commission (ZAMCON) should be established in the next future, Zambia recently refused to sign and ratify the ZAMCON Protocol and the road toward a fully cooperative framework is still long. Results show that increasing levels of information exchange can help in mitigating the conflict generated by a non-cooperative setting as it allows the downstream agents, i.e. Mozambique country, to better adapt to the upstream management strategies. Furthermore, the role of information exchange depends on the considered objectives and it is particularly relevant for environmental interests.

Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

PubMed

Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

2017-08-24

Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.

Towards Integrated Health Technology Assessment for Improving Decision Making in Selected Countries.

PubMed

Oortwijn, Wija; Determann, Domino; Schiffers, Krijn; Tan, Siok Swan; van der Tuin, Jeroen

2017-09-01

To assess the level of comprehensiveness of health technology assessment (HTA) practices around the globe and to formulate recommendations for enhancing legitimacy and fairness of related decision-making processes. To identify best practices, we developed an evaluation framework consisting of 13 criteria on the basis of the INTEGRATE-HTA model (integrative perspective on assessing health technologies) and the Accountability for Reasonableness framework (deliberative appraisal process). We examined different HTA systems in middle-income countries (Argentina, Brazil, and Thailand) and high-income countries (Australia, Canada, England, France, Germany, Scotland, and South Korea). For this purpose, desk research and structured interviews with relevant key stakeholders (N = 32) in the selected countries were conducted. HTA systems in Canada, England, and Scotland appear relatively well aligned with our framework, followed by Australia, Germany, and France. Argentina and South Korea are at an early stage, whereas Brazil and Thailand are at an intermediate level. Both desk research and interviews revealed that scoping is often not part of the HTA process. In contrast, providing evidence reports for assessment is well established. Indirect and unintended outcomes are increasingly considered, but there is room for improvement. Monitoring and evaluation of the HTA process is not well established across countries. Finally, adopting transparent and robust processes, including stakeholder consultation, takes time. This study presents a framework for assessing the level of comprehensiveness of the HTA process in a country. On the basis of applying the framework, we formulate recommendations on how the HTA community can move toward a more integrated decision-making process using HTA. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cognitive Phenotypes and the Evolution of Animal Decisions.

PubMed

Mendelson, Tamra C; Fitzpatrick, Courtney L; Hauber, Mark E; Pence, Charles H; Rodríguez, Rafael L; Safran, Rebecca J; Stern, Caitlin A; Stevens, Jeffrey R

2016-11-01

Despite the clear fitness consequences of animal decisions, the science of animal decision making in evolutionary biology is underdeveloped compared with decision science in human psychology. Specifically, the field lacks a conceptual framework that defines and describes the relevant components of a decision, leading to imprecise language and concepts. The 'judgment and decision-making' (JDM) framework in human psychology is a powerful tool for framing and understanding human decisions, and we apply it here to components of animal decisions, which we refer to as 'cognitive phenotypes'. We distinguish multiple cognitive phenotypes in the context of a JDM framework and highlight empirical approaches to characterize them as evolvable traits. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trajectory-Based Performance Assessment for Aviation Weather Information

NASA Technical Reports Server (NTRS)

Vigeant-Langlois, Laurence; Hansman, R. John, Jr.

2003-01-01

Based on an analysis of aviation decision-makers' time-related weather information needs, an abstraction of the aviation weather decision task was developed, that involves 4-D intersection testing between aircraft trajectory hypertubes and hazardous weather hypervolumes. The framework builds on the hypothesis that hazardous meteorological fields can be simplified using discrete boundaries of surrogate threat attributes. The abstractions developed in the framework may be useful in studying how to improve the performance of weather forecasts from the trajectory-centric perspective, as well as for developing useful visualization techniques of weather information.

Using the Vessel Health and Preservation framework to enhance vein assessment and vascular access device selection.

PubMed

Shaw, Sally Jane

2017-07-12

There is a range of risk factors that can lead to peripheral intravenous (IV) cannula failure, and several failed cannulation attempts can result in the patient experiencing increased pain, discomfort and delays in receiving IV therapy. The Vessel Health and Preservation (VHP) framework is a tool that can be used to improve clinical decision-making and the patient experience in relation to vascular access and IV therapy. Use of the VHP framework can ensure the right vein and right vascular access device (VAD) is selected at the right time for each patient. This article describes how healthcare practitioners can use the VHP framework to support and enhance vein assessment and VAD selection. It outlines the various types of VAD available, focusing on short-term peripheral IV cannulae, which are the most commonly used devices. It also explores the potential benefits of implementing the VHP framework in clinical areas.

Derisking Renewable Energy Investment. A Framework to Support Policymakers in Selecting Public Instruments to Promote Renewable Energy Investment in Developing Countries

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

Waissbein, Oliver; Glemarec, Yannick; Bayraktar, Hande

2013-03-15

This report introduces an innovative framework to assist policymakers to quantitatively compare the impact of different public instruments to promote renewable energy. The report identifies the need to reduce the high financing costs for renewable energy in developing countries as an important task for policymakers acting today. The framework is structured in four stages: (i) risk environment, (ii) public instruments, (iii) levelised cost and (iv) evaluation. To illustrate how the framework can support decision-making in practice, the report presents findings from illustrative case studies in four developing countries. It then draws on these results to discuss possible directions for enhancingmore » public interventions to scale-up renewable energy investment. UNDP is also releasing a financial tool for policymakers to accompany the framework. The financial tool is available for download on the UNDP website.« less

The sociocultural appraisals, values, and emotions (SAVE) framework of prosociality: core processes from gene to meme.

PubMed

Keltner, Dacher; Kogan, Aleksandr; Piff, Paul K; Saturn, Sarina R

2014-01-01

The study of prosocial behavior--altruism, cooperation, trust, and the related moral emotions--has matured enough to produce general scholarly consensus that prosociality is widespread, intuitive, and rooted deeply within our biological makeup. Several evolutionary frameworks model the conditions under which prosocial behavior is evolutionarily viable, yet no unifying treatment exists of the psychological decision-making processes that result in prosociality. Here, we provide such a perspective in the form of the sociocultural appraisals, values, and emotions (SAVE) framework of prosociality. We review evidence for the components of our framework at four levels of analysis: intrapsychic, dyadic, group, and cultural. Within these levels, we consider how phenomena such as altruistic punishment, prosocial contagion, self-other similarity, and numerous others give rise to prosocial behavior. We then extend our reasoning to chart the biological underpinnings of prosociality and apply our framework to understand the role of social class in prosociality.

Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature.

PubMed

Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R; Salek, Sam

2017-01-01

Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general paucity of research in this area, particularly regarding the development and systematic application of techniques for evaluating quality decision making, with no consensus around a gold standard. This review has identified QoDoS as the most promising available technique for assessing decision making in the lifecycle of medicines and the next steps would be to further test its validity, sensitivity, and reliability.

Manager`s views of public involvement

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

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

1995-12-01

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

Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

2016-01-01

Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

Current understanding of decision-making in adolescents with cancer: A narrative systematic review

PubMed Central

Day, Emma; Jones, Louise; Langner, Richard; Bluebond-Langner, Myra

2016-01-01

Background: Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. Aims: To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. Design: A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. Data Sources: The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13–19 years) with cancer. Results: Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. Conclusion: Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory. PMID:27160700

Factors influencing the clinical decision-making of midwives: a qualitative study.

PubMed

Daemers, Darie O A; van Limbeek, Evelien B M; Wijnen, Hennie A A; Nieuwenhuijze, Marianne J; de Vries, Raymond G

2017-10-06

Although midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives' decisions are based on more than the evidence based medicine (EBM) model - i.e. clinical evidence, midwife's expertise, and woman's values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently. We used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives' clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts. We identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives' clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged. Midwives' clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made.

Effluent trading in river systems through stochastic decision-making process: a case study.

PubMed

Zolfagharipoor, Mohammad Amin; Ahmadi, Azadeh

2017-09-01

The objective of this paper is to provide an efficient framework for effluent trading in river systems. The proposed framework consists of two pessimistic and optimistic decision-making models to increase the executability of river water quality trading programs. The models used for this purpose are (1) stochastic fallback bargaining (SFB) to reach an agreement among wastewater dischargers and (2) stochastic multi-criteria decision-making (SMCDM) to determine the optimal treatment strategy. The Monte-Carlo simulation method is used to incorporate the uncertainty into analysis. This uncertainty arises from stochastic nature and the errors in the calculation of wastewater treatment costs. The results of river water quality simulation model are used as the inputs of models. The proposed models are used in a case study on the Zarjoub River in northern Iran to determine the best solution for the pollution load allocation. The best treatment alternatives selected by each model are imported, as the initial pollution discharge permits, into an optimization model developed for trading of pollution discharge permits among pollutant sources. The results show that the SFB-based water pollution trading approach reduces the costs by US$ 14,834 while providing a relative consensus among pollutant sources. Meanwhile, the SMCDM-based water pollution trading approach reduces the costs by US$ 218,852, but it is less acceptable by pollutant sources. Therefore, it appears that giving due attention to stability, or in other words acceptability of pollution trading programs for all pollutant sources, is an essential element of their success.

Valuing information for sewer replacement decisions.

PubMed

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

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

Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'.

PubMed

Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F

2012-03-14

A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

Contraceptive Decision-Making in Sexual Relationships: Young Men’s Experiences, Attitudes, and Values

PubMed Central

Raine, Tina R.; Gard, Jennifer C.; Boyer, Cherrie B.; Haider, Sadia; Brown, Beth A.; Hernandez, F. Antonio Ramirez; Harper, Cynthia C.

2009-01-01

Much attention has been focused on efforts to reduce unintended pregnancy by improving contraceptive use among high-risk women; however, there is limited information to guide interventions to engage young men in contraceptive decision-making. We conducted focus groups of young men, ages 19–26, from diverse racial backgrounds from low-income communities in the San Francisco Bay Area to examine social norms about sexual relationships and how they impact on contraceptive use. The data were analysed using content analysis. A range of relationships were described, however casual relationships predominated. While young men expressed strong desires to avoid pregnancy in casual relationships, the unpredictable nature of relationships, together with low communication and regard for the women involved, made stressing consistent contraceptive use among partners unlikely. The themes expressed by these young men about sex and behaviour in different relationships illustrate a spectrum of decision-making dilemmas and illustrate the inherent difficulty in fully engaging young men in contraceptive decision-making. A strategy is needed to address relationship values, dynamics, and condom use beyond STI prevention frameworks, and young women’s ability to make appropriate contraceptive choices in light of the inherent difficulties and uncertainty associated with casual relationships. PMID:20169479

Measuring the Impact of Data Mining on Churn Management.

ERIC Educational Resources Information Center

Lejeune, Miguel A. P. M.

2001-01-01

Churn management is a concern for businesses, particularly in the digital economy. A customer relationship framework is proposed to help deal with churn issues. The model integrates the electronic channel and involves four tools for enhancing data collection, data treatment, data analysis and data integration in the decision-making process.…

The Capital Costs Of A University.

ERIC Educational Resources Information Center

Winslow, Frederic D.

This study examines the capital cost component of higher education. The focus is on data related to the capital stock of the University of California. A conceptual framework is provided as a method for analyzing three types of choices facing university decisionmakers. These choices concern: (1) the relative size of various educational programs by…

Implementing Competency-Based Education: Challenges, Strategies, and a Decision-Making Framework

ERIC Educational Resources Information Center

Dragoo, Amie; Barrows, Richard

2016-01-01

The number of competency-based education (CBE) degree programs has increased rapidly over the past five years, yet there is little research on CBE program development. This study utilized conceptual models of higher education change and a qualitative methodology to analyze the strategies and challenges in implementing CBE business degree programs…

AN OVERVIEW: DECISION-MAKING FRAMEWORK FOR THE ANALYSIS OF ALTERNATIVES FOR THE LONG TERM MANAGEMENT OF MERCURY

EPA Science Inventory

Over the past decade, the Environmental Protection Agency (EPA) has promoted the use of alternatives to mercury because it is a persistent, bio-accumulative, and toxic (PBT) chemical. The Agency's long-term goal for mercury is the elimination of mercury released to the air, wate...

Teacher Grading Decisions: Influences, Rationale, and Practices

ERIC Educational Resources Information Center

Kunnath, Joshua P.

2017-01-01

This mixed-methods study applied a decision-making theoretical framework to an investigation of teacher grading in a large urban school district in California. A sample of 251 high school teachers of core subjects were surveyed, and 15 teachers participated in four focus group interviews in order provide data on the influences, rationale, and…

Coherent District Reform: A Case Study of Two California School Districts

ERIC Educational Resources Information Center

Ezzani, Miriam

2015-01-01

The purpose of this paper is to enhance our understanding of districts that are implementing sustainable professional learning in data-driven decision-making (DDDM) to improve student achievement. The data-informed leadership framework, comprised of leadership practices that acknowledge the complexities that play into data use, guided the inquiry.…

A Conceptual Framework of "Top 5" Ethical Lessons for the Helping Professions

ERIC Educational Resources Information Center

Castro-Atwater, Sheri A.; Huynh Hohnbaum, Anh-Luu

2015-01-01

One of the important tasks of supervisors and educators in the human service fields is to provide their fieldwork students with models of appropriate ethical behavior and decision-making. The ethical training that educators provide to students in the helping professions will greatly influence how prepared students feel to navigate through…

Application of adverse outcome pathways (AOPs) in human health and ecotoxicology capturing divergent consequences of conserved molecular initiating events via AOP networks

EPA Science Inventory

The adverse outcome pathway (AOP) framework was developed to help organize and disseminate existing knowledge concerning the means through which specific perturbations of biological pathways can lead to adverse outcomes considered relevant to risk-based regulatory decision-making...

Application of Adverse Outcome Pathways (AOPs) in Human Health and Ecotoxicology Capturing Divergent Consequences of Conserved Molecular Initiating Events via AOP Networks (Presentation)

EPA Science Inventory

The adverse outcome pathway (AOP) framework was developed to help organize and disseminate existing knowledge concerning the means through which specific perturbations of biological pathways can lead to adverse outcomes considered relevant to risk-based regulatory decision-making...

Distributive Decisions in Education: Goals, Trade-Offs, and Feasibility Constraints

ERIC Educational Resources Information Center

Shores, Kenneth; Loeb, Susanna

2016-01-01

Educators, policymakers, and citizens face questions of how to allocate scarce resources in the pursuit of competing goals for children and youth. Our goal in this article is to provide decision-makers with a framework for considering allocative problems in education, explicitly highlighting the implications of relevant feasibility constraints. We…

Functional Measurement in the Field of Empirical Bioethics

ERIC Educational Resources Information Center

Mullet, Etienne; Sorum, Paul C.; Teysseire, Nathalie; Nann, Stephanie; Martinez, Guadalupe Elizabeth Morales; Ahmed, Ramadan; Kamble, Shanmukh; Olivari, Cecilia; Sastre, Maria Teresa Munoz

2012-01-01

We present, in a synthetic way, some of the main findings from five studies that were conducted in the field of empirical bioethics, using the Functional Measurement framework. These studies were about (a) the rationing of rare treatments, (b) adolescents' abortions, (c) end-of-life decision-making regarding damaged neonates, (d) end-of-life…

Gaming Personality and Game Dynamics in Online Discussion Instructions

ERIC Educational Resources Information Center

Tu, Chih-Hsiung; Yen, Cherng-Jyh; Sujo-Montes, Laura; Roberts, Gayle A.

2015-01-01

Gamification is the use of game mechanics to drive game-like engagements and actions. It applies game mechanics, dynamics and frameworks to promote desired learning behaviours. Positive and effective gamification could enhance learning and engage learners in more social and context-rich decision-making for problem-solving in learning tasks.…

An Examination of the Role of Attachment and Efficacy in Life Satisfaction

ERIC Educational Resources Information Center

Wright, Stephen L.; Perrone, Kristin M.

2010-01-01

The study examined interrelationships between attachment, social self-efficacy, career decision-making self-efficacy, and life satisfaction. Social cognitive career theory and attachment theory were integrated to provide a framework for this study. A conceptual model was proposed and tested to determine if social self-efficacy and career decision…

Board and Senior Management Alignment on School Strategy

ERIC Educational Resources Information Center

Sarros, James C.; Sarros, Anne M.; Cooper, Brian K.; Santora, Joseph C.; Baker, Robin

2016-01-01

This study examines the degree to which senior executive members of a school's decision-making team (senior management team and board of directors) are aligned on fundamental principles of school strategy. Our study is based on a conceptual framework of strategic leadership as it applies in an Australian independent school context. We also examine…

Towards a Theory of Psychosocial Development and Fertility Control.

ERIC Educational Resources Information Center

Cvetkovich, George

It is popularly held that the low rate of birth control use among sexually-active American teenagers is primarily due to their immaturity. Many teenagers are commencing their sexual careers prior to acquisition of the social and cognitive abilities demanded by responsible contraceptive use. A general decision-making framework can be used to create…

Evaluation Blueprint for School-Wide Positive Behavior Support

ERIC Educational Resources Information Center

Algozzine, Bob; Horner, Robert H.; Sugai, George; Barrett, Susan; Dickey, Celeste Rossetto; Eber, Lucille; Kincaid, Donald; Lewis, Timothy; Tobin, Tary

2010-01-01

Evaluation is the process of collecting and using information for decision-making. A hallmark of School-wide Positive Behavior Support (SWPBS) is a commitment to formal evaluation. The purpose of this SWPBS Evaluation Blueprint is to provide those involved in developing Evaluation Plans and Evaluation Reports with a framework for (a) addressing…

Threshold Pricing: A Strategy for the Marketing of Adult Education Courses.

ERIC Educational Resources Information Center

Lamoureux, Marvin E.

Because threshold pricing's scope for course price development had a good potential for application to the marketing of services by nonprofit organizations, this study's purpose was to determine the existence and applicability of course price thresholds or ranges to the decisionmaking framework of adult educators, with special reference to…

How To Use Differentiated Instruction with Students with Developmental Disabilities in the General Education Classroom. DDD Prism Series.

ERIC Educational Resources Information Center

Gartin, Barbara C.; Murdick, Nikki L.; Imbeau, Marcia; Perner, Darlene E.

This book discusses how educators can achieve inclusive classrooms that give students with different abilities the maximum opportunity for growth. It provides frameworks for planning learning environments, content, process, and products that enable students with learning challenges to succeed with meaningful curriculum. Decision-making guidelines…

An Integrated Decision-Making Framework for Sustainability Assessment: A Case Study of Memorial University

ERIC Educational Resources Information Center

Waheed, Bushra; Khan, Faisal; Veitch, Brian; Hawboldt, Kelly

2011-01-01

This article presents an overview of the sustainability initiatives at the St. John's campus of Memorial University in Newfoundland and Labrador (Canada). The key initiatives include setting a realistic goal for energy efficiency, becoming carbon neutral, and conducting various research and outreach projects related to sustainability. As…

Contract Management or Self-Operation: A Decision-Making Guide for Higher Education.

ERIC Educational Resources Information Center

Goldstein, Philip J.; And Others

This guide offers an objective framework for deciding whether self-operation or contract management (also known as privatization or "outsourcing") will best serve the goals and objectives of an individual institution of higher education. The guide is organized into four chapters. Chapter 1 briefly outlines the evolution of contract…

Maximising Confidence in Assessment Decision-Making: A Springboard to Quality in Assessment.

ERIC Educational Resources Information Center

Clayton, Berwyn; Booth, Robin; Roy, Sue

The introduction of training packages has focused attention on the quality of assessment in the Australian vocational education and training (VET) sector on the quality of assessment. For the process of mutual recognition under the Australian Recognition Framework (ARF) to work effectively, there needs to be confidence in assessment decisions made…

Using the Kaldor-Hicks Tableau Format for Cost-Benefit Analysis and Policy Evaluation

ERIC Educational Resources Information Center

Krutilla, Kerry

2005-01-01

This note describes the Kaldor-Hicks (KH) tableau format as a framework for distributional accounting in cost-benefit analysis and policy evaluation. The KH tableau format can serve as a heuristic aid for teaching microeconomics-based policy analysis, and offer insight to policy analysts and decisionmakers beyond conventional efficiency analysis.

Management needs assessment for the Copper River Delta, Alaska.

Treesearch

L.E. Kruger; C.B. Tyler

1995-01-01

This report assesses needs, problems, and perceptions relevant to management for the Copper River Delta (Alaska)—the largest coastal wetland on the Pacific coast of North America. The assessment provides a basis for planning and decisionmaking and a framework for ongoing research, development, and application. It also underscores concerns about human impacts...

An Integrated Modeling Framework for Performing Environmental Assessments: Application to Ecosystem Services in the Albemarle-Pamlico Basins (NC and VA,USA)

EPA Science Inventory

The U.S. Environmental Protection Agency uses environmental models to inform rulemaking and policy decisions at multiple spatial and temporal scales. As decision-making has moved towards integrated thinking and assessment (e.g. media, site, region, services), the increasing compl...

Online Course Design in a Programmatic Framework: A Case from Social Work

ERIC Educational Resources Information Center

Stewart, Patricia Lynn

2014-01-01

The focus of this study centers on the way instructors, and more specifically, instructors within a programmatic initiative, think about teaching and the decision-making process they employ to design learning experiences for an online environment. Often administrative initiatives do not consider the unique individual instructor needs when planning…

An Evaluation of an Innovative Drug Education Program: First Year Results.

ERIC Educational Resources Information Center

Schaps, Eric; And Others

An innovative drug education course was taught to seventh and eighth graders and evaluated in a true experiment. Students learned Lasswell's framework for understanding human needs and motives, a systematic decision-making procedure, and information about the pharmacological, psychological, and social consequences of licit and illicit drug use.…

An Evaluation of an Innovative Drug Education Program: Follow-Up Results.

ERIC Educational Resources Information Center

Moskowitz, Joel M.; And Others

This study provides a follow-up assessment of an innovative drug education program for seventh and eighth graders. Students learned Lasswell's framework for understanding human needs and motives, a systematic decision-making procedure, and information about the pharmacological, psychological, and social consequences of licit and illicit drug use.…

Networks and games for precision medicine.

PubMed

Biane, Célia; Delaplace, Franck; Klaudel, Hanna

2016-12-01

Recent advances in omics technologies provide the leverage for the emergence of precision medicine that aims at personalizing therapy to patient. In this undertaking, computational methods play a central role for assisting physicians in their clinical decision-making by combining data analysis and systems biology modelling. Complex diseases such as cancer or diabetes arise from the intricate interplay of various biological molecules. Therefore, assessing drug efficiency requires to study the effects of elementary perturbations caused by diseases on relevant biological networks. In this paper, we propose a computational framework called Network-Action Game applied to best drug selection problem combining Game Theory and discrete models of dynamics (Boolean networks). Decision-making is modelled using Game Theory that defines the process of drug selection among alternative possibilities, while Boolean networks are used to model the effects of the interplay between disease and drugs actions on the patient's molecular system. The actions/strategies of disease and drugs are focused on arc alterations of the interactome. The efficiency of this framework has been evaluated for drug prediction on a model of breast cancer signalling. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Implementing climate change mitigation in health services: the importance of context.

PubMed

Desmond, Sharon

2016-10-01

Academic interest in strategies to reduce the impact of health services on climate change is quickening. Research has largely focused on local innovations with little consideration of the contextual and systemic elements that influence sustainable development across health systems. A realistic framework specifically to guide decision-making by health care providers is still needed. To address this deficit, the literature is explored in relation to health services and climate change mitigation strategies, and the contextual factors that influence efforts to mitigate climate effects in health service delivery environments are highlighted. A conceptual framework is proposed that offers a model for the pursuit of sustainable development practice in health services. A set of propositions is advanced to provide a systems approach to assist decision-making by decoding the challenges faced in implementing sustainable health services. This has important implications for health care providers, funders and legislators since the financial, policy and regulatory environment of health care, along with its leadership and models of care generally conflict with carbon literacy and climate change mitigation strategies. © The Author(s) 2016.

Meta-analysis in evidence-based healthcare: a paradigm shift away from random effects is overdue.

PubMed

Doi, Suhail A R; Furuya-Kanamori, Luis; Thalib, Lukman; Barendregt, Jan J

2017-12-01

Each year up to 20 000 systematic reviews and meta-analyses are published whose results influence healthcare decisions, thus making the robustness and reliability of meta-analytic methods one of the world's top clinical and public health priorities. The evidence synthesis makes use of either fixed-effect or random-effects statistical methods. The fixed-effect method has largely been replaced by the random-effects method as heterogeneity of study effects led to poor error estimation. However, despite the widespread use and acceptance of the random-effects method to correct this, it too remains unsatisfactory and continues to suffer from defective error estimation, posing a serious threat to decision-making in evidence-based clinical and public health practice. We discuss here the problem with the random-effects approach and demonstrate that there exist better estimators under the fixed-effect model framework that can achieve optimal error estimation. We argue for an urgent return to the earlier framework with updates that address these problems and conclude that doing so can markedly improve the reliability of meta-analytical findings and thus decision-making in healthcare.

Decision-making under surprise and uncertainty: Arsenic contamination of water supplies

NASA Astrophysics Data System (ADS)

Randhir, Timothy O.; Mozumder, Pallab; Halim, Nafisa

2018-05-01

With ignorance and potential surprise dominating decision making in water resources, a framework for dealing with such uncertainty is a critical need in hydrology. We operationalize the 'potential surprise' criterion proposed by Shackle, Vickers, and Katzner (SVK) to derive decision rules to manage water resources under uncertainty and ignorance. We apply this framework to managing water supply systems in Bangladesh that face severe, naturally occurring arsenic contamination. The uncertainty involved with arsenic in water supplies makes the application of conventional analysis of decision-making ineffective. Given the uncertainty and surprise involved in such cases, we find that optimal decisions tend to favor actions that avoid irreversible outcomes instead of conventional cost-effective actions. We observe that a diversification of the water supply system also emerges as a robust strategy to avert unintended outcomes of water contamination. Shallow wells had a slight higher optimal level (36%) compare to deep wells and surface treatment which had allocation levels of roughly 32% under each. The approach can be applied in a variety of other cases that involve decision making under uncertainty and surprise, a frequent situation in natural resources management.

Visual short-term memory for oriented, colored objects.

PubMed

Shin, Hongsup; Ma, Wei Ji

2017-08-01

A central question in the study of visual short-term memory (VSTM) has been whether its basic units are objects or features. Most studies addressing this question have used change detection tasks in which the feature value before the change is highly discriminable from the feature value after the change. This approach assumes that memory noise is negligible, which recent work has shown not to be the case. Here, we investigate VSTM for orientation and color within a noisy-memory framework, using change localization with a variable magnitude of change. A specific consequence of the noise is that it is necessary to model the inference (decision) stage. We find that (a) orientation and color have independent pools of memory resource (consistent with classic results); (b) an irrelevant feature dimension is either encoded but ignored during decision-making, or encoded with low precision and taken into account during decision-making; and (c) total resource available in a given feature dimension is lower in the presence of task-relevant stimuli that are neutral in that feature dimension. We propose a framework in which feature resource comes both in packaged and in targeted form.

Economic benefits of meteorological services

NASA Astrophysics Data System (ADS)

Freebairn, John W.; Zillman, John W.

2002-03-01

There is an increasing need for more rigorous and more broadly based determination of the economic value of meteorological services as an aid to decision-making on the appropriate level of funding to be committed to their provision at the national level. This paper develops an overall framework for assessment of the economic value of meteorological services based on the recognition that most national meteorological infrastructure and services possess the non rival properties of public goods. Given this overall framework for determination of both total and marginal benefits, four main methodologies appropriate for use in valuation studies - market prices, normative or prescriptive decision-making models, descriptive behavioural response studies and contingent valuation studies - are outlined and their strengths and limitations described. Notwithstanding the methodological limitations and the need for a much more comprehensive set of studies for the various application sectors, it is clear that the actual and potential benefits to individuals, firms, industry sectors and national economies from state-of-the-art meteorological and related services are substantial and that, at this stage, they are inadequately recognised and insufficiently exploited in many countries.

Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

PubMed

Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

2017-08-01

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care

PubMed Central

Ramsey, Alex; Lord, Sarah; Torrey, John; Marsch, Lisa; Lardiere, Michael

2014-01-01

This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision-makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision-makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost, privacy), potential end-users (e.g., technology literacy, attitudes about technology), organization structure and climate (e.g., budget, infrastructure), and factors external to organizations (e.g., broadband accessibility, reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools. PMID:25192755

Evolutionary Agent-based Models to design distributed water management strategies

NASA Astrophysics Data System (ADS)

Giuliani, M.; Castelletti, A.; Reed, P. M.

2012-12-01

There is growing awareness in the scientific community that the traditional centralized approach to water resources management, as described in much of the water resources literature, provides an ideal optimal solution, which is certainly useful to quantify the best physically achievable performance, but is generally inapplicable. Most real world water resources management problems are indeed characterized by the presence of multiple, distributed and institutionally-independent decision-makers. Multi-Agent Systems provide a potentially more realistic alternative framework to model multiple and self-interested decision-makers in a credible context. Each decision-maker can be represented by an agent who, being self-interested, acts according to local objective functions and produces negative externalities on system level objectives. Different levels of coordination can potentially be included in the framework by designing coordination mechanisms to drive the current decision-making structure toward the global system efficiency. Yet, the identification of effective coordination strategies can be particularly complex in modern institutional contexts and current practice is dependent on largely ad-hoc coordination strategies. In this work we propose a novel Evolutionary Agent-based Modeling (EAM) framework that enables a mapping of fully uncoordinated and centrally coordinated solutions into their relative "many-objective" tradeoffs using multiobjective evolutionary algorithms. Then, by analysing the conflicts between local individual agent and global system level objectives it is possible to more fully understand the causes, consequences, and potential solution strategies for coordination failures. Game-theoretic criteria have value for identifying the most interesting alternatives from a policy making point of view as well as the coordination mechanisms that can be applied to obtain these interesting solutions. The proposed approach is numerically tested on a synthetic case study, representing a Y-shaped system composed by two regulated lakes, whose releases merge just upstream of a city. Each reservoir is operated by an agent in order to prevent floods along the lake shores (local objective). However, the optimal operation of the reservoirs with respect to the local objectives is conflicting with the minimization of floods in the city (global objective). The evolution of the Agent-based Model from individualistic management strategies of the reservoirs toward a global compromise that reduces the costs for the city is analysed.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 8: developing, implementing and evaluating an evidence dissemination service in a local healthcare setting.

PubMed

Harris, Claire; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Waller, Cara; King, Richard; Ramsey, Wayne

2018-03-02

This is the eighth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for disinvestment within a large Australian health service. One of the aims was to explore methods to deliver existing high quality synthesised evidence directly to decision-makers to drive decision-making proactively. An Evidence Dissemination Service (EDS) was proposed. While this was conceived as a method to identify disinvestment opportunities, it became clear that it could also be a way to review all practices for consistency with current evidence. This paper reports the development, implementation and evaluation of two models of an in-house EDS. Frameworks for development of complex interventions, implementation of evidence-based change, and evaluation and explication of processes and outcomes were adapted and/or applied. Mixed methods including a literature review, surveys, interviews, workshops, audits, document analysis and action research were used to capture barriers, enablers and local needs; identify effective strategies; develop and refine proposals; ascertain feedback and measure outcomes. Methods to identify, capture, classify, store, repackage, disseminate and facilitate use of synthesised research evidence were investigated. In Model 1, emails containing links to multiple publications were sent to all self-selected participants who were asked to determine whether they were the relevant decision-maker for any of the topics presented, whether change was required, and to take the relevant action. This voluntary framework did not achieve the aim of ensuring practice was consistent with current evidence. In Model 2, the need for change was established prior to dissemination, then a summary of the evidence was sent to the decision-maker responsible for practice in the relevant area who was required to take appropriate action and report the outcome. This mandatory governance framework was successful. The factors influencing decisions, processes and outcomes were identified. An in-house EDS holds promise as a method of identifying disinvestment opportunities and/or reviewing local practice for consistency with current evidence. The resource-intensive nature of delivery of the EDS is a potential barrier. The findings from this study will inform further exploration.

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.

PubMed

Haigh, Fiona; Harris, Elizabeth; Harris-Roxas, Ben; Baum, Fran; Dannenberg, Andrew L; Harris, Mark F; Keleher, Helen; Kemp, Lynn; Morgan, Richard; Ng Chok, Harrison; Spickett, Jeff

2015-10-03

While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.

Updated preparedness and response framework for influenza pandemics.

PubMed

Holloway, Rachel; Rasmussen, Sonja A; Zaza, Stephanie; Cox, Nancy J; Jernigan, Daniel B

2014-09-26

The complexities of planning for and responding to the emergence of novel influenza viruses emphasize the need for systematic frameworks to describe the progression of the event; weigh the risk of emergence and potential public health impact; evaluate transmissibility, antiviral resistance, and severity; and make decisions about interventions. On the basis of experience from recent influenza responses, CDC has updated its framework to describe influenza pandemic progression using six intervals (two prepandemic and four pandemic intervals) and eight domains. This updated framework can be used for influenza pandemic planning and serves as recommendations for risk assessment, decision-making, and action in the United States. The updated framework replaces the U.S. federal government stages from the 2006 implementation plan for the National Strategy for Pandemic Influenza (US Homeland Security Council. National strategy for pandemic influenza: implementation plan. Washington, DC: US Homeland Security Council; 2006. Available at http://www.flu.gov/planning-preparedness/federal/pandemic-influenza-implementation.pdf). The six intervals of the updated framework are as follows: 1) investigation of cases of novel influenza, 2) recognition of increased potential for ongoing transmission, 3) initiation of a pandemic wave, 4) acceleration of a pandemic wave, 5) deceleration of a pandemic wave, and 6) preparation for future pandemic waves. The following eight domains are used to organize response efforts within each interval: incident management, surveillance and epidemiology, laboratory, community mitigation, medical care and countermeasures, vaccine, risk communications, and state/local coordination. Compared with the previous U.S. government stages, this updated framework provides greater detail and clarity regarding the potential timing of key decisions and actions aimed at slowing the spread and mitigating the impact of an emerging pandemic. Use of this updated framework is anticipated to improve pandemic preparedness and response in the United States. Activities and decisions during a response are event-specific. These intervals serve as a reference for public health decision-making by federal, state, and local health authorities in the United States during an influenza pandemic and are not meant to be prescriptive or comprehensive. This framework incorporates information from newly developed tools for pandemic planning and response, including the Influenza Risk Assessment Tool and the Pandemic Severity Assessment Framework, and has been aligned with the pandemic phases restructured in 2013 by the World Health Organization.

Model-based hierarchical reinforcement learning and human action control

PubMed Central

Botvinick, Matthew; Weinstein, Ari

2014-01-01

Recent work has reawakened interest in goal-directed or ‘model-based’ choice, where decisions are based on prospective evaluation of potential action outcomes. Concurrently, there has been growing attention to the role of hierarchy in decision-making and action control. We focus here on the intersection between these two areas of interest, considering the topic of hierarchical model-based control. To characterize this form of action control, we draw on the computational framework of hierarchical reinforcement learning, using this to interpret recent empirical findings. The resulting picture reveals how hierarchical model-based mechanisms might play a special and pivotal role in human decision-making, dramatically extending the scope and complexity of human behaviour. PMID:25267822

Surrogate decision making: reconciling ethical theory and clinical practice.

PubMed

Berger, Jeffrey T; DeRenzo, Evan G; Schwartz, Jack

2008-07-01

The care of adult patients without decision-making abilities is a routine part of medical practice. Decisions for these patients are typically made by surrogates according to a process governed by a hierarchy of 3 distinct decision-making standards: patients' known wishes, substituted judgments, and best interests. Although this framework offers some guidance, it does not readily incorporate many important considerations of patients and families and does not account for the ways in which many patients and surrogates prefer to make decisions. In this article, the authors review the research on surrogate decision making, compare it with normative standards, and offer ways in which the 2 can be reconciled for the patient's benefit.

Combining ecosystem service relationships and DPSIR framework to manage multiple ecosystem services.

PubMed

Xue, Hui; Li, Shiyu; Chang, Jie

2015-03-01

Ecosystem service (ES) relationship occurs due to two types of mechanisms: (1) interact directly or (2) interact through the impact of a shared factor. Identifying such mechanisms behind ES relationship within a single land-use/land-cover category and combining it with a system thinking framework is especially necessary for effective decision-making to manage multiple ESs generated by this land-use/land-cover. In this study, we use tea plantations in China to investigate mechanisms behind ES relationships. We find that tea production is positively correlated with four regulating services (i.e., carbon sequestration, soil N protection, soil P protection, and water conservation). Several regulating services, such as carbon sequestration and soil N, P, and K protection, have positive correlations with each other. Tea production, carbon sequestration, and soil retention are significantly correlated with local annual mean temperature and precipitation. We then establish driver-pressure-state-impact-response (DPSIR) framework for tea plantations, which has been widely used for environmental management issues. Integrating our findings of ES relationship into DPSIR framework, we can estimate how ES change is responding to two types of responses: response to control drivers and response to maintain or restore state. Scenario analysis showed that the responses to control drivers have a larger impact on ES. We discuss that DPSIR would favor managing multiple ES because it enables a more precise understanding of how ES interacts through the effects of factors from various hierarchies. Finally, we suggest integrating ES direct interaction into DPSIR framework. We think such integration could improve the ability of DPSIR framework to support decision-making in multiple ES management, specifically in at least three aspects: (1) favor to identify all possible response alternatives, (2) enable us to evaluate ES which cannot be assessed if without such combining, and (3) help to identify ecological leverage points where small management investment can yield substantial benefits.

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

Dale, Virginia H.; Efroymson, Rebecca Ann; Kline, Keith L.

A framework for selecting and evaluating indicators of bioenergy sustainability is presented. This framework is designed to facilitate decision-making about which indicators are useful for assessing sustainability of bioenergy systems and supporting their deployment. Efforts to develop sustainability indicators in the United States and Europe are reviewed. The first steps of the framework for indicator selection are defining the sustainability goals and other goals for a bioenergy project or program, gaining an understanding of the context, and identifying the values of stakeholders. From the goals, context, and stakeholders, the objectives for analysis and criteria for indicator selection can be developed.more » The user of the framework identifies and ranks indicators, applies them in an assessment, and then evaluates their effectiveness, while identifying gaps that prevent goals from being met, assessing lessons learned, and moving toward best practices. The framework approach emphasizes that the selection of appropriate criteria and indicators is driven by the specific purpose of an analysis. Realistic goals and measures of bioenergy sustainability can be developed systematically with the help of the framework presented here.« less

To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

PubMed Central

Lovell, Sarah; Walker, Robert J; Schollum, John B W; Marshall, Mark R; McNoe, Bronwen M; Derrett, Sarah

2017-01-01

Background Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing. Study population Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand. All participants had reached chronic kidney disease (CKD) stage 5 and had undergone dialysis education but had not started dialysis or recently started dialysis within the past 6 months. Methodology Serial qualitative interviews were undertaken to explore the decision-making processes and subsequent treatment experiences of patients with ESKD. Analytical approach: A framework method guided the iterative process of analysis. Decision-making codes were generated within NVivo software and then compared with the body of the interviews. Results Interviews were undertaken with 17 participants. We observed that decision-making was often a fluid process, rather than occurring at a single point in time, and was heavily influenced by perceptions of oneself as becoming old, social circumstances, life events and health status. Limitations This study focuses on participants' experiences of decision-making about treatment and does not include perspectives of their nephrologists or other members of the nephrology team. Conclusions Older patients often delay dialysis as an act of self-efficacy. They often do not commit to a dialysis decision following predialysis education. Delaying decision-making and initiating dialysis were common. This was not seen by participants as a final decision about therapy. Predialysis care and education should be different for older patients, who will delay decision-making until the time of facing obvious uraemic symptoms, threatening blood tests or paternalistic guidance from their nephrologist. Trial registration number Australasian Clinical Trials Registry ACTRN 12611000024943; results. PMID:28360253

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

A review and synthesis of recreation ecology research supporting carrying capacity and visitor use management decisionmaking

USGS Publications Warehouse

Marion, Jeff

2016-01-01

Resource and experiential impacts associated with visitation to wilderness and other similar backcountry settings have long been addressed by land managers under the context of “carrying capacity” decisionmaking. Determining a maximum level of allowable use, below which high-quality resource and experiential conditions would be sustained, was an early focus in the 1960s and 1970s. However, decades of recreation ecology research have shown that the severity and areal extent of visitor impact problems are influenced by an interrelated array of use-related, environmental, and managerial factors. This complexity, with similar findings from social science research, prompted scientists and managers to develop more comprehensive carrying capacity frameworks, including a new Visitor Use Management framework. These frameworks rely on a diverse array of management strategies and actions, often termed a “management toolbox,” for resolving visitor impact problems. This article reviews the most recent and relevant recreation ecology studies that have been applied in wildland settings to avoid or minimize resource impacts. The key findings and their management implications are highlighted to support the professional management of common trail, recreation site, and wildlife impact problems. These studies illustrate the need to select from a more diverse array of impact management strategies and actions based on an evaluation of problems to identify the most influential factors that can be manipulated.

A decision-making framework for total ownership cost management of complex systems: A Delphi study

NASA Astrophysics Data System (ADS)

King, Russel J.

This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

An integrated decision-making framework for transportation architectures: Application to aviation systems design

NASA Astrophysics Data System (ADS)

Lewe, Jung-Ho

The National Transportation System (NTS) is undoubtedly a complex system-of-systems---a collection of diverse 'things' that evolve over time, organized at multiple levels, to achieve a range of possibly conflicting objectives, and never quite behaving as planned. The purpose of this research is to develop a virtual transportation architecture for the ultimate goal of formulating an integrated decision-making framework. The foundational endeavor begins with creating an abstraction of the NTS with the belief that a holistic frame of reference is required to properly study such a multi-disciplinary, trans-domain system. The culmination of the effort produces the Transportation Architecture Field (TAF) as a mental model of the NTS, in which the relationships between four basic entity groups are identified and articulated. This entity-centric abstraction framework underpins the construction of a virtual NTS couched in the form of an agent-based model. The transportation consumers and the service providers are identified as adaptive agents that apply a set of preprogrammed behavioral rules to achieve their respective goals. The transportation infrastructure and multitude of exogenous entities (disruptors and drivers) in the whole system can also be represented without resorting to an extremely complicated structure. The outcome is a flexible, scalable, computational model that allows for examination of numerous scenarios which involve the cascade of interrelated effects of aviation technology, infrastructure, and socioeconomic changes throughout the entire system.

Developing and Evaluating Workshop Frameworks to Improve Climate Literacy

NASA Astrophysics Data System (ADS)

Averyt, K.; Alvord, C.; Joyce, L. A.; Lukas, J.; Barsugli, J. J.; Owen, G.; Udall, B.

2009-12-01

A burgeoning need for climate information is rising from a variety of stakeholders. A new federal report encourages federal resource management efforts to consider climate in assessments-leaving agency scientists and resource managers searching for appropriate data and methodologies. At the other end of the spectrum, small-scale decision makers realize the need to develop scientifically-informed climate adaptation plans, but are unclear about what science is relevant. It is becoming necessary to improve the climate literacy across all sectors. However, past examples illustrate that climate science has been insufficiently communicated, resulting in perceptions that misinform decision-making and planning. Given the necessity to include climate science in planning on multiple scales, scientific educators must work with stakeholders to determine how best to improve climate literacy. Doing so will reduce uncertainty in the application of climate data in planning, and thus mitigate vulnerabilities to the impacts of climate change. Here, we present the design and assessment of two workshop frameworks intended to improve the climate literacy of two distinct entities with different climate information needs. This work represents initial steps by the Western Water Assessment, a NOAA- Regionally Integrated Sciences and Assessments (RISA) Program, towards the development of a suite of process-oriented frameworks geared toward improving the climate literacy of different users with distinct informational needs. Both workshops focused on water-related climate issues: the first (Dealing with Drought: Climate Change in Colorado) was geared toward an audience with minimal exposure to climate information; the second was for US Forest Service hydrologists and managers with technical backgrounds. In both cases, the workshop format included presentations of relevant climate science, introductions to varied climate tools and products, and a needs-and-gaps assessment. Evaluation of each workshop drew upon a variety of tested social science methods, such as focus groups, decision games, surveys, and structured interviews. The efficacy of the framework developed was assessed by evaluating the relationship among the climate information presented, user perceptions about climate information, and incorporation into decision-making. In addition to climate literacy evaluations, participants were presented with a scenario at the beginning of the meeting, and were asked to report periodically on their thoughts on how to approach the scenario as new information was presented throughout the workshop. This allowed us to track the co-evolution of climate literacy, accuracy of data interpretation, and the sophistication of participants’ decision-making. In the 12-months after each workshop, we will track how the climate literacy of the participants evolves, and how their informational needs for decision-making change. The results here will frame a process for how a larger, federal climate-training program might be conducted, and how training needs can be assessed through climate literacy assessments.

Shared decision-making – transferring research into practice: the Analytic Hierarchy Process (AHP)

PubMed Central

Dolan, James G.

2008-01-01

Objective To illustrate how the Analytic Hierarchy Process (AHP) can be used to promote shared decision-making and enhance clinician-patient communication. Methods Tutorial review. Results The AHP promotes shared decision making by creating a framework that is used to define the decision, summarize the information available, prioritize information needs, elicit preferences and values, and foster meaningful communication among decision stakeholders. Conclusions The AHP and related multi-criteria methods have the potential for improving the quality of clinical decisions and overcoming current barriers to implementing shared decision making in busy clinical settings. Further research is needed to determine the best way to implement these tools and to determine their effectiveness. Practice Implications Many clinical decisions involve preference-based trade-offs between competing risks and benefits. The AHP is a well-developed method that provides a practical approach for improving patient-provider communication, clinical decision-making, and the quality of patient care in these situations. PMID:18760559

Do (un)certainty appraisal tendencies reverse the influence of emotions on risk taking in sequential tasks?

PubMed

Bagneux, Virginie; Bollon, Thierry; Dantzer, Cécile

2012-01-01

According to the Appraisal-Tendency Framework (Han, Lerner, & Keltner, 2007), certainty-associated emotions increase risk taking compared with uncertainty-associated emotions. To date, this general effect has only been shown in static judgement and decision-making paradigms; therefore, the present study tested the effect of certainty on risk taking in a sequential decision-making task. We hypothesised that the effect would be reversed due to the kind of processing involved, as certainty is considered to encourage heuristic processing that takes into account the emotional cues arising from previous decisions, whereas uncertainty leads to more systematic processing. One hundred and one female participants were induced to feel one of three emotions (film clips) before performing a decision-making task involving risk (Game of Dice Task; Brand et al., 2005). As expected, the angry and happy participants (certainty-associated emotions) were more likely than the fearful participants (uncertainty-associated emotion) to make safe decisions (vs. risky decisions).

[Ethical principles and approaches to health systems governance research: conceptual and methodological implications].

PubMed

Flores, Walter

2010-01-01

Governance refers to decision-making processes in which power relationships and actors and institutions' particular interests converge. Situations of consensus and conflict are inherent to such processes. Furthermore, decision-making happens within a framework of ethical principles, motivations and incentives which could be explicit or implicit. Health systems in most Latin-American and Caribbean countries take the principles of equity, solidarity, social participation and the right to health as their guiding principles; such principles must thus rule governance processes. However, this is not always the case and this is where the importance of investigating governance in health systems lies. Making advances in investigating governance involves conceptual and methodological implications. Clarifying and integrating normative and analytical approaches is relevant at conceptual level as both are necessary for an approach seeking to investigate and understand social phenomena's complexity. In relation to methodological level, there is a need to expand the range of variables, sources of information and indicators for studying decision-making aimed to greater equity, health citizenship and public policy efficiency.

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

PubMed

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

2005-06-01

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

Prefrontal contributions to metacognition in perceptual decision-making

PubMed Central

Fleming, Stephen M.; Huijgen, Josefien; Dolan, Raymond J.

2012-01-01

Neuroscience has made considerable progress in understanding the neural substrates supporting cognitive performance in a number of domains, including memory, perception and decision-making. In contrast, how the human brain generates metacognitive awareness of task performance remains unclear. Here, we address this question by asking participants to perform perceptual decisions while providing concurrent metacognitive reports, during fMRI scanning. We show that activity in right rostrolateral prefrontal cortex (rlPFC) satisfies three constraints for a role in metacognitive aspects of decision-making. Right rlPFC showed greater activity during self-report compared to a matched control condition; activity in this region correlated with reported confidence; and the strength of the relationship between activity and confidence predicted metacognitive ability across individuals. In addition, functional connectivity between right rlPFC and both contralateral PFC and visual cortex increased during metacognitive reports. We discuss these findings in a theoretical framework where rlPFC re-represents object-level decision uncertainty to facilitate metacognitive report. PMID:22553018

Encapsulation of a Decision-Making Model to Optimize Supplier Selection via Structural Equation Modeling (SEM)

NASA Astrophysics Data System (ADS)

Sahul Hameed, Ruzanna; Thiruchelvam, Sivadass; Nasharuddin Mustapha, Kamal; Che Muda, Zakaria; Mat Husin, Norhayati; Ezanee Rusli, Mohd; Yong, Lee Choon; Ghazali, Azrul; Itam, Zarina; Hakimie, Hazlinda; Beddu, Salmia; Liyana Mohd Kamal, Nur

2016-03-01

This paper proposes a conceptual framework to compare criteria/factor that influence the supplier selection. A mixed methods approach comprising qualitative and quantitative survey will be used. The study intend to identify and define the metrics that key stakeholders at Public Works Department (PWD) believed should be used for supplier. The outcomes would foresee the possible initiatives to bring procurement in PWD to a strategic level. The results will provide a deeper understanding of drivers for supplier’s selection in the construction industry. The obtained output will benefit many parties involved in the supplier selection decision-making. The findings provides useful information and greater understanding of the perceptions that PWD executives hold regarding supplier selection and the extent to which these perceptions are consistent with findings from prior studies. The findings from this paper can be utilized as input for policy makers to outline any changes in the current procurement code of practice in order to enhance the degree of transparency and integrity in decision-making.

Eutrophication of lakes and reservoirs: A framework for making management decisions

USGS Publications Warehouse

Rast, W.; Holland, M.

1988-01-01

The development of management strategies for the protection of environmental quality usually involves consideration both of technical and nontechnical issues. A logical, step-by-step framework for development of such strategies is provided. Its application to the control of cultured eutrophication of lakes and reservoirs illustrates its potential usefulness. From the perspective of the policymaker, the main consideration is that the eutrophication-related water quality of a lake or reservoir can be managed for given water uses. The approach presented here allows the rational assessment of relevant water-quality parameters and establishment of water-quality goals, consideration of social and other nontechnical issues, the possibilities of public involvement in the decision-making process, and a reasonable economic analysis within a management framework.

Revealing Neurocomputational Mechanisms of Reinforcement Learning and Decision-Making With the hBayesDM Package

PubMed Central

Ahn, Woo-Young; Haines, Nathaniel; Zhang, Lei

2017-01-01

Reinforcement learning and decision-making (RLDM) provide a quantitative framework and computational theories with which we can disentangle psychiatric conditions into the basic dimensions of neurocognitive functioning. RLDM offer a novel approach to assessing and potentially diagnosing psychiatric patients, and there is growing enthusiasm for both RLDM and computational psychiatry among clinical researchers. Such a framework can also provide insights into the brain substrates of particular RLDM processes, as exemplified by model-based analysis of data from functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). However, researchers often find the approach too technical and have difficulty adopting it for their research. Thus, a critical need remains to develop a user-friendly tool for the wide dissemination of computational psychiatric methods. We introduce an R package called hBayesDM (hierarchical Bayesian modeling of Decision-Making tasks), which offers computational modeling of an array of RLDM tasks and social exchange games. The hBayesDM package offers state-of-the-art hierarchical Bayesian modeling, in which both individual and group parameters (i.e., posterior distributions) are estimated simultaneously in a mutually constraining fashion. At the same time, the package is extremely user-friendly: users can perform computational modeling, output visualization, and Bayesian model comparisons, each with a single line of coding. Users can also extract the trial-by-trial latent variables (e.g., prediction errors) required for model-based fMRI/EEG. With the hBayesDM package, we anticipate that anyone with minimal knowledge of programming can take advantage of cutting-edge computational-modeling approaches to investigate the underlying processes of and interactions between multiple decision-making (e.g., goal-directed, habitual, and Pavlovian) systems. In this way, we expect that the hBayesDM package will contribute to the dissemination of advanced modeling approaches and enable a wide range of researchers to easily perform computational psychiatric research within different populations. PMID:29601060

A framework for selecting indicators of bioenergy sustainability

DOE PAGES

Dale, Virginia H.; Efroymson, Rebecca Ann; Kline, Keith L.; ...

2015-05-11

A framework for selecting and evaluating indicators of bioenergy sustainability is presented. This framework is designed to facilitate decision-making about which indicators are useful for assessing sustainability of bioenergy systems and supporting their deployment. Efforts to develop sustainability indicators in the United States and Europe are reviewed. The first steps of the framework for indicator selection are defining the sustainability goals and other goals for a bioenergy project or program, gaining an understanding of the context, and identifying the values of stakeholders. From the goals, context, and stakeholders, the objectives for analysis and criteria for indicator selection can be developed.more » The user of the framework identifies and ranks indicators, applies them in an assessment, and then evaluates their effectiveness, while identifying gaps that prevent goals from being met, assessing lessons learned, and moving toward best practices. The framework approach emphasizes that the selection of appropriate criteria and indicators is driven by the specific purpose of an analysis. Realistic goals and measures of bioenergy sustainability can be developed systematically with the help of the framework presented here.« less

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland

PubMed Central

2011-01-01

Background In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective. Aim The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM. Methods The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM. Results The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant. Conclusions The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities. PMID:21880141

The Rational Approach to Budget Cuts: One University's Experience. ASHE 1987 Annual Meeting Paper.

ERIC Educational Resources Information Center

Hardy, Cynthia

The experiences of the University of Montreal in using a rational-analytic framework to allocate resources at a time of budget costs are discussed. The following characteristics for rational decision-making are identified and applied to the University of Montreal: whether goals were known, whether alternative methods of resource allocation were…

Taking an Evaluative Stance to Decision-Making about Professional Development Options in Early Childhood Education and Care

ERIC Educational Resources Information Center

Brownlee, Joanne Lunn; Sumsion, Jennifer; Irvine, Susan; Berthelsen, Donna; Farrell, Ann; Walsh, Kerryann; Ryan, Sharon; Mulhearn, Gerry

2015-01-01

This article builds on our ongoing work in conceptualising an "evaluative stance" framework to assist in understanding how leaders in the field of early childhood education and care (ECEC) make decisions about the selection of professional development options for themselves and their staff. It introduces the notion that evaluative…

Career Decision-Making and College and Career Access among Recent African Immigrant Students

ERIC Educational Resources Information Center

Wambu, Grace; Hutchison, Brian; Pietrantoni, Zachary

2017-01-01

The number of African immigrant youth in American classrooms is on the rise. School counselors are uniquely positioned to help these students to be college and career ready. Using the Social Cognitive Career Theory framework, this article aims to address the unique career development needs, college and career access challenges faced by African…

The Role of Cultural Capital in Higher Education Access and Institutional Choice

ERIC Educational Resources Information Center

Košutic, Iva

2017-01-01

This paper aims to explore social inequalities in school achievement and educational decision-making of the final-year students of secondary schools in the City of Zagreb and Zagreb County, Croatia (N = 534). The theoretical framework of the paper was Bourdieu's theory of cultural and social reproduction (1977a). The main objectives were an…

The Second Language Curriculum.

ERIC Educational Resources Information Center

Johnson, Robert Keith, Ed.

The aim of this collection is to present "state of the art" papers in language curriculum studies by writers who have been actively involved in shaping theory in the field and who, between them, have applied that theory in almost every part of the world and in a variety of contexts. Papers include the following: "A Decision-Making Framework for…

Social Indicators for Rural Development: Descriptive Social Reporting. Final Report, Sociology Report No. 141.

ERIC Educational Resources Information Center

Carter, Keith A.; And Others

Project 2142 was a multi-phase effort to discover and mobilize for dissemination to rural decision-makers various information and findings pertaining to the quality of life experienced by rural people. The initial research phases involved design of a conceptual framework that placed some parameters on the variety of social phenomena studied.…

Reviewing Quantitative Research To Inform Educational Policy Processes. Fundamentals of Educational Planning.

ERIC Educational Resources Information Center

Hite, Seven J.

Educational planners and policymakers are rarely able to base their decision-making on sound information and research, according to this book. Because the situation is even more difficult in developing countries, educational policy often is based on research conducted in others parts of the world. This book provides a practical framework that can…

The University Supervisor, edTPA, and the New Making of the Teacher

ERIC Educational Resources Information Center

Donovan, Martha K.; Cannon, Susan O.

2018-01-01

As university supervisors at a large, urban university in the southern US, we examined the ways that the Education Teacher Performance Assessment (edTPA) shaped the pedagogic relationships and decision-making processes of our students and ourselves during the spring of 2016. We situated this study of edTPA within the framework of critical policy…

Playing with a "Full DECK": A Creative Application of the Integrative Decision-Making Framework of Ethical Behavior

ERIC Educational Resources Information Center

Case, Jan C.; Plaisance, Pamela M.; Renfrow, Jennifer J.; Olivier, Brandi N.

2008-01-01

Rehabilitation practitioners are faced with a variety of complex ethical decisions in a dynamic, changing world. Attention to principle ethics, virtue ethics, critical thinking, and creativity are essential for best practice. This article presents one tool (DECK--Decision-Making that Enhances Counselor Know-How) to facilitate such ethical…

Evaluating the ecological economic success of riparian restoration projects in Arizona (Abstract)

Treesearch

Gary B. Snider

2000-01-01

The past 4 years the Arizona Water Protection Fund provided more than $25 million to individuals and organizations for stream and riparian restoration projects in Arizona. Information which increases the awareness of the value of Arizona's riparian systems is crucial to the incorporation of ecosystem services into decision-making frameworks, which are largely...

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…

Wilderness party size regulations: implications for management and a decisionmaking framework

Treesearch

Christopher Monz; Joseph W. Roggenbuck; David N. Cole; Richard Brame; Andrew Yoder

2000-01-01

Arriving at appropriate limits on the size of groups in wilderness remains a difficult and often controversial management challenge. This paper presents a review of the state of knowledge regarding group size from an ecological impact and visitor experience standpoint, a survey of wilderness managers regarding the current status of group size regulations and a proposed...

Culture, Motivation, and Vocational Decision-Making of Australian Senior High School Students in Private Schools

ERIC Educational Resources Information Center

Jung, Jae Yup; McCormick, John; Gregory, Gary; Barnett, Kerry

2011-01-01

The purpose of this study was to investigate the roles of culture and motivation in the occupational decisions of senior high school students attending private schools. A theoretical framework guided the study. A questionnaire was administered to 492 Grade 11 students attending a stratified random sample of six independent (private) schools…

Curriculum-Based Measurement of Reading Progress Monitoring: The Importance of Growth Magnitude and Goal Setting in Decision Making

ERIC Educational Resources Information Center

Van Norman, Ethan R.; Christ, Theodore J.; Newell, Kirsten W.

2017-01-01

Research regarding the technical adequacy of growth estimates from curriculum-based measurement of reading progress monitoring data suggests that current decision-making frameworks are likely to yield inaccurate recommendations unless data are collected for extensive periods of time. Instances where data may not need to be collected for long…

Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation. Volume 1: Study results

NASA Technical Reports Server (NTRS)

Lowrie, J. W.; Fermelia, A. J.; Haley, D. C.; Gremban, K. D.; Vanbaalen, J.; Walsh, R. W.

1982-01-01

A variety of artificial intelligence techniques which could be used with regard to NASA space applications and robotics were evaluated. The techniques studied were decision tree manipulators, problem solvers, rule based systems, logic programming languages, representation language languages, and expert systems. The overall structure of a robotic simulation tool was defined and a framework for that tool developed. Nonlinear and linearized dynamics equations were formulated for n link manipulator configurations. A framework for the robotic simulation was established which uses validated manipulator component models connected according to a user defined configuration.

[Basic principles and methodological considerations of health economic evaluations].

PubMed

Loza, Cesar; Castillo-Portilla, Manuel; Rojas, José Luis; Huayanay, Leandro

2011-01-01

Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.

The embodied spaces of children with complex care needs: Effects on the social realities and power negotiations of families.

PubMed

Woodgate, Roberta L; Zurba, Melanie; Edwards, Marie; Ripat, Jacquie D; Rempel, Gina

2017-07-01

This paper presents research findings that advance knowledge around the power and agency families with children with complex care needs (CCN). Our conceptual framework uses concepts from geography towards situating the experiences and social realities of family carers within the 'embodied space of care'. The data originate from a longitudinal qualitative study of Canadian families with children with CCN. Findings reveal that interactions and decision-making processes relating to health and everyday life were complex and socially interconnected, and emphasize the need for provisions for family-based decision-making and enhanced social inclusion of families and the importance of the renegotiation of power. Copyright © 2017 Elsevier Ltd. All rights reserved.

Intelligent deflection routing in buffer-less networks.

PubMed

Haeri, Soroush; Trajković, Ljiljana

2015-02-01

Deflection routing is employed to ameliorate packet loss caused by contention in buffer-less architectures such as optical burst-switched networks. The main goal of deflection routing is to successfully deflect a packet based only on a limited knowledge that network nodes possess about their environment. In this paper, we present a framework that introduces intelligence to deflection routing (iDef). iDef decouples the design of the signaling infrastructure from the underlying learning algorithm. It consists of a signaling and a decision-making module. Signaling module implements a feedback management protocol while the decision-making module implements a reinforcement learning algorithm. We also propose several learning-based deflection routing protocols, implement them in iDef using the ns-3 network simulator, and compare their performance.

Clinical decision-making: the case against the new casuistry.

PubMed

Ananth, Mahesh

2017-01-01

Albert Jonsen and Stephen Toulmin have argued that the best way to resolve the complex issues in medical settings is to focus on the actual details of cases and then determine what to do in the given cases. This approach to medical decision-making, labeled "casuistry," has met with much criticism. In response, Carson Strong has attempted to save much of Jonsen and Toulmin's version of casuistry. This analysis reveals that Strong's recent salvage efforts fail to deflect the major criticisms. The upshot of this analysis is that Jonsen and Toulmin's version of casuistry is not an appropriate framework from which to resolve complex issues in clinical settings. Copyright © 2017 by the National Legal Center for the Medically Dependent and Disabled, Inc.

Attention as an effect not a cause

PubMed Central

Krauzlis, Richard J.; Bollimunta, Anil; Arcizet, Fabrice; Wang, Lupeng

2014-01-01

Attention is commonly thought to be important for managing the limited resources available in sensory areas of neocortex. Here we present an alternative view that attention arises as a byproduct of circuits centered on the basal ganglia involved in value-based decision-making. The central idea is that decision-making depends on properly estimating the current state of the animal and its environment, and that the weighted inputs to the currently prevailing estimate give rise to the filter-like properties of attention. After outlining this new framework, we describe findings from physiology, anatomy, computational and clinical work that support this point of view. We conclude that the brain mechanisms responsible for attention employ a conserved circuit motif that predates the emergence of the neocortex. PMID:24953964

A framework for the social valuation of ecosystem services.

PubMed

Felipe-Lucia, María R; Comín, Francisco A; Escalera-Reyes, Javier

2015-05-01

Methods to assess ecosystem services using ecological or economic approaches are considerably better defined than methods for the social approach. To identify why the social approach remains unclear, we reviewed current trends in the literature. We found two main reasons: (i) the cultural ecosystem services are usually used to represent the whole social approach, and (ii) the economic valuation based on social preferences is typically included in the social approach. Next, we proposed a framework for the social valuation of ecosystem services that provides alternatives to economics methods, enables comparison across studies, and supports decision-making in land planning and management. The framework includes the agreements emerged from the review, such as considering spatial-temporal flows, including stakeholders from all social ranges, and using two complementary methods to value ecosystem services. Finally, we provided practical recommendations learned from the application of the proposed framework in a case study.

Opportunistic management of estuaries under climate change: A new adaptive decision-making framework and its practical application.

PubMed

Peirson, William; Davey, Erica; Jones, Alan; Hadwen, Wade; Bishop, Keith; Beger, Maria; Capon, Samantha; Fairweather, Peter; Creese, Bob; Smith, Timothy F; Gray, Leigh; Tomlinson, Rodger

2015-11-01

Ongoing coastal development and the prospect of severe climate change impacts present pressing estuary management and governance challenges. Robust approaches must recognise the intertwined social and ecological vulnerabilities of estuaries. Here, a new governance and management framework is proposed that recognises the integrated social-ecological systems of estuaries so as to permit transformative adaptation to climate change within these systems. The framework lists stakeholders and identifies estuarine uses and values. Goals are categorised that are specific to ecosystems, private property, public infrastructure, and human communities. Systematic adaptation management strategies are proposed with conceptual examples and associated governance approaches. Contrasting case studies are used to illustrate the practical application of these ideas. The framework will assist estuary managers worldwide to achieve their goals, minimise maladaptative responses, better identify competing interests, reduce stakeholder conflict and exploit opportunities for appropriate ecosystem restoration and sustainable development. Copyright © 2015 Elsevier Ltd. All rights reserved.

Process change evaluation framework for allogeneic cell therapies: impact on drug development and commercialization.

PubMed

Hassan, Sally; Huang, Hsini; Warren, Kim; Mahdavi, Behzad; Smith, David; Jong, Simcha; Farid, Suzanne S

2016-04-01

Some allogeneic cell therapies requiring a high dose of cells for large indication groups demand a change in cell expansion technology, from planar units to microcarriers in single-use bioreactors for the market phase. The aim was to model the optimal timing for making this change. A development lifecycle cash flow framework was created to examine the implications of process changes to microcarrier cultures at different stages of a cell therapy's lifecycle. The analysis performed under assumptions used in the framework predicted that making this switch earlier in development is optimal from a total expected out-of-pocket cost perspective. From a risk-adjusted net present value view, switching at Phase I is economically competitive but a post-approval switch can offer the highest risk-adjusted net present value as the cost of switching is offset by initial market penetration with planar technologies. The framework can facilitate early decision-making during process development.

A framework for service enterprise workflow simulation with multi-agents cooperation

NASA Astrophysics Data System (ADS)

Tan, Wenan; Xu, Wei; Yang, Fujun; Xu, Lida; Jiang, Chuanqun

2013-11-01

Process dynamic modelling for service business is the key technique for Service-Oriented information systems and service business management, and the workflow model of business processes is the core part of service systems. Service business workflow simulation is the prevalent approach to be used for analysis of service business process dynamically. Generic method for service business workflow simulation is based on the discrete event queuing theory, which is lack of flexibility and scalability. In this paper, we propose a service workflow-oriented framework for the process simulation of service businesses using multi-agent cooperation to address the above issues. Social rationality of agent is introduced into the proposed framework. Adopting rationality as one social factor for decision-making strategies, a flexible scheduling for activity instances has been implemented. A system prototype has been developed to validate the proposed simulation framework through a business case study.

Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review

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

Soltani, Atousa; Hewage, Kasun; Reza, Bahareh

2015-01-15

Highlights: • We review Municipal Solid Waste Management studies with focus on multiple stakeholders. • We focus on studies with multi-criteria decision analysis methods and discover their trends. • Most studies do not offer solutions for situations where stakeholders compete for more benefits or have unequal voting powers. • Governments and experts are the most participated stakeholders and AHP is the most dominant method. - Abstract: Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, andmore » finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies.« less

A spiral model of musical decision-making.

PubMed

Bangert, Daniel; Schubert, Emery; Fabian, Dorottya

2014-01-01

This paper describes a model of how musicians make decisions about performing notated music. The model builds on psychological theories of decision-making and was developed from empirical studies of Western art music performance that aimed to identify intuitive and deliberate processes of decision-making, a distinction consistent with dual-process theories of cognition. The model proposes that the proportion of intuitive (Type 1) and deliberate (Type 2) decision-making processes changes with increasing expertise and conceptualizes this change as movement along a continually narrowing upward spiral where the primary axis signifies principal decision-making type and the vertical axis marks level of expertise. The model is intended to have implications for the development of expertise as described in two main phases. The first is movement from a primarily intuitive approach in the early stages of learning toward greater deliberation as analytical techniques are applied during practice. The second phase occurs as deliberate decisions gradually become automatic (procedural), increasing the role of intuitive processes. As a performer examines more issues or reconsiders decisions, the spiral motion toward the deliberate side and back to the intuitive is repeated indefinitely. With increasing expertise, the spiral tightens to signify greater control over decision type selection. The model draws on existing theories, particularly Evans' (2011) Intervention Model of dual-process theories, Cognitive Continuum Theory Hammond et al. (1987), Hammond (2007), Baylor's (2001) U-shaped model for the development of intuition by level of expertise. By theorizing how musical decision-making operates over time and with increasing expertise, this model could be used as a framework for future research in music performance studies and performance science more generally.

A qualitative study on community pharmacists' decision-making process when making a diagnosis.

PubMed

Sinopoulou, Vassiliki; Summerfield, Paul; Rutter, Paul

2017-12-01

Self-care policies are increasingly directing patients to seek advice from community pharmacists. This means pharmacists need to have sound diagnostic decision-making skills to enable them to recognise a variety of conditions. The aim of this study was to investigate the process by which pharmacists manage patient signs and symptoms and to explore their use of decision-making for diagnostic purposes. Data were collected through semi-structured, face-to-face interviews with community pharmacists working in England, between August 2013 and November 2014. Pharmacists were asked to share their experiences on how they performed patient consultations, and more specifically how they would approach a hypothetical headache scenario. As part of the interview, their sources of knowledge and experience were also explored. Framework analysis was used to identify themes and subthemes. Eight interviews were conducted with pharmacists who had a wide range of working practice, from 1 year through to 40 years of experience. The pharmacists' main motivations during consultations were product selection and risk minimisation. Their questioning approach and decision-making relied heavily on mnemonic methods. This led to poor quality information gathering-although pharmacists acknowledged they needed to "delve deeper" but were often unable to articulate how or why. Some pharmacists exhibited elements of clinical reasoning in their consultations, but this seemed, mostly, to be unconscious and subsequently applied inappropriately. Overall, pharmacists exhibited poor decision-making ability, and often decisions were based on personal belief and experiences rather than evidence. Community pharmacists relied heavily on mnemonic methods to manage patients' signs and symptoms with diagnosis-based decision-making being seldom employed. These findings suggest practicing pharmacists should receive more diagnostic training. © 2017 John Wiley & Sons, Ltd.

A spiral model of musical decision-making

PubMed Central

Bangert, Daniel; Schubert, Emery; Fabian, Dorottya

2014-01-01

This paper describes a model of how musicians make decisions about performing notated music. The model builds on psychological theories of decision-making and was developed from empirical studies of Western art music performance that aimed to identify intuitive and deliberate processes of decision-making, a distinction consistent with dual-process theories of cognition. The model proposes that the proportion of intuitive (Type 1) and deliberate (Type 2) decision-making processes changes with increasing expertise and conceptualizes this change as movement along a continually narrowing upward spiral where the primary axis signifies principal decision-making type and the vertical axis marks level of expertise. The model is intended to have implications for the development of expertise as described in two main phases. The first is movement from a primarily intuitive approach in the early stages of learning toward greater deliberation as analytical techniques are applied during practice. The second phase occurs as deliberate decisions gradually become automatic (procedural), increasing the role of intuitive processes. As a performer examines more issues or reconsiders decisions, the spiral motion toward the deliberate side and back to the intuitive is repeated indefinitely. With increasing expertise, the spiral tightens to signify greater control over decision type selection. The model draws on existing theories, particularly Evans’ (2011) Intervention Model of dual-process theories, Cognitive Continuum Theory Hammond et al. (1987), Hammond (2007), Baylor’s (2001) U-shaped model for the development of intuition by level of expertise. By theorizing how musical decision-making operates over time and with increasing expertise, this model could be used as a framework for future research in music performance studies and performance science more generally. PMID:24795673

Evaluating team decision-making as an emergent phenomenon.

PubMed

Kinnear, John; Wilson, Nick; O'Dwyer, Anthony

2018-04-01

The complexity of modern clinical practice has highlighted the fallibility of individual clinicians' decision-making, with effective teamwork emerging as a key to patient safety. Dual process theory is widely accepted as a framework for individual decision-making, with type 1 processes responsible for fast, intuitive and automatic decisions and type 2 processes for slow, analytical decisions. However, dual process theory does not explain cognition at the group level, when individuals act in teams. Team cognition resulting from dynamic interaction of individuals is said to be more resilient to decision-making error and greater than simply aggregated cognition. Clinicians were paired as teams and asked to solve a cognitive puzzle constructed as a drug calculation. The frequency at which the teams made incorrect decisions was compared with that of individual clinicians answering the same question. When clinicians acted in pairs, 63% answered the cognitive puzzle correctly, compared with 33% of clinicians as individuals, showing a statistically significant difference in performance (χ 2 (1, n=116)=24.329, P<0.001). Based on the predicted performance of teams made up of the random pairing of individuals who had the same propensity to answer as previously, there was no statistical difference in the actual and predicted teams' performance. Teams are less prone to making errors of decision-making than individuals. However, the improved performance is likely to be owing to the effect of aggregated cognition rather than any improved decision-making as a result of the interaction. There is no evidence of team cognition as an emergent and distinct entity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cultural Challenges to Engaging Patients in Shared Decision Making

PubMed Central

Hawley, Sarah T.; Morris, Arden M.

2016-01-01

Objective Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making. Discussion The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority. Conclusion While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care. PMID:27461943

Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment.

PubMed

Whitty, Jennifer A; Littlejohns, Peter

2015-02-01

To describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia. The processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting. Transparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity. Priority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens' Jury. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A unified framework for addiction: Vulnerabilities in the decision process

PubMed Central

Redish, A. David; Jensen, Steve; Johnson, Adam

2013-01-01

The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) changing allostatic set points, (3) euphorigenic “reward-like” signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual’s susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment. PMID:18662461

Everyday ethics and help-seeking in early rheumatoid arthritis

PubMed Central

Townsend, A.; Adam, P.; Cox, S.M.; Li, L.C.

2018-01-01

Background Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience. Methods In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach. Results Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient–practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals. Conclusions For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient–practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults. PMID:20610465

Beyond evidence-based nursing: tools for practice.

PubMed

Jutel, Annemarie

2008-05-01

This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions. As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach. This article summarizes nursing's simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making. I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale. Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more. This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important decision-making skills which provide an even stronger foundation for robust nursing decisions.

Rational decision-making in inhibitory control.

PubMed

Shenoy, Pradeep; Yu, Angela J

2011-01-01

An important aspect of cognitive flexibility is inhibitory control, the ability to dynamically modify or cancel planned actions in response to changes in the sensory environment or task demands. We formulate a probabilistic, rational decision-making framework for inhibitory control in the stop signal paradigm. Our model posits that subjects maintain a Bayes-optimal, continually updated representation of sensory inputs, and repeatedly assess the relative value of stopping and going on a fine temporal scale, in order to make an optimal decision on when and whether to go on each trial. We further posit that they implement this continual evaluation with respect to a global objective function capturing the various reward and penalties associated with different behavioral outcomes, such as speed and accuracy, or the relative costs of stop errors and go errors. We demonstrate that our rational decision-making model naturally gives rise to basic behavioral characteristics consistently observed for this paradigm, as well as more subtle effects due to contextual factors such as reward contingencies or motivational factors. Furthermore, we show that the classical race model can be seen as a computationally simpler, perhaps neurally plausible, approximation to optimal decision-making. This conceptual link allows us to predict how the parameters of the race model, such as the stopping latency, should change with task parameters and individual experiences/ability.

Rational Decision-Making in Inhibitory Control

PubMed Central

Shenoy, Pradeep; Yu, Angela J.

2011-01-01

An important aspect of cognitive flexibility is inhibitory control, the ability to dynamically modify or cancel planned actions in response to changes in the sensory environment or task demands. We formulate a probabilistic, rational decision-making framework for inhibitory control in the stop signal paradigm. Our model posits that subjects maintain a Bayes-optimal, continually updated representation of sensory inputs, and repeatedly assess the relative value of stopping and going on a fine temporal scale, in order to make an optimal decision on when and whether to go on each trial. We further posit that they implement this continual evaluation with respect to a global objective function capturing the various reward and penalties associated with different behavioral outcomes, such as speed and accuracy, or the relative costs of stop errors and go errors. We demonstrate that our rational decision-making model naturally gives rise to basic behavioral characteristics consistently observed for this paradigm, as well as more subtle effects due to contextual factors such as reward contingencies or motivational factors. Furthermore, we show that the classical race model can be seen as a computationally simpler, perhaps neurally plausible, approximation to optimal decision-making. This conceptual link allows us to predict how the parameters of the race model, such as the stopping latency, should change with task parameters and individual experiences/ability. PMID:21647306

Cultural challenges to engaging patients in shared decision making.

PubMed

Hawley, Sarah T; Morris, Arden M

2017-01-01

Engaging patients in their health care through shared decision-making is a priority embraced by several national and international groups. Missing from these initiatives is an understanding of the challenges involved in engaging patients from diverse backgrounds in shared decision-making. In this commentary, we summarize some of the challenges and pose points for consideration regarding how to move toward more culturally appropriate shared decision-making. The past decade has seen repeated calls for health policies, research projects and interventions that more actively include patients in decision making. Yet research has shown that patients from different racial/ethnic and cultural backgrounds appraise their decision making process less positively than do white, U.S.-born patients who are the current demographic majority. While preliminary conceptual frameworks have been proposed for considering the role of race/ethnicity and culture in healthcare utilization, we maintain that more foundational and empirical work is necessary. We offer recommendations for how to best involve patients early in treatment and how to maximize decision making in the way most meaningful to patients. Innovative and sustained efforts are needed to educate and train providers to communicate effectively in engaging patients in informed, shared decision-making and to provide culturally competent health care. Published by Elsevier Ireland Ltd.

Health state utilities: a framework for studying the gap between the imagined and the real.

PubMed

Stiggelbout, Anne M; de Vogel-Voogt, Elsbeth

2008-01-01

Health state utilities play an important role in decision analysis and cost-utility analysis. The question whose utilities to use at various levels of health-care decision-making has been subject of considerable debate. The observation that patients often value their own health, but also other health states, higher than members of the general public raises the question what underlies such differences? Is it an artifact of the valuation methods? Is it adaptation versus poor anticipated adaptation? This article describes a framework for the understanding and study of potential mechanisms that play a role in health state valuation. It aims at connecting research from within different fields so that cross-fertilization of ideas may occur. The framework is based on stimulus response models from social judgment theory. For each phase, from stimulus, through information interpretation and integration, to judgment, and, finally, to response, we provide evidence of factors and processes that may lead to different utilities in patients and healthy subjects. Examples of factors and processes described are the lack of scope of scenarios in the stimulus phase, and appraisal processes and framing effects in the information interpretation phase. Factors that play a role in the judgment phase are, for example, heuristics and biases, adaptation, and comparison processes. Some mechanisms related to the response phase are end aversion bias, probability distortion, and noncompensatory decision-making. The framework serves to explain many of the differences in valuations between respondent groups. We discuss some of the findings as they relate to the field of response shift research. We propose issues for discussion in the field, and suggestions for improvement of the process of utility assessment.

Health literacy skills for informed decision making in colorectal cancer screening: Perceptions of screening invitees and experts.

PubMed

Woudstra, Anke J; Timmermans, Daniëlle R M; Uiters, Ellen; Dekker, Evelien; Smets, Ellen M A; Fransen, Mirjam P

2018-06-01

The process of informed decision making (IDM) requires an adequate level of health literacy. To ensure that all individuals have equal opportunity to make an informed decision in colorectal cancer (CRC) screening, it is essential to gain more insight into which health literacy skills are needed for IDM. Our aims were (i) to explore how individuals make a decision about CRC screening and (ii) to explore which skills are needed for IDM in CRC screening and (iii) to integrate these findings within a conceptual framework. We conducted 3 focus groups with individuals eligible for CRC screening (n = 22) and 2 focus groups with experts in the field of health literacy, oncology and decision making, including scientific researchers and health-care professionals (n = 17). We used framework analysis to analyse our data. We identified and specified ten health literacy skills, which varied from the ability to read and understand CRC screening information to the ability to weigh up pros and cons of screening for personal relevance. The skills were linked to 8 decision-making stages in CRC screening within a conceptual framework. We found differences in perceptions between screening invitees and experts, especially in the perceived importance of CRC screening information for IDM. This study provides insight into the decision-making stages and health literacy skills that are essential for IDM in CRC screening. The proposed conceptual framework can be used to inform the development of context-based measurement of health literacy and interventions to support IDM in cancer screening. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

Building a framework for theory-based ethnographies for studying intergenerational family food practices.

PubMed

Visser, Sanne Siete; Hutter, Inge; Haisma, Hinke

2016-02-01

The growing rates of (childhood) obesity worldwide are a source concern for health professionals, policy-makers, and researchers. The increasing prevalence of associated diseases-such as diabetes, cardiovascular diseases, and psychological problems-shows the impact of obesity on people's health, already from a young age. In turn, these problems have obvious consequences for the health care system, including higher costs. However, the treatment of obesity has proven to be difficult, which makes prevention an important goal. In this study, we focus on food practices, one of the determinants of obesity. In recent years, it has become increasingly clear that interventions designed to encourage healthy eating of children and their families are not having the desired impact, especially among groups with a lower socioeconomic background (SEB). To understand why interventions fail to have an impact, we need to study the embedded social and cultural constructions of families. We argue that we need more than just decision-making theories to understand this cultural embeddedness, and to determine what cultural and social factors influence the decision-making process. By allowing families to explain their cultural background, their capabilities, and their opportunities, we will gain new insights into how families choose what they eat from a complex set of food choices. We have thus chosen to build a framework based on Sen's capability approach and the theory of cultural schemas. This framework, together with a holistic ethnographic research approach, can help us better understand what drives the food choices made in families. The framework is built to serve as a starting point for ethnographic research on food choice in families, and could contribute to the development of interventions that are embedded in the cultural realities of the targeted groups. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Graduate Attributes for Master's Programs in Health Services and Policy Research: Results of a National Consultation

PubMed Central

Morgan, Steve; Orr, Karen; Mah, Catherine

2010-01-01

Objective: Our objective was to identify desirable attributes to be developed through graduate training in health services and policy research (HSPR) by identifying the knowledge, skills and abilities thought to be keys to success in HSPR-related careers. We aimed for a framework clear enough to serve as a touchstone for HSPR training programs across Canada yet flexible enough to permit diversity of specialization across and within those programs. Methods: Our approach involved several stages of data collection and analysis: a review of literature; telephone interviews with opinion leaders; online surveys of HSPR students, recent graduates and employers; an invitational workshop; and an interactive panel at a national conference. Our final framework was arrived at through an iterative process of thematic analysis, reflection on invited feedback from consultation participants and triangulation with existing competency frameworks. Results: Our final result was a framework that identifies traits, knowledge and abilities of master's-level graduates who are capable of fostering health system improvement through planning, management, analysis or monitoring that is informed by credible evidence and relevant theory. These attributes are organized into three levels: generic graduate attributes, knowledge related to health and health systems and, finally, attributes related to the application of knowledge for health system improvement. The HSPR-specific attributes include not only an understanding of HSPR theories and methods but also the skills related to the practical application of knowledge in the complex environments of health system decision-making and healthcare policy. Conclusion: Master's-level HSPR training programs should prepare students to pose and seek answers to important questions and provide them with the skills necessary to apply their knowledge within complex decision-making environments. PMID:21804839

Re-engineering the Federal planning process: A total Federal planning strategy, integrating NEPA with modern management tools

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

Eccleston, C.H.

1997-09-05

The National Environmental Policy Act (NEPA) of 1969 was established by Congress more than a quarter of a century ago, yet there is a surprising lack of specific tools, techniques, and methodologies for effectively implementing these regulatory requirements. Lack of professionally accepted techniques is a principal factor responsible for many inefficiencies. Often, decision makers do not fully appreciate or capitalize on the true potential which NEPA provides as a platform for planning future actions. New approaches and modem management tools must be adopted to fully achieve NEPA`s mandate. A new strategy, referred to as Total Federal Planning, is proposed formore » unifying large-scale federal planning efforts under a single, systematic, structured, and holistic process. Under this approach, the NEPA planning process provides a unifying framework for integrating all early environmental and nonenvironmental decision-making factors into a single comprehensive planning process. To promote effectiveness and efficiency, modem tools and principles from the disciplines of Value Engineering, Systems Engineering, and Total Quality Management are incorporated. Properly integrated and implemented, these planning tools provide the rigorous, structured, and disciplined framework essential in achieving effective planning. Ultimately, the goal of a Total Federal Planning strategy is to construct a unified and interdisciplinary framework that substantially improves decision-making, while reducing the time, cost, redundancy, and effort necessary to comply with environmental and other planning requirements. At a time when Congress is striving to re-engineer the governmental framework, apparatus, and process, a Total Federal Planning philosophy offers a systematic approach for uniting the disjointed and often convoluted planning process currently used by most federal agencies. Potentially this approach has widespread implications in the way federal planning is approached.« less

High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.

PubMed

Smith, Neale; Mitton, Craig; Hall, William; Bryan, Stirling; Donaldson, Cam; Peacock, Stuart; Gibson, Jennifer L; Urquhart, Bonnie

2016-08-01

Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA. Copyright © 2016 Elsevier Ltd. All rights reserved.

The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes.

PubMed

Baker, Elizabeth A; Ledford, Cynthia H; Fogg, Louis; Way, David P; Park, Yoon Soo

2015-01-01

Construct: Clinical skills are used in the care of patients, including reporting, diagnostic reasoning, and decision-making skills. Written comprehensive new patient admission notes (H&Ps) are a ubiquitous part of student education but are underutilized in the assessment of clinical skills. The interpretive summary, differential diagnosis, explanation of reasoning, and alternatives (IDEA) assessment tool was developed to assess students' clinical skills using written comprehensive new patient admission notes. The validity evidence for assessment of clinical skills using clinical documentation following authentic patient encounters has not been well documented. Diagnostic justification tools and postencounter notes are described in the literature (1,2) but are based on standardized patient encounters. To our knowledge, the IDEA assessment tool is the first published tool that uses medical students' H&Ps to rate students' clinical skills. The IDEA assessment tool is a 15-item instrument that asks evaluators to rate students' reporting, diagnostic reasoning, and decision-making skills based on medical students' new patient admission notes. This study presents validity evidence in support of the IDEA assessment tool using Messick's unified framework, including content (theoretical framework), response process (interrater reliability), internal structure (factor analysis and internal-consistency reliability), and relationship to other variables. Validity evidence is based on results from four studies conducted between 2010 and 2013. First, the factor analysis (2010, n = 216) yielded a three-factor solution, measuring patient story, IDEA, and completeness, with reliabilities of .79, .88, and .79, respectively. Second, an initial interrater reliability study (2010) involving two raters demonstrated fair to moderate consensus (κ = .21-.56, ρ =.42-.79). Third, a second interrater reliability study (2011) with 22 trained raters also demonstrated fair to moderate agreement (intraclass correlations [ICCs] = .29-.67). There was moderate reliability for all three skill domains, including reporting skills (ICC = .53), diagnostic reasoning skills (ICC = .64), and decision-making skills (ICC = .63). Fourth, there was a significant correlation between IDEA rating scores (2010-2013) and final Internal Medicine clerkship grades (r = .24), 95% confidence interval (CI) [.15, .33]. The IDEA assessment tool is a novel tool with validity evidence to support its use in the assessment of students' reporting, diagnostic reasoning, and decision-making skills. The moderate reliability achieved supports formative or lower stakes summative uses rather than high-stakes summative judgments.

Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature

PubMed Central

Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R.; Salek, Sam

2017-01-01

Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general paucity of research in this area, particularly regarding the development and systematic application of techniques for evaluating quality decision making, with no consensus around a gold standard. This review has identified QoDoS as the most promising available technique for assessing decision making in the lifecycle of medicines and the next steps would be to further test its validity, sensitivity, and reliability. PMID:28443022

Developing a rapid-response program for health system decision-makers in Canada: findings from an issue brief and stakeholder dialogue.

PubMed

Wilson, Michael G; Lavis, John N; Gauvin, Francois-Pierre

2015-03-11

There is currently no mechanism in place outside of government to provide rapid syntheses of the best available research evidence about problems, options and/or implementation considerations related to a specific health system challenge that Canadian health system decision-makers need to address in a timely manner. A 'rapid-response' program could address this gap by providing access to optimally packaged, relevant and high-quality research evidence over short periods of time (i.e. days or weeks). We prepared an issue brief that describes the best available research evidence related to the problem, three broad features of a program that addresses the problem and implementation considerations. We identified systematic reviews by searching for organization-targeted implementation strategies in Health Systems Evidence ( www.healthsystemsevidence.org ) and drew on an existing analytical framework for how knowledge-brokering organizations can organize themselves to operationalize the program features. The issue brief was then used to inform a half-day stakeholder dialogue about whether and how to develop a rapid-response program for health system decision-makers in Canada. We thematically synthesized the deliberations. We found very few relevant systematic reviews but used frameworks and examples from existing programs to 1) outline key considerations for organizing a rapid-response program,, 2) determine what can be done in timelines ranging from 3 to 10 and 30 business days, and 3) define success and measure it. The 11 dialogue participants from across Canada largely agreed with the content presented in the brief, but noted two key challenges to consider: securing stable, long-term funding and finding a way to effectively and equitably manage the expected demand. Recommendations and suggestions for next steps from dialogue participants included taking an 'organic' approach to developing a pan-Canadian network and including jurisdictional scans as a type of product to deliver through the program (rather than only syntheses of research evidence). Dialogue participants clearly signalled that there is an appetite for a rapid-response program for health system decision-makers in Canada. To 'organically' build such a program, we are currently engaging in efforts to build partnerships and secure funding to support the creation of a pan-Canadian network for conducting rapid syntheses for health system decision-makers in Canada.

A conceptual framework for understanding the perspectives on the causes of the science-practice gap in ecology and conservation.

PubMed

Bertuol-Garcia, Diana; Morsello, Carla; N El-Hani, Charbel; Pardini, Renata

2018-05-01

Applying scientific knowledge to confront societal challenges is a difficult task, an issue known as the science-practice gap. In Ecology and Conservation, scientific evidence has been seldom used directly to support decision-making, despite calls for an increasing role of ecological science in developing solutions for a sustainable future. To date, multiple causes of the science-practice gap and diverse approaches to link science and practice in Ecology and Conservation have been proposed. To foster a transparent debate and broaden our understanding of the difficulties of using scientific knowledge, we reviewed the perceived causes of the science-practice gap, aiming to: (i) identify the perspectives of ecologists and conservation scientists on this problem, (ii) evaluate the predominance of these perspectives over time and across journals, and (iii) assess them in light of disciplines studying the role of science in decision-making. We based our review on 1563 sentences describing causes of the science-practice gap extracted from 122 articles and on discussions with eight scientists on how to classify these sentences. The resulting process-based framework describes three distinct perspectives on the relevant processes, knowledge and actors in the science-practice interface. The most common perspective assumes only scientific knowledge should support practice, perceiving a one-way knowledge flow from science to practice and recognizing flaws in knowledge generation, communication, and/or use. The second assumes that both scientists and decision-makers should contribute to support practice, perceiving a two-way knowledge flow between science and practice through joint knowledge-production/integration processes, which, for several reasons, are perceived to occur infrequently. The last perspective was very rare, and assumes scientists should put their results into practice, but they rarely do. Some causes (e.g. cultural differences between scientists and decision-makers) are shared with other disciplines, while others seem specific to Ecology and Conservation (e.g. inadequate research scales). All identified causes require one of three general types of solutions, depending on whether the causal factor can (e.g. inadequate research questions) or cannot (e.g. scientific uncertainty) be changed, or if misconceptions (e.g. undervaluing abstract knowledge) should be solved. The unchanged predominance of the one-way perspective over time may be associated with the prestige of evidence-based conservation and suggests that debates in Ecology and Conservation lag behind trends in other disciplines towards bidirectional views ascribing larger roles to decision-makers. In turn, the two-way perspective seems primarily restricted to research traditions historically isolated from mainstream conservation biology. All perspectives represented superficial views of decision-making by not accounting for limits to human rationality, complexity of decision-making contexts, fuzzy science-practice boundaries, ambiguity brought about by science, and different types of knowledge use. However, joint knowledge-production processes from the two-way perspective can potentially allow for democratic decision-making processes, explicit discussions of values and multiple types of science use. To broaden our understanding of the interface and foster productive science-practice linkages, we argue for dialogue among different research traditions within Ecology and Conservation, joint knowledge-production processes between scientists and decision-makers and interdisciplinarity across Ecology, Conservation and Political Science in both research and education. © 2017 Cambridge Philosophical Society.