Sample records for explicit decision support
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NASA Astrophysics Data System (ADS)
Zachary, Wayne; Eggleston, Robert; Donmoyer, Jason; Schremmer, Serge
2003-09-01
Decision-making is strongly shaped and influenced by the work context in which decisions are embedded. This suggests that decision support needs to be anchored by a model (implicit or explicit) of the work process, in contrast to traditional approaches that anchor decision support to either context free decision models (e.g., utility theory) or to detailed models of the external (e.g., battlespace) environment. An architecture for cognitively-based, work centered decision support called the Work-centered Informediary Layer (WIL) is presented. WIL separates decision support into three overall processes that build and dynamically maintain an explicit context model, use the context model to identify opportunities for decision support and tailor generic decision-support strategies to the current context and offer them to the system-user/decision-maker. The generic decision support strategies include such things as activity/attention aiding, decision process structuring, work performance support (selective, contextual automation), explanation/ elaboration, infosphere data retrieval, and what if/action-projection and visualization. A WIL-based application is a work-centered decision support layer that provides active support without intent inferencing, and that is cognitively based without requiring classical cognitive task analyses. Example WIL applications are detailed and discussed.
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Decision support systems in health economics.
Quaglini, S; Dazzi, L; Stefanelli, M; Barosi, G; Marchetti, M
1999-08-01
This article describes a system addressed to different health care professionals for building, using, and sharing decision support systems for resource allocation. The system deals with selected areas, namely the choice of diagnostic tests, the therapy planning, and the instrumentation purchase. Decision support is based on decision-analytic models, incorporating an explicit knowledge representation of both the medical domain knowledge and the economic evaluation theory. Application models are built on top of meta-models, that are used as guidelines for making explicit both the cost and effectiveness components. This approach improves the transparency and soundness of the collaborative decision-making process and facilitates the result interpretation.
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Forecasting and communicating the potential outcomes of decision options requires support tools that aid in evaluating alternative scenarios in a user-friendly context and that highlight variables relevant to the decision options and valuable stakeholders. Envision is a GIS-base...
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Spatially explicit multi-criteria decision analysis for managing vector-borne diseases
2011-01-01
The complex epidemiology of vector-borne diseases creates significant challenges in the design and delivery of prevention and control strategies, especially in light of rapid social and environmental changes. Spatial models for predicting disease risk based on environmental factors such as climate and landscape have been developed for a number of important vector-borne diseases. The resulting risk maps have proven value for highlighting areas for targeting public health programs. However, these methods generally only offer technical information on the spatial distribution of disease risk itself, which may be incomplete for making decisions in a complex situation. In prioritizing surveillance and intervention strategies, decision-makers often also need to consider spatially explicit information on other important dimensions, such as the regional specificity of public acceptance, population vulnerability, resource availability, intervention effectiveness, and land use. There is a need for a unified strategy for supporting public health decision making that integrates available data for assessing spatially explicit disease risk, with other criteria, to implement effective prevention and control strategies. Multi-criteria decision analysis (MCDA) is a decision support tool that allows for the consideration of diverse quantitative and qualitative criteria using both data-driven and qualitative indicators for evaluating alternative strategies with transparency and stakeholder participation. Here we propose a MCDA-based approach to the development of geospatial models and spatially explicit decision support tools for the management of vector-borne diseases. We describe the conceptual framework that MCDA offers as well as technical considerations, approaches to implementation and expected outcomes. We conclude that MCDA is a powerful tool that offers tremendous potential for use in public health decision-making in general and vector-borne disease management in particular. PMID:22206355
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Colangelo, Annette; Buchanan, Lori
2006-12-01
The failure of inhibition hypothesis posits a theoretical distinction between implicit and explicit access in deep dyslexia. Specifically, the effects of failure of inhibition are assumed only in conditions that have an explicit selection requirement in the context of production (i.e., aloud reading). In contrast, the failure of inhibition hypothesis proposes that implicit processing and explicit access to semantic information without production demands are intact in deep dyslexia. Evidence for intact implicit and explicit access requires that performance in deep dyslexia parallels that observed in neurologically intact participants on tasks based on implicit and explicit processes. In other words, deep dyslexics should produce normal effects in conditions with implicit task demands (i.e., lexical decision) and on tasks based on explicit access without production (i.e., forced choice semantic decisions) because failure of inhibition does not impact the availability of lexical information, only explicit retrieval in the context of production. This research examined the distinction between implicit and explicit processes in deep dyslexia using semantic blocking in lexical decision and forced choice semantic decisions as a test for the failure of inhibition hypothesis. The results of the semantic blocking paradigm support the distinction between implicit and explicit processing and provide evidence for failure of inhibition as an explanation for semantic errors in deep dyslexia.
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Multi-criteria Integrated Resource Assessment (MIRA)
MIRA is an approach that facilitates stakeholder engagement for collaborative multi-objective decision making. MIRA is designed to facilitate and support an inclusive, explicit, transparent, iterative learning-based decision process.
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Spatially explicit decision support for selecting translocation areas for Mojave desert tortoises
Heaton, Jill S.; Nussear, Kenneth E.; Esque, Todd C.; Inman, Richard D.; Davenport, Frank; Leuteritz, Thomas E.; Medica, Philip A.; Strout, Nathan W.; Burgess, Paul A.; Benvenuti, Lisa
2008-01-01
Spatially explicit decision support systems are assuming an increasing role in natural resource and conservation management. In order for these systems to be successful, however, they must address real-world management problems with input from both the scientific and management communities. The National Training Center at Fort Irwin, California, has expanded its training area, encroaching U.S. Fish and Wildlife Service critical habitat set aside for the Mojave desert tortoise (Gopherus agassizii), a federally threatened species. Of all the mitigation measures proposed to offset expansion, the most challenging to implement was the selection of areas most feasible for tortoise translocation. We developed an objective, open, scientifically defensible spatially explicit decision support system to evaluate translocation potential within the Western Mojave Recovery Unit for tortoise populations under imminent threat from military expansion. Using up to a total of 10 biological, anthropogenic, and/or logistical criteria, seven alternative translocation scenarios were developed. The final translocation model was a consensus model between the seven scenarios. Within the final model, six potential translocation areas were identified.
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New Interoperable Tools to Facilitate Decision-Making to Support Community Sustainability
Communities, regional planning authorities, regulatory agencies, and other decision-making bodies do not currently have adequate access to spatially explicit information crucial to making decisions that allow them to consider a full accounting of the costs, benefits, and trade-of...
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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.
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Linking climate change and fish conservation efforts using spatially explicit decision support tools
Douglas P. Peterson; Seth J. Wenger; Bruce E. Rieman; Daniel J. Isaak
2013-01-01
Fisheries professionals are increasingly tasked with incorporating climate change projections into their decisions. Here we demonstrate how a structured decision framework, coupled with analytical tools and spatial data sets, can help integrate climate and biological information to evaluate management alternatives. We present examples that link downscaled climate...
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A decision-supported outpatient practice system.
Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.
1996-01-01
We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774
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Decision-Guided Recommenders with Composite Alternatives
ERIC Educational Resources Information Center
Alodhaibi, Khalid
2011-01-01
Recommender systems aim to support users in their decision-making process while interacting with large information spaces and recommend items of interest to users based on preferences they have expressed, either explicitly or implicitly. Recommender systems are increasingly used with product and service selection over the Internet. Although…
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2009-01-01
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing – or supporting the development of – evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan? PMID:20018110
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Lavis, John N; Oxman, Andrew D; Lewin, Simon; Fretheim, Atle
2009-12-16
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing--or supporting the development of--evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan?
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THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKING
van Ryn, Michelle; Burgess, Diana J.; Dovidio, John F.; Phelan, Sean M.; Saha, Somnath; Malat, Jennifer; Griffin, Joan M.; Fu, Steven S.; Perry, Sylvia
2014-01-01
Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians’ behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians’ behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations. PMID:24761152
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29 CFR 18.103 - Rulings on evidence.
Code of Federal Regulations, 2010 CFR
2010-07-01
... is more probably true than not true that the error did not materially contribute to the decision or... if explicitly not relied upon by the judge in support of the decision or order. (b) Record of offer... making of an offer in question and answer form. (c) Plain error. Nothing in this rule precludes taking...
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Neuro-Fuzzy Support of Knowledge Management in Social Regulation
NASA Astrophysics Data System (ADS)
Petrovic-Lazarevic, Sonja; Coghill, Ken; Abraham, Ajith
2002-09-01
The aim of the paper is to demonstrate the neuro-fuzzy support of knowledge management in social regulation. Knowledge could be understood for social regulation purposes as explicit and tacit. Explicit knowledge relates to the community culture indicating how things work in the community based on social policies and procedures. Tacit knowledge is ethics and norms of the community. The former could be codified, stored and transferable in order to support decision making, while the latter being based on personal knowledge, experience and judgments is difficult to codify and store. Tacit knowledge expressed through linguistic information can be stored and used to support knowledge management in social regulation through the application of fuzzy and neuro-fuzzy logic.
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Priority setting in the provincial health services authority: survey of key decision makers
Teng, Flora; Mitton, Craig; MacKenzie, Jennifer
2007-01-01
Background In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. Methods A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. Results Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. Conclusion This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts. PMID:17565691
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Treatment algorithms and protocolized care.
Morris, Alan H
2003-06-01
Excess information in complex ICU environments exceeds human decision-making limits and likely contributes to unnecessary variation in clinical care, increasing the likelihood of clinical errors. I reviewed recent critical care clinical trials searching for information about the impact of protocol use on clinically pertinent outcomes. Several recently published clinical trials illustrate the importance of distinguishing efficacy and effectiveness trials. One of these trials illustrates the danger of conducting effectiveness trials before the efficacy of an intervention is established. The trials also illustrate the importance of distinguishing guidelines and inadequately explicit protocols from adequately explicit protocols. Only adequately explicit protocols contain enough detail to lead different clinicians to the same decision when faced with the same clinical scenario. Differences between guidelines and protocols are important. Guidelines lack detail and provide general guidance that requires clinicians to fill in many gaps. Computerized or paper-based protocols are detailed and, when used for complex clinical ICU problems, can generate patient-specific, evidence-based therapy instructions that can be carried out by different clinicians with almost no interclinician variability. Individualization of patient therapy can be preserved by these protocols when they are driven by individual patient data. Explicit decision-support tools (eg, guidelines and protocols) have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice. Guidelines and protocols that aid ICU decision makers should be more widely distributed.
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Decision or no decision: how do patient-physician interactions end and what matters?
Tai-Seale, Ming; Bramson, Rachel; Bao, Xiaoming
2007-03-01
A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient-physician communications. Little is known about how often explicit decisions are made in primary care visits. To use an innovative videotape analysis approach to assess physicians' propensity to state decisions explicitly, and to examine the factors influencing decision patterns. We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics. About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p < 0.01). Increases in the number of topics discussed in visits (OR = 0.95, p < .05), and topics on lifestyle and habits (OR = 0.60, p < .01) were associated with lower odds of explicit decisions. Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients' voice and developing clinical tools, e.g., an "exit prescription," to improving decision making.
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ERIC Educational Resources Information Center
Tindal, Gerald; Lee, Daesik; Geller, Leanne Ketterlin
2008-01-01
In this paper we review different methods for teachers to recommend accommodations in large scale tests. Then we present data on the stability of their judgments on variables relevant to this decision-making process. The outcomes from the judgments support the need for a more explicit model. Four general categories are presented: student…
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Gent, David H; De Wolf, Erick; Pethybridge, Sarah J
2011-06-01
Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.
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Middle Mississippi River decision support system: user's manual
Rohweder, Jason J.; Zigler, Steven J.; Fox, Timothy J.; Hulse, Steven N.
2005-01-01
This user's manual describes the Middle Mississippi River Decision Support System (MMRDSS) and gives detailed examples on its use. The MMRDSS provides a framework to assist decision makers regarding natural resource issues in the Middle Mississippi River floodplain. The MMRDSS is designed to provide users with a spatially explicit tool for tasks, such as inventorying existing knowledge, developing models to investigate the potential effects of management decisions, generating hypotheses to advance scientific understanding, and developing scientifically defensible studies and monitoring. The MMRDSS also includes advanced tools to assist users in evaluating differences in complexity, connectivity, and structure of aquatic habitats among river reaches. The Environmental Systems Research Institute ArcView 3.x platform was used to create and package the data and tools of the MMRDSS.
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2010-01-01
Background Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. Method This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. Results EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. Discussion This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research. PMID:20920289
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Gibert, Karina; García-Alonso, Carlos; Salvador-Carulla, Luis
2010-09-30
Decision support in health systems is a highly difficult task, due to the inherent complexity of the process and structures involved. This paper introduces a new hybrid methodology Expert-based Cooperative Analysis (EbCA), which incorporates explicit prior expert knowledge in data analysis methods, and elicits implicit or tacit expert knowledge (IK) to improve decision support in healthcare systems. EbCA has been applied to two different case studies, showing its usability and versatility: 1) Bench-marking of small mental health areas based on technical efficiency estimated by EbCA-Data Envelopment Analysis (EbCA-DEA), and 2) Case-mix of schizophrenia based on functional dependency using Clustering Based on Rules (ClBR). In both cases comparisons towards classical procedures using qualitative explicit prior knowledge were made. Bayesian predictive validity measures were used for comparison with expert panels results. Overall agreement was tested by Intraclass Correlation Coefficient in case "1" and kappa in both cases. EbCA is a new methodology composed by 6 steps:. 1) Data collection and data preparation; 2) acquisition of "Prior Expert Knowledge" (PEK) and design of the "Prior Knowledge Base" (PKB); 3) PKB-guided analysis; 4) support-interpretation tools to evaluate results and detect inconsistencies (here Implicit Knowledg -IK- might be elicited); 5) incorporation of elicited IK in PKB and repeat till a satisfactory solution; 6) post-processing results for decision support. EbCA has been useful for incorporating PEK in two different analysis methods (DEA and Clustering), applied respectively to assess technical efficiency of small mental health areas and for case-mix of schizophrenia based on functional dependency. Differences in results obtained with classical approaches were mainly related to the IK which could be elicited by using EbCA and had major implications for the decision making in both cases. This paper presents EbCA and shows the convenience of completing classical data analysis with PEK as a mean to extract relevant knowledge in complex health domains. One of the major benefits of EbCA is iterative elicitation of IK.. Both explicit and tacit or implicit expert knowledge are critical to guide the scientific analysis of very complex decisional problems as those found in health system research.
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Shaban-Nejad, Arash; Lavigne, Maxime; Okhmatovskaia, Anya; Buckeridge, David L
2017-01-01
Population health decision makers must consider complex relationships between multiple concepts measured with differential accuracy from heterogeneous data sources. Population health information systems are currently limited in their ability to integrate data and present a coherent portrait of population health. Consequentially, these systems can provide only basic support for decision makers. The Population Health Record (PopHR) is a semantic web application that automates the integration and extraction of massive amounts of heterogeneous data from multiple distributed sources (e.g., administrative data, clinical records, and survey responses) to support the measurement and monitoring of population health and health system performance for a defined population. The design of the PopHR draws on the theories of the determinants of health and evidence-based public health to harmonize and explicitly link information about a population with evidence about the epidemiology and control of chronic diseases. Organizing information in this manner and linking it explicitly to evidence is expected to improve decision making related to the planning, implementation, and evaluation of population health and health system interventions. In this paper, we describe the PopHR platform and discuss the architecture, design, key modules, and its implementation and use. © 2016 New York Academy of Sciences.
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Believable Social and Emotional Agents.
1996-05-01
While building tools to support the creation of believable emotional agents, I had to make a number of important design decisions . Before describing...processing systems, it is difficult to give an artist direct control over the emotion - al aspects of the character. By making these decisions explicit, I hope...Woody on “Cheers”). Believable Agents BELIEVABLE SOCIAL AND EMOTIONAL AGENTS 11 Lesson: We don’t want agent architectures that enforce rationality and
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Drake, Julia I.; de Hart, Juan Carlos Trujillo; Monleón, Clara; Toro, Walter; Valentim, Joice
2017-01-01
ABSTRACT Background and objectives: MCDA is a decision-making tool with increasing use in the healthcare sector, including HTA (Health Technology Assessment). By applying multiple criteria, including innovation, in a comprehensive, structured and explicit manner, MCDA fosters a transparent, participative, consistent decision-making process taking into consideration values of all stakeholders. This paper by FIFARMA (Latin American Federation of Pharmaceutical Industry) proposes the deliberative (partial) MCDA as a more pragmatic, agile approach, especially when newly implemented. Methods: Literature review including real-world examples of effective MCDA implementation in healthcare decision making in both the public and private sector worldwide and in LA. Results and conclusion: It is the view of FIFARMA that MCDA should strongly be considered as a tool to support HTA and broader healthcare decision making such as the contracts and tenders process in order to foster transparency, fairness, and collaboration amongst stakeholders. PMID:29081919
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Predicting species distributions for conservation decisions
Guisan, Antoine; Tingley, Reid; Baumgartner, John B; Naujokaitis-Lewis, Ilona; Sutcliffe, Patricia R; Tulloch, Ayesha I T; Regan, Tracey J; Brotons, Lluis; McDonald-Madden, Eve; Mantyka-Pringle, Chrystal; Martin, Tara G; Rhodes, Jonathan R; Maggini, Ramona; Setterfield, Samantha A; Elith, Jane; Schwartz, Mark W; Wintle, Brendan A; Broennimann, Olivier; Austin, Mike; Ferrier, Simon; Kearney, Michael R; Possingham, Hugh P; Buckley, Yvonne M
2013-01-01
Species distribution models (SDMs) are increasingly proposed to support conservation decision making. However, evidence of SDMs supporting solutions for on-ground conservation problems is still scarce in the scientific literature. Here, we show that successful examples exist but are still largely hidden in the grey literature, and thus less accessible for analysis and learning. Furthermore, the decision framework within which SDMs are used is rarely made explicit. Using case studies from biological invasions, identification of critical habitats, reserve selection and translocation of endangered species, we propose that SDMs may be tailored to suit a range of decision-making contexts when used within a structured and transparent decision-making process. To construct appropriate SDMs to more effectively guide conservation actions, modellers need to better understand the decision process, and decision makers need to provide feedback to modellers regarding the actual use of SDMs to support conservation decisions. This could be facilitated by individuals or institutions playing the role of ‘translators’ between modellers and decision makers. We encourage species distribution modellers to get involved in real decision-making processes that will benefit from their technical input; this strategy has the potential to better bridge theory and practice, and contribute to improve both scientific knowledge and conservation outcomes. PMID:24134332
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Decision Support Systems: Theory.
1976-01-01
Ko tt r, 1.. "Toward an Explicit Model for Media Selection," ,J. Advertising Res. 4, 14-41 , Mar. 1964. Kriebel, C. tt., "MIS Technology - A View of...Research Study of Sales Re- sponse to Advertising ," Opns. Res. 5, 370-381 ,1957. Von Bertalanffy, Ludwig , General Systems Theory. New York: George...Zangwill, W. I., " Media Slection by Decision Programming," J. Advertising Res. 5.30-36 , Sept. 1964. Zeleny, M., Linear Multiobjective Programming
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Parental Explicit Heuristics in Decision-making for Children With Life-threatening Illnesses
Renjilian, Chris B.; Womer, James W.; Carroll, Karen W.; Kang, Tammy I.
2013-01-01
OBJECTIVE: To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. METHODS: Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children’s Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. RESULTS: All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. CONCLUSIONS: Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process. PMID:23319524
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Parental explicit heuristics in decision-making for children with life-threatening illnesses.
Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris
2013-02-01
To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.
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Ochoa, Cristian; Alvarez-Moya, Eva M; Penelo, Eva; Aymami, M Neus; Gómez-Peña, Mónica; Fernández-Aranda, Fernando; Granero, Roser; Vallejo-Ruiloba, Julio; Menchón, José Manuel; Lawrence, Natalia S; Jiménez-Murcia, Susana
2013-01-01
A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH). We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge. The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures. Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making. Copyright © American Academy of Addiction Psychiatry.
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(De)centralization of social support in six Western European countries.
Kroneman, Madelon; Cardol, Mieke; Friele, Roland
2012-06-01
Participation of disabled or chronically ill persons into the society may require support in the sense of human or technical aid. In this study we look into the decision making power of governments and the way citizens are involved in these processes. Decision making power can be political, financial and administrative and may be organized at national, regional or local level. This is a cross-sectional descriptive study of the decision making power in Belgium, France, Germany, the Netherlands, Sweden and the United Kingdom in 2010. We focused on acts and regulations for human and technical aids and for making the environment accessible. Several acts and regulations were identified in relation to social support. In the Netherlands and Sweden social support was mainly organized in one act, whereas in the other countries social support was part of several acts or regulations. Citizen's voice appeared to be represented in boards or advisory committees. Descriptions of entitlements varied from explicitly formulated to globally described. The level of decision making power varies between the countries en between the types of decision making power. Citizens' participation is mainly represented through patient associations. Countries with strongly decentralized decision making make use of framework legislation at national level to set general targets or aims. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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A decision support system for forest harvest planning in North Carolina
D.G. Jones
2010-01-01
Forest preharvest planning (FPP) can enhance recognition of environmentally-sensitive areas in advance of forest harvesting, including soil and water resources. While preharvest planning is often a standard component of many forest harvesting operations, either explicitly with paper-based checklists or implicitly with best professional judgment, Geographic Information...
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75 FR 57033 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2010-09-17
... promotion of improvements in clinical and health system practices, including the prevention of diseases and... database of evidence-based clinical practice guidelines meeting explicit criteria. The NGC also supports... evidence to make informed health care decisions. The NGC is a vehicle for such encouragement. The mission...
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Promoting Children's Ethical Development through Social and Emotional Learning
ERIC Educational Resources Information Center
Devaney, Elizabeth; O'Brien, Mary Utne; Tavegia, Mary; Resnik, Hank
2005-01-01
Although few educators, youth development practitioners, and student support services personnel question the importance of helping children to develop the skills necessary to be successful in the workplace, make ethical decisions, and be engaged and contributing citizens, these skills are rarely taught explicitly and effectively. The pressures of…
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Hallgren, Kevin A; Bauer, Amy M; Atkins, David C
2017-06-01
Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.
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Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy
2016-01-01
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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Health policy in a new key: setting democratic priorities.
Jennings, B
1993-01-01
Health policy in the United States is entering an era in which explicitly value-based allocation decisions require direct attention. Policies concerning access to care, financing, and utilization management will necessarily have redistributive effects. For these policies to command social legitimacy and political support, some consensus will have to emerge around the values and ideals justifying these policies. This article addresses the problems of conceptual clarification and democratic process raised by the prospect of an explicitly value-based allocation policy. It offers a conceptual matrix distinguishing the scope of the issue of allocation in health care. Drawing on the activities of community health decisions projects in several states, it also offers suggestions about building a participatory and educational process at the grassroots level that might lead to a democratic consensus suitable for guiding policy choice.
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The design of patient decision support interventions: addressing the theory-practice gap.
Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky
2011-08-01
Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions. © 2010 Blackwell Publishing Ltd.
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Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila
2012-01-01
Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.
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Somatic Markers and Explicit Knowledge Are both Involved in Decision-Making
ERIC Educational Resources Information Center
Guillaume, Sebastien; Jollant, Fabrice; Jaussent, Isabelle; Lawrence, Natalia; Malafosse, Alain; Courtet, Philippe
2009-01-01
In 1994, it was proposed that decision-making requires emotion-related signals, known as somatic markers. In contrast, some authors argued that conscious knowledge of contingencies is sufficient for advantageous decision-making. We aimed to investigate the respective roles of somatic markers and explicit knowledge in decision-making. Thirty…
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Spatial decision support system to evaluate crop residue energy potential by anaerobic digestion.
Escalante, Humberto; Castro, Liliana; Gauthier-Maradei, Paola; Rodríguez De La Vega, Reynel
2016-11-01
Implementing anaerobic digestion (AD) in energy production from crop residues requires development of decision tools to assess its feasibility and sustainability. A spatial decision support system (SDSS) was constructed to assist decision makers to select appropriate feedstock according to biomethanation potential, identify the most suitable location for biogas facilities, determine optimum plant capacity and supply chain, and evaluate associated risks and costs. SDSS involves a spatially explicit analysis, fuzzy multi-criteria analysis, and statistical and optimization models. The tool was validated on seven crop residues located in Santander, Colombia. For example, fique bagasse generates about 0.21millionm(3)CH4year(-1) (0.329m(3)CH4kg(-1) volatile solids) with a minimum profitable plant of about 2000tonyear(-1) and an internal rate of return of 10.5%. SDSS can be applied to evaluate other biomass resources, availability periods, and co-digestion potential. Copyright © 2016. Published by Elsevier Ltd.
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Issues of Spatial and Temporal Scale in Modeling the Effects of Field Operatiions on Soil Properties
USDA-ARS?s Scientific Manuscript database
Tillage is an important procedure for modifying the soil environment in order to enhance crop growth and conserve soil and water resources. Process-based models of crop production are widely used in decision support, but few explicitly simulate tillage. The Cropping Systems Model (CSM) was modified ...
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Hysteresis as an Implicit Prior in Tactile Spatial Decision Making
Thiel, Sabrina D.; Bitzer, Sebastian; Nierhaus, Till; Kalberlah, Christian; Preusser, Sven; Neumann, Jane; Nikulin, Vadim V.; van der Meer, Elke; Villringer, Arno; Pleger, Burkhard
2014-01-01
Perceptual decisions not only depend on the incoming information from sensory systems but constitute a combination of current sensory evidence and internally accumulated information from past encounters. Although recent evidence emphasizes the fundamental role of prior knowledge for perceptual decision making, only few studies have quantified the relevance of such priors on perceptual decisions and examined their interplay with other decision-relevant factors, such as the stimulus properties. In the present study we asked whether hysteresis, describing the stability of a percept despite a change in stimulus property and known to occur at perceptual thresholds, also acts as a form of an implicit prior in tactile spatial decision making, supporting the stability of a decision across successively presented random stimuli (i.e., decision hysteresis). We applied a variant of the classical 2-point discrimination task and found that hysteresis influenced perceptual decision making: Participants were more likely to decide ‘same’ rather than ‘different’ on successively presented pin distances. In a direct comparison between the influence of applied pin distances (explicit stimulus property) and hysteresis, we found that on average, stimulus property explained significantly more variance of participants’ decisions than hysteresis. However, when focusing on pin distances at threshold, we found a trend for hysteresis to explain more variance. Furthermore, the less variance was explained by the pin distance on a given decision, the more variance was explained by hysteresis, and vice versa. Our findings suggest that hysteresis acts as an implicit prior in tactile spatial decision making that becomes increasingly important when explicit stimulus properties provide decreasing evidence. PMID:24587045
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Donati, Maria Anna; Panno, Angelo; Chiesi, Francesca; Primi, Caterina
2014-01-01
This study tested the mediating role of probabilistic reasoning ability in the relationship between fluid intelligence and advantageous decision making among adolescents in explicit situations of risk--that is, in contexts in which information on the choice options (gains, losses, and probabilities) were explicitly presented at the beginning of the task. Participants were 282 adolescents attending high school (77% males, mean age = 17.3 years). We first measured fluid intelligence and probabilistic reasoning ability. Then, to measure decision making under explicit conditions of risk, participants performed the Game of Dice Task, in which they have to decide among different alternatives that are explicitly linked to a specific amount of gain or loss and have obvious winning probabilities that are stable over time. Analyses showed a significant positive indirect effect of fluid intelligence on advantageous decision making through probabilistic reasoning ability that acted as a mediator. Specifically, fluid intelligence may enhance ability to reason in probabilistic terms, which in turn increases the likelihood of advantageous choices when adolescents are confronted with an explicit decisional context. Findings show that in experimental paradigm settings, adolescents are able to make advantageous decisions using cognitive abilities when faced with decisions under explicit risky conditions. This study suggests that interventions designed to promote probabilistic reasoning, for example by incrementing the mathematical prerequisites necessary to reason in probabilistic terms, may have a positive effect on adolescents' decision-making abilities.
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Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.
Syrowatka, Ania; Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn
2016-01-26
Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.
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Multiple sclerosis decreases explicit counterfactual processing and risk taking in decision making.
Simioni, Samanta; Schluep, Myriam; Bault, Nadège; Coricelli, Giorgio; Kleeberg, Joerg; Du Pasquier, Renaud A; Gschwind, Markus; Vuilleumier, Patrik; Annoni, Jean-Marie
2012-01-01
Deficits in decision making (DM) are commonly associated with prefrontal cortical damage, but may occur with multiple sclerosis (MS). There are no data concerning the impact of MS on tasks evaluating DM under explicit risk, where different emotional and cognitive components can be distinguished. We assessed 72 relapsing-remitting MS (RRMS) patients with mild to moderate disease and 38 healthy controls in two DM tasks involving risk with explicit rules: (1) The Wheel of Fortune (WOF), which probes the anticipated affects of decisions outcomes on future choices; and (2) The Cambridge Gamble Task (CGT) which measures risk taking. Participants also underwent a neuropsychological and emotional assessment, and skin conductance responses (SCRs) were recorded. In the WOF, RRMS patients showed deficits in integrating positive counterfactual information (p<0.005) and greater risk aversion (p<0.001). They reported less negative affect than controls (disappointment: p = 0.007; regret: p = 0.01), although their implicit emotional reactions as measured by post-choice SCRs did not differ. In the CGT, RRMS patients differed from controls in quality of DM (p = 0.01) and deliberation time (p = 0.0002), the latter difference being correlated with attention scores. Such changes did not result in overall decreases in performance (total gains). The quality of DM under risk was modified by MS in both tasks. The reduction in the expression of disappointment coexisted with an increased risk aversion in the WOF and alexithymia features. These concomitant emotional alterations may have implications for better understanding the components of explicit DM and for the clinical support of MS patients.
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Willed action, free will, and the stochastic neurodynamics of decision-making
Rolls, Edmund T.
2012-01-01
It is shown that the randomness of the firing times of neurons in decision-making attractor neuronal networks that is present before the decision cues are applied can cause statistical fluctuations that influence the decision that will be taken. In this rigorous sense, it is possible to partially predict decisions before they are made. This raises issues about free will and determinism. There are many decision-making networks in the brain. Some decision systems operate to choose between gene-specified rewards such as taste, touch, and beauty (in for example the peacock's tail). Other processes capable of planning ahead with multiple steps held in working memory may require correction by higher order thoughts that may involve explicit, conscious, processing. The explicit system can allow the gene-specified rewards not to be selected or deferred. The decisions between the selfish gene-specified rewards, and the explicitly calculated rewards that are in the interests of the individual, the phenotype, may themselves be influenced by noise in the brain. When the explicit planning system does take the decision, it can report on its decision-making, and can provide a causal account rather than a confabulation about the decision process. We might use the terms “willed action” and “free will” to refer to the operation of the planning system that can think ahead over several steps held in working memory with which it can take explicit decisions. Reduced connectivity in some of the default mode cortical regions including the precuneus that are active during self-initiated action appears to be related to the reduction in the sense of self and agency, of causing willed actions, that can be present in schizophrenia. PMID:22973205
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Multi-criteria development and incorporation into decision tools for health technology adoption.
Poulin, Paule; Austen, Lea; Scott, Catherine M; Waddell, Cameron D; Dixon, Elijah; Poulin, Michelle; Lafrenière, René
2013-01-01
When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi-criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed-upon criteria and decision tools to enhance a pre-existing local health technology assessment (HTA) decision support program. The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools. A set of user-validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent. This framework can be used by others to develop decision-making criteria and tools to enhance similar technology adoption programs. The development of clear, user-validated criteria for evaluating new technologies adds a critical element to improve decision-making on technology adoption, and the decision tools ensure consistency, transparency, and real-world relevance.
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Health care priority setting in Norway a multicriteria decision analysis
2012-01-01
Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions. PMID:22335815
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Health care priority setting in Norway a multicriteria decision analysis.
Defechereux, Thierry; Paolucci, Francesco; Mirelman, Andrew; Youngkong, Sitaporn; Botten, Grete; Hagen, Terje P; Niessen, Louis W
2012-02-15
Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.
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Time to decision: the drivers of innovation adoption decisions
NASA Astrophysics Data System (ADS)
Ciganek, Andrew Paul; (Dave) Haseman, William; Ramamurthy, K.
2014-03-01
Organisations desire timeliness. Timeliness facilitates a better responsiveness to changes in an organisation's external environment to either attain or maintain competitiveness. Despite its importance, decision timeliness has not been explicitly examined. Decision timeliness is measured in this study as the time taken to commit to a decision. The research objective is to identify the drivers of decision timeliness in the context of adopting service-oriented architecture (SOA), an innovation for enterprise computing. A research model rooted in the technology-organisation-environment (TOE) framework is proposed and tested with data collected in a large-scale study. The research variables have been examined before in the context of adoption, but their applicability to the timeliness of innovation decision-making has not received much attention and their salience is unclear. The results support multiple hypothesised relationships, including the finding that a risk-oriented organisational culture as well as normative and coercive pressures accelerates decision timeliness. Top management support as well as the traditional innovation attributes (compatibility, relative advantage and complexity/ease-of-use) were not found to be significant when examining their influence on decision timeliness, which appears inconsistent with generally accepted knowledge and deserves further examination.
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Benefit-Risk Analysis for Decision-Making: An Approach.
Raju, G K; Gurumurthi, K; Domike, R
2016-12-01
The analysis of benefit and risk is an important aspect of decision-making throughout the drug lifecycle. In this work, the use of a benefit-risk analysis approach to support decision-making was explored. The proposed approach builds on the qualitative US Food and Drug Administration (FDA) approach to include a more explicit analysis based on international standards and guidance that enables aggregation and comparison of benefit and risk on a common basis and a lifecycle focus. The approach is demonstrated on six decisions over the lifecycle (e.g., accelerated approval, withdrawal, and traditional approval) using two case studies: natalizumab for multiple sclerosis (MS) and bedaquiline for multidrug-resistant tuberculosis (MDR-TB). © 2016 American Society for Clinical Pharmacology and Therapeutics.
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Niewada, Maciej; Polkowska, Małgorzata; Jakubczyk, Michał; Golicki, Dominik
This study aimed to evaluate the factors that are associated with positive (supporting public funding) and negative recommendations of the Agency for Health Technology Assessment in Poland. Two independent analysts reviewed all the recommendations publicly available online before October 7, 2011. For each recommendation, predefined decision rationales, that is, clinical efficacy, safety, cost-effectiveness, and formal aspects, were sought, either advocating or discouraging the public financing. In the analysis, we used descriptive statistics and a logistic regression model so as to identify the association between predefined criteria and the recommendation being positive. We identified 344 recommendations-218 positive (62.8%) and 126 negative (37.2%). Negative recommendations were better justified and also the comments were less ambiguous in accordance with the recommendation (except for clinical efficacy). In general, the specified criteria supported the decision (either positive or negative) in 209 (60.8%), 107 (31.1%), 124 (36.0%), 96 (27.9%), and 61 (17.7%) recommendations, respectively, and ran contrary to the actual decision in the remaining ones. Threshold values for either cost-effectiveness or budget impact distinguishing positive from negative recommendations could not be specified. The following parameters reached statistical significance in logistic regression: clinical efficacy (both explicitly positive and explicitly negative evaluations impacted in opposite directions), lack of impact on hard end points, unfavorable safety profile, cost-effectiveness results, and formal shortcomings (all reduced the probability of a positive recommendation). Decision making of the Agency for Health Technology Assessment in Poland is multicriterial, and its results cannot be easily decomposed into simple associations or easily predicted. Still, efficacy and safety seem to contribute most to final recommendations. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
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Validation of educational assessments: a primer for simulation and beyond.
Cook, David A; Hatala, Rose
2016-01-01
Simulation plays a vital role in health professions assessment. This review provides a primer on assessment validation for educators and education researchers. We focus on simulation-based assessment of health professionals, but the principles apply broadly to other assessment approaches and topics. Validation refers to the process of collecting validity evidence to evaluate the appropriateness of the interpretations, uses, and decisions based on assessment results. Contemporary frameworks view validity as a hypothesis, and validity evidence is collected to support or refute the validity hypothesis (i.e., that the proposed interpretations and decisions are defensible). In validation, the educator or researcher defines the proposed interpretations and decisions, identifies and prioritizes the most questionable assumptions in making these interpretations and decisions (the "interpretation-use argument"), empirically tests those assumptions using existing or newly-collected evidence, and then summarizes the evidence as a coherent "validity argument." A framework proposed by Messick identifies potential evidence sources: content, response process, internal structure, relationships with other variables, and consequences. Another framework proposed by Kane identifies key inferences in generating useful interpretations: scoring, generalization, extrapolation, and implications/decision. We propose an eight-step approach to validation that applies to either framework: Define the construct and proposed interpretation, make explicit the intended decision(s), define the interpretation-use argument and prioritize needed validity evidence, identify candidate instruments and/or create/adapt a new instrument, appraise existing evidence and collect new evidence as needed, keep track of practical issues, formulate the validity argument, and make a judgment: does the evidence support the intended use? Rigorous validation first prioritizes and then empirically evaluates key assumptions in the interpretation and use of assessment scores. Validation science would be improved by more explicit articulation and prioritization of the interpretation-use argument, greater use of formal validation frameworks, and more evidence informing the consequences and implications of assessment.
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A spatially explicit decision support model for restoration of forest bird habitat
Twedt, D.J.; Uihlein, W.B.; Elliott, A.B.
2006-01-01
The historical area of bottomland hardwood forest in the Mississippi Alluvial Valley has been reduced by >75%. Agricultural production was the primary motivator for deforestation; hence, clearing deliberately targeted higher and drier sites. Remaining forests are highly fragmented and hydrologically altered, with larger forest fragments subject to greater inundation, which has negatively affected many forest bird populations. We developed a spatially explicit decision support model, based on a Partners in Flight plan for forest bird conservation, that prioritizes forest restoration to reduce forest fragmentation and increase the area of forest core (interior forest >1 km from 'hostile' edge). Our primary objective was to increase the number of forest patches that harbor >2000 ha of forest core, but we also sought to increase the number and area of forest cores >5000 ha. Concurrently, we targeted restoration within local (320 km2) landscapes to achieve >60% forest cover. Finally, we emphasized restoration of higher-elevation bottomland hardwood forests in areas where restoration would not increase forest fragmentation. Reforestation of 10% of restorable land in the Mississippi Alluvial Valley (approximately 880,000 ha) targeted at priorities established by this decision support model resulted in approximately 824,000 ha of new forest core. This is more than 32 times the amount of core forest added through reforestation of randomly located fields (approximately 25,000 ha). The total area of forest core (1.6 million ha) that resulted from targeted restoration exceeded habitat objectives identified in the Partners in Flight Bird Conservation Plan and approached the area of forest core present in the 1950s.
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This synthetic, multi-scale approach will generate a sequence of spatially explicit maps that will provide science guidance to support strategic decision-making regarding the spatially-distributed risk of, and possible adaptation to, the spread of invasive species at local to ...
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Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses
Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn
2016-01-01
Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness. PMID:26813512
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NASA Astrophysics Data System (ADS)
Matkins, Juanita Jo; Bell, Randy L.
2007-04-01
This investigation assessed the impact of situating explicit nature of science (NOS) instruction within the issues surrounding global climate change and global warming (GCC/GW). Participants in the study were 15 preservice elementary teachers enrolled in a science methods course. The instructional intervention included explicit NOS instruction combined with explicit GCC/GW instruction situated within the normal elementary science methods curriculum. Participants’ conceptions of NOS and GCC/GW were assessed with pre- and postadministrations of open-ended questionnaires and interviews. Results indicated that participants’ conceptions of NOS and GCC/GW improved over the course of the semester. Furthermore, participants were able to apply their conceptions to decision making about socioscientific issues. The results provide support for context-based NOS instruction in an elementary science methods course.
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Swanberg, Jennifer E.; Nichols, Helen M.; Ko, Jungyai; Tracy, J. Kathleen; Vanderpool, Robin C.
2017-01-01
Advances in breast cancer screening and treatment have led to an overall 5-year survival rate of 90%. Many of these cancer cases are diagnosed in working women. Few studies have explicitly examined the cancer–work interface, as experienced by low-wage earning women with breast cancer. This study uses in-depth, semistructured interviews with 24 low-wage breast cancer survivors to identify employment decisions and factors that influenced or enabled these decisions, and examine the individual strategies and workplace supports used to manage the cancer–work interface among a subset of women (n = 13) who continued to work. Future research areas and clinical implications are discussed. PMID:28045595
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Swanberg, Jennifer E; Nichols, Helen M; Ko, Jungyai; Tracy, J Kathleen; Vanderpool, Robin C
2017-01-01
Advances in breast cancer screening and treatment have led to an overall 5-year survival rate of 90%. Many of these cancer cases are diagnosed in working women. Few studies have explicitly examined the cancer-work interface, as experienced by low-wage earning women with breast cancer. This study uses in-depth, semistructured interviews with 24 low-wage breast cancer survivors to identify employment decisions and factors that influenced or enabled these decisions, and examine the individual strategies and workplace supports used to manage the cancer-work interface among a subset of women (n = 13) who continued to work. Future research areas and clinical implications are discussed.
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Abhyankar, Purva; Velikova, Galina; Summers, Barbara; Bekker, Hilary L
2016-07-01
Research governance requires patients give informed consent to participate in clinical trials. However, there are concerns that consent information may not support patient participation decisions. This study investigates the utility of consent information in supporting women's trial participation decisions when receiving treatment for cancer. An interview study with women receiving cancer treatments at a medical oncology outpatient clinic in Yorkshire (UK). All women over 18 years, not admitted to a hospital ward and who had currently or previously been invited to take part in a trial were invited to take part in the study over a three month period. Interviews were audio-tape recorded, transcribed and analysed using thematic analysis. Of those eligible (n = 41), 21 women with breast (n = 11), ovarian (n = 8) and endometrial (n = 2) cancer participated (mean age = 57 years). Eighteen had made at least one trial decision and three were considering taking part in a trial. Findings are synthesised under two analytical themes: 1) Influence of the cancer and cancer treatment context on decision making for trial participation; and 2) Experiences of the consenting process and their influence on decision making. Designing trial information to represent explicitly the trial participation decision as being between standard care and study-related care options is more likely to effectively support patients in making informed decisions between standard care treatments and taking part in a trial. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Towards a more open debate about values in decision-making on agricultural biotechnology.
Devos, Yann; Sanvido, Olivier; Tait, Joyce; Raybould, Alan
2014-12-01
Regulatory decision-making over the use of products of new technology aims to be based on science-based risk assessment. In some jurisdictions, decision-making about the cultivation of genetically modified (GM) plants is blocked supposedly because of scientific uncertainty about risks to the environment. However, disagreement about the acceptability of risks is primarily a dispute over normative values, which is not resolvable through natural sciences. Natural sciences may improve the quality and relevance of the scientific information used to support environmental risk assessments and make scientific uncertainties explicit, but offer little to resolve differences about values. Decisions about cultivating GM plants will thus not necessarily be eased by performing more research to reduce scientific uncertainty in environmental risk assessments, but by clarifying the debate over values. We suggest several approaches to reveal values in decision-making: (1) clarifying policy objectives; (2) determining what constitutes environmental harm; (3) making explicit the factual and normative premises on which risk assessments are based; (4) better demarcating environmental risk assessment studies from ecological research; (5) weighing the potential for environmental benefits (i.e., opportunities) as well as the potential for environmental harms (i.e., risks); and (6) expanding participation in the risk governance of GM plants. Recognising and openly debating differences about values will not remove controversy about the cultivation of GM plants. However, by revealing what is truly in dispute, debates about values will clarify decision-making criteria.
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Schiebener, Johannes; Brand, Matthias
2017-06-01
Previous literature has explained older individuals' disadvantageous decision-making under ambiguity in the Iowa Gambling Task (IGT) by reduced emotional warning signals preceding decisions. We argue that age-related reductions in IGT performance may also be explained by reductions in certain cognitive abilities (reasoning, executive functions). In 210 participants (18-86 years), we found that the age-related variance on IGT performance occurred only in the last 60 trials. The effect was mediated by cognitive abilities and their relation with decision-making performance under risk with explicit rules (Game of Dice Task). Thus, reductions in cognitive functions in older age may be associated with both a reduced ability to gain explicit insight into the rules of the ambiguous decision situation and with failure to choose the less risky options consequently after the rules have been understood explicitly. Previous literature may have underestimated the relevance of cognitive functions for age-related decline in decision-making performance under ambiguity.
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Bayes` theorem and quantitative risk assessment
DOE Office of Scientific and Technical Information (OSTI.GOV)
Kaplan, S.
1994-12-31
This paper argues that for a quantitative risk analysis (QRA) to be useful for public and private decision making, and for rallying the support necessary to implement those decisions, it is necessary that the QRA results be ``trustable.`` Trustable means that the results are based solidly and logically on all the relevant evidence available. This, in turn, means that the quantitative results must be derived from the evidence using Bayes` theorem. Thus, it argues that one should strive to make their QRAs more clearly and explicitly Bayesian, and in this way make them more ``evidence dependent`` than ``personality dependent.``
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Lessons for outsourcing and interim management relationships.
Macko, W; Kostyack, P T
1999-01-01
Few decisions can affect an organization more than the selection of an outsourcing or interim management partner. More and more health care organizations face such decisions in today's competitive market in order to face new business needs. Making these relationships successful can be important for health care organizations seeking competitive advantages or seeking immediately accessible management support. These relationships, however, require careful partner selection and development. Success in outsourcing and interim management relationships is contingent upon a thorough selection process, a strong contract that has clearly and explicitly detailed responsibilities and a culture-sensitive business rapport between the client and selected partner.
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Pletzer, Belinda; M Ortner, Tuulia
2016-09-01
Personality assessment has been challenged by the fact that different assessment methods (implicit measures, behavioral measures and explicit rating scales) show little or no convergence in behavioral studies. In this neuroimaging study we address for the first time, whether different assessment methods rely on separate or overlapping neuronal systems. Fifty nine healthy adult participants completed two objective personality tests of risk propensity: the more implicit Balloon Analogue Risk Task (BART) and the more explicit Game of Dice Task (GDT). Significant differences in activation, as well as connectivity patterns between both tasks were observed. In both tasks, risky decisions yielded significantly stronger activations than safe decisions in the bilateral caudate, as well as the bilateral Insula. The finding of overlapping brain areas validates different assessment methods, despite their behavioral non-convergence. This suggests that neuroimaging can be an important tool of validation in the field of personality assessment. Copyright © 2016 Elsevier B.V. All rights reserved.
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Thinking Together: Modeling Clinical Decision-Support as a Sociotechnical System
Hussain, Mustafa I.; Reynolds, Tera L.; Mousavi, Fatemeh E.; Chen, Yunan; Zheng, Kai
2017-01-01
Computerized clinical decision-support systems are members of larger sociotechnical systems, composed of human and automated actors, who send, receive, and manipulate artifacts. Sociotechnical consideration is rare in the literature. This makes it difficult to comparatively evaluate the success of CDS implementations, and it may also indicate that sociotechnical context receives inadequate consideration in practice. To facilitate sociotechnical consideration, we developed the Thinking Together model, a flexible diagrammatical means of representing CDS systems as sociotechnical systems. To develop this model, we examined the literature with the lens of Distributed Cognition (DCog) theory. We then present two case studies of vastly different CDSSs, one almost fully automated and the other with minimal automation, to illustrate the flexibility of the Thinking Together model. We show that this model, informed by DCog and the CDS literature, are capable of supporting both research, by enabling comparative evaluation, and practice, by facilitating explicit sociotechnical planning and communication. PMID:29854164
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Anticipatory stress influences decision making under explicit risk conditions.
Starcke, Katrin; Wolf, Oliver T; Markowitsch, Hans J; Brand, Matthias
2008-12-01
Recent research has suggested that stress may affect memory, executive functioning, and decision making on the basis of emotional feedback processing. The current study examined whether anticipatory stress affects decision making measured with the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps both executive functioning and feedback learning. The authors induced stress in 20 participants by having them anticipate giving a public speech and also examined 20 comparison subjects. The authors assessed the level of stress with questionnaires and endocrine markers (salivary cortisol and alpha-amylase), both revealing that speech anticipation led to increased stress. Results of the GDT showed that participants under stress scored significantly lower than the comparison group and that GDT performance was negatively correlated with the increase of cortisol. Our results indicate that stress can lead to disadvantageous decision making even when explicit and stable information about outcome contingencies is provided.
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Norman, Laura; Tallent-Halsell, Nita; Labiosa, William; Weber, Matt; McCoy, Amy; Hirschboeck, Katie; Callegary, James; van Riper, Charles; Gray, Floyd
2010-01-01
Using respective strengths of the biological, physical, and social sciences, we are developing an online decision support tool, the Santa Cruz Watershed Ecosystem Portfolio Model (SCWEPM), to help promote the use of information relevant to water allocation and land management in a binational watershed along the U.S.-Mexico border. The SCWEPM will include an ES valuation system within a suite of linked regional driver-response models and will use a multicriteria scenario-evaluation framework that builds on GIS analysis and spatially-explicit models that characterize important ecological, economic, and societal endpoints and consequences that are sensitive to climate patterns, regional water budgets, and regional LULC change in the SCW.
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Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O
2012-06-01
It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), p<0.001. We conclude that non-stationary fuzzy models provide a valuable new approach that may be applied to clinical decision support systems in any application domain. Copyright © 2012 Elsevier Inc. All rights reserved.
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Liu, X; Gorsevski, P V; Yacobucci, M M; Onasch, C M
2016-06-01
Planning of shale gas infrastructure and drilling sites for hydraulic fracturing has important spatial implications. The evaluation of conflicting and competing objectives requires an explicit consideration of multiple criteria as they have important environmental and economic implications. This study presents a web-based multicriteria spatial decision support system (SDSS) prototype with a flexible and user-friendly interface that could provide educational or decision-making capabilities with respect to hydraulic fracturing site selection in eastern Ohio. One of the main features of this SDSS is to emphasize potential trade-offs between important factors of environmental and economic ramifications from hydraulic fracturing activities using a weighted linear combination (WLC) method. In the prototype, the GIS-enabled analytical components allow spontaneous visualization of available alternatives on maps which provide value-added features for decision support processes and derivation of final decision maps. The SDSS prototype also facilitates nonexpert participation capabilities using a mapping module, decision-making tool, group decision module, and social media sharing tools. The logical flow of successively presented forms and standardized criteria maps is used to generate visualization of trade-off scenarios and alternative solutions tailored to individual user's preferences that are graphed for subsequent decision-making.
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D. Todd Jones-Farrand; John M. Tirpak; Frank R. Thompson; Daniel J. Twedt; Charles K. Baxter; Jane A. Fitzgerald; William B. Uihlein
2009-01-01
Setting and achieving population objectives for priority landbirds must be informed by, 1) the quantity, quality, and spatial confi guration of available habitat, 2) an explicit linkage between habitat condition and population response, and 3) expected future habitat conditions. Based on this philosophy, the Central Hardwoods and Lower Mississippi Valley Joint Ventures...
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Utility assessment of a map-based online geo-collaboration tool.
Sidlar, Christopher L; Rinner, Claus
2009-05-01
Spatial group decision-making processes often include both informal and analytical components. Discussions among stakeholders or planning experts are an example of an informal component. When participants discuss spatial planning projects they typically express concerns and comments by pointing to places on a map. The Argumentation Map model provides a conceptual basis for collaborative tools that enable explicit linkages of arguments to the places to which they refer. These tools allow for the input of explicitly geo-referenced arguments as well as the visual access to arguments through a map interface. In this paper, we will review previous utility studies in geo-collaboration and evaluate a case study of a Web-based Argumentation Map application. The case study was conducted in the summer of 2005 when student participants discussed planning issues on the University of Toronto St. George campus. During a one-week unmoderated discussion phase, 11 participants wrote 60 comments on issues such as safety, facilities, parking, and building aesthetics. By measuring the participants' use of geographic references, we draw conclusions on how well the software tool supported the potential of the underlying concept. This research aims to contribute to a scientific approach to geo-collaboration in which the engineering of novel spatial decision support methods is complemented by a critical assessment of their utility in controlled, realistic experiments.
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Huang, Yumi H; Wood, Stacey; Berger, Dale E; Hanoch, Yaniv
2015-09-01
Older adults experience declines in deliberative decisional capacities, while their affective or experiential abilities tend to remain intact (Peters & Bruine de Bruin, 2012). The current study used this framework to investigate age differences in description-based and experience-based decision-making tasks. Description-based tasks emphasize deliberative processing by allowing decision makers to analyze explicit descriptions of choice-reward information. Experience-based tasks emphasize affective or experiential processing because they lack the explicit choice-reward information, forcing decision makers to rely on feelings and information derived from past experiences. This study used the Columbia Card Task (CCT) as a description-based task where probability information is provided and the Iowa Gambling Task (IGT) as an experience-based task, where it is not. As predicted, compared to younger adults (N = 65), older adults (N = 65) performed more poorly on the CCT but performed similarly on the IGT. Deliberative capacities (i.e., executive control and numeracy abilities) explained the relationship between age and performance on the CCT, suggesting that age-related differences in description-based decision-making tasks are related to declines in deliberative capacities. However, deliberative capacities were not associated with performance on the IGT for either older or younger adults. Nevertheless, on the IGT, older adults reported more use of affect-based strategies versus deliberative strategies, whereas younger adults reported similar use of these strategies. This finding offers partial support for the idea that decision-making tasks that rely on deliberate processing are more likely to demonstrate age effects than those that are more experiential. (c) 2015 APA, all rights reserved).
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Optimal routing of hazardous substances in time-varying, stochastic transportation networks
DOE Office of Scientific and Technical Information (OSTI.GOV)
Woods, A.L.; Miller-Hooks, E.; Mahmassani, H.S.
This report is concerned with the selection of routes in a network along which to transport hazardous substances, taking into consideration several key factors pertaining to the cost of transport and the risk of population exposure in the event of an accident. Furthermore, the fact that travel time and the risk measures are not constant over time is explicitly recognized in the routing decisions. Existing approaches typically assume static conditions, possibly resulting in inefficient route selection and unnecessary risk exposure. The report described the application of recent advances in network analysis methodologies to the problem of routing hazardous substances. Severalmore » specific problem formulations are presented, reflecting different degrees of risk aversion on the part of the decision-maker, as well as different possible operational scenarios. All procedures explicitly consider travel times and travel costs (including risk measures) to be stochastic time-varying quantities. The procedures include both exact algorithms, which may require extensive computational effort in some situations, as well as more efficient heuristics that may not guarantee a Pareto-optimal solution. All procedures are systematically illustrated for an example application using the Texas highway network, for both normal and incident condition scenarios. The application illustrates the trade-offs between the information obtained in the solution and computational efficiency, and highlights the benefits of incorporating these procedures in a decision-support system for hazardous substance shipment routing decisions.« less
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Implicit race attitudes predict trustworthiness judgments and economic trust decisions
Stanley, Damian A.; Sokol-Hessner, Peter; Banaji, Mahzarin R.; Phelps, Elizabeth A.
2011-01-01
Trust lies at the heart of every social interaction. Each day we face decisions in which we must accurately assess another individual's trustworthiness or risk suffering very real consequences. In a global marketplace of increasing heterogeneity with respect to nationality, race, and multiple other social categories, it is of great value to understand how implicitly held attitudes about group membership may support or undermine social trust and thereby implicitly shape the decisions we make. Recent behavioral and neuroimaging work suggests that a common mechanism may underlie the expression of implicit race bias and evaluations of trustworthiness, although no direct evidence of a connection exists. In two behavioral studies, we investigated the relationship between implicit race attitude (as measured by the Implicit Association Test) and social trust. We demonstrate that race disparity in both an individual's explicit evaluations of trustworthiness and, more crucially, his or her economic decisions to trust is predicted by that person's bias in implicit race attitude. Importantly, this relationship is robust and is independent of the individual's bias in explicit race attitude. These data demonstrate that the extent to which an individual invests in and trusts others with different racial backgrounds is related to the magnitude of that individual's implicit race bias. The core dimension of social trust can be shaped, to some degree, by attitudes that reside outside conscious awareness and intention. PMID:21518877
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Implicit race attitudes predict trustworthiness judgments and economic trust decisions.
Stanley, Damian A; Sokol-Hessner, Peter; Banaji, Mahzarin R; Phelps, Elizabeth A
2011-05-10
Trust lies at the heart of every social interaction. Each day we face decisions in which we must accurately assess another individual's trustworthiness or risk suffering very real consequences. In a global marketplace of increasing heterogeneity with respect to nationality, race, and multiple other social categories, it is of great value to understand how implicitly held attitudes about group membership may support or undermine social trust and thereby implicitly shape the decisions we make. Recent behavioral and neuroimaging work suggests that a common mechanism may underlie the expression of implicit race bias and evaluations of trustworthiness, although no direct evidence of a connection exists. In two behavioral studies, we investigated the relationship between implicit race attitude (as measured by the Implicit Association Test) and social trust. We demonstrate that race disparity in both an individual's explicit evaluations of trustworthiness and, more crucially, his or her economic decisions to trust is predicted by that person's bias in implicit race attitude. Importantly, this relationship is robust and is independent of the individual's bias in explicit race attitude. These data demonstrate that the extent to which an individual invests in and trusts others with different racial backgrounds is related to the magnitude of that individual's implicit race bias. The core dimension of social trust can be shaped, to some degree, by attitudes that reside outside conscious awareness and intention.
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Fujiwara, Esther; Tomlinson, Sara E; Purdon, Scot E; Gill, M John; Power, Christopher
2015-01-01
Human immunodeficiency virus (HIV) can affect the frontal-striatal brain regions, which are known to subserve decision-making functions. Previous studies have reported impaired decision making among HIV+ individuals using the Iowa Gambling Task, a task that assesses decision making under ambiguity. Previous study populations often had significant comorbidities such as past or present substance use disorders and/or hepatitis C virus coinfection, complicating conclusions about the unique contributions of HIV-infection to decision making. Decision making under explicit risk has very rarely been examined in HIV+ individuals and was tested here using the Game of Dice Task (GDT). We examined decision making under explicit risk in the GDT in 20 HIV+ individuals without substance use disorder or HCV coinfection, including a demographically matched healthy control group (n = 20). Groups were characterized on a standard neuropsychological test battery. For the HIV+ group, several disease-related parameters (viral load, current and nadir CD4 T-cell count) were included. Analyses focused on the GDT and spanned between-group (t-tests; analysis of covariance, ANCOVA) as well as within-group comparisons (Pearson/Spearman correlations). HIV+ individuals were impaired in the GDT, compared to healthy controls (p = .02). Their decision-making impairments were characterized by less advantageous choices and more random choice strategies, especially towards the end of the task. Deficits in the GDT in the HIV+ group were related to executive dysfunctions, slowed processing/motor speed, and current immune system status (CD4+ T-cell levels, ps < .05). Decision making under explicit risk in the GDT can occur in HIV-infected individuals without comorbidities. The correlational patterns may point to underlying fronto-subcortical dysfunctions in HIV+ individuals. The GDT provides a useful measure to assess risky decision making in this population and should be tested in larger studies.
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Embracing uncertainty in applied ecology.
Milner-Gulland, E J; Shea, K
2017-12-01
Applied ecologists often face uncertainty that hinders effective decision-making.Common traps that may catch the unwary are: ignoring uncertainty, acknowledging uncertainty but ploughing on, focussing on trivial uncertainties, believing your models, and unclear objectives.We integrate research insights and examples from a wide range of applied ecological fields to illustrate advances that are generally underused, but could facilitate ecologists' ability to plan and execute research to support management.Recommended approaches to avoid uncertainty traps are: embracing models, using decision theory, using models more effectively, thinking experimentally, and being realistic about uncertainty. Synthesis and applications . Applied ecologists can become more effective at informing management by using approaches that explicitly take account of uncertainty.
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Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G
2013-09-01
Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.
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Girvan, Erik J; Deason, Grace; Borgida, Eugene
2015-10-01
Decades of social-psychological research show that gender bias can result from features of the social context and from individual-level psychological predispositions. Do these sources of bias impact legal decisions, which are frequently made by people subject to factors that have been proposed to reduce bias (training and accountability)? To answer the question, we examined the potential for 3 major social-psychological theories of gender bias (role-congruity theory, ambivalent sexism, and implicit bias) to predict outcomes of labor arbitration decisions. In the first study, undergraduate students and professional arbitrators made decisions about 2 mock arbitration cases in which the gender of the employee-grievants was experimentally manipulated. Student participants' decisions showed the predicted gender bias, whereas the decisions of experienced professionals did not. Individual-level attitudes did not predict the extent of the observed bias and accountability did not attenuate it. In the second study, arbitrators' explicit and implicit gender attitudes were significant predictors of their decisions in published cases. The laboratory and field results suggest that context, expertise, and implicit and explicit attitudes are relevant to legal decision-making, but that laboratory experiments alone may not fully capture the nature of their effect on legal professionals' decisions in real cases. (c) 2015 APA, all rights reserved).
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Gareau, Alexandre; Gaudreau, Patrick
2017-11-01
In previous research, autonomous motivation (AM) has been found to be associated with school achievement, but the relation has been largely heterogeneous across studies. AM has typically been assessed with explicit measures such as self-report questionnaires. Recent self-determination theory (SDT) research has suggested that converging implicit and explicit measures can be taken to characterize the integrative process in SDT. Drawing from dual-process theories, we contended that explicit AM is likely to promote school achievement when it is part of an integrated cognitive system that combines easily accessible mental representations (i.e., implicit AM) and efficient executive functioning. A sample of 272 university students completed a questionnaire and a lexical decision task to assess their explicit and implicit AM, respectively, and they also completed working memory capacity measures. Grades were obtained at the end of the semester to examine the short-term prospective effect of implicit and explicit AM, working memory, and their interaction. Results of moderation analyses have provided support for a synergistic interaction in which the association between explicit AM and academic achievement was positive and significant only for individuals with high level of implicit AM. Moreover, working memory was moderating the synergistic effect of explicit and implicit AM. Explicit AM was positively associated with academic achievement for students with average-to-high levels of working memory capacity, but only if their motivation operated synergistically with high implicit AM. The integrative process thus seems to hold better proprieties for achievement than the sole effect of explicit AM. Implications for SDT are outlined. © 2017 The British Psychological Society.
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Faulkner, Stephen P.
2010-01-01
Landscape patterns and processes reflect both natural ecosystem attributes and the policy and management decisions of individual Federal, State, county, and private organizations. Land-use regulation, water management, and habitat conservation and restoration efforts increasingly rely on landscape-level approaches that incorporate scientific information into the decision-making process. Since management actions are implemented to affect future conditions, decision-support models are necessary to forecast potential future conditions resulting from these decisions. Spatially explicit modeling approaches enable testing of different scenarios and help evaluate potential outcomes of management actions in conjunction with natural processes such as climate change. The ability to forecast the effects of changing land use and climate is critically important to land and resource managers since their work is inherently site specific, yet conservation strategies and practices are expressed at higher spatial and temporal scales that must be considered in the decisionmaking process.
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Facing uncertainty in ecosystem services-based resource management.
Grêt-Regamey, Adrienne; Brunner, Sibyl H; Altwegg, Jürg; Bebi, Peter
2013-09-01
The concept of ecosystem services is increasingly used as a support for natural resource management decisions. While the science for assessing ecosystem services is improving, appropriate methods to address uncertainties in a quantitative manner are missing. Ignoring parameter uncertainties, modeling uncertainties and uncertainties related to human-environment interactions can modify decisions and lead to overlooking important management possibilities. In this contribution, we present a new approach for mapping the uncertainties in the assessment of multiple ecosystem services. The spatially explicit risk approach links Bayesian networks to a Geographic Information System for forecasting the value of a bundle of ecosystem services and quantifies the uncertainties related to the outcomes in a spatially explicit manner. We demonstrate that mapping uncertainties in ecosystem services assessments provides key information for decision-makers seeking critical areas in the delivery of ecosystem services in a case study in the Swiss Alps. The results suggest that not only the total value of the bundle of ecosystem services is highly dependent on uncertainties, but the spatial pattern of the ecosystem services values changes substantially when considering uncertainties. This is particularly important for the long-term management of mountain forest ecosystems, which have long rotation stands and are highly sensitive to pressing climate and socio-economic changes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Tang, Zhongqian; Zhang, Hua; Yi, Shanzhen; Xiao, Yangfan
2018-03-01
GIS-based multi-criteria decision analysis (MCDA) is increasingly used to support flood risk assessment. However, conventional GIS-MCDA methods fail to adequately represent spatial variability and are accompanied with considerable uncertainty. It is, thus, important to incorporate spatial variability and uncertainty into GIS-based decision analysis procedures. This research develops a spatially explicit, probabilistic GIS-MCDA approach for the delineation of potentially flood susceptible areas. The approach integrates the probabilistic and the local ordered weighted averaging (OWA) methods via Monte Carlo simulation, to take into account the uncertainty related to criteria weights, spatial heterogeneity of preferences and the risk attitude of the analyst. The approach is applied to a pilot study for the Gucheng County, central China, heavily affected by the hazardous 2012 flood. A GIS database of six geomorphological and hydrometeorological factors for the evaluation of susceptibility was created. Moreover, uncertainty and sensitivity analysis were performed to investigate the robustness of the model. The results indicate that the ensemble method improves the robustness of the model outcomes with respect to variation in criteria weights and identifies which criteria weights are most responsible for the variability of model outcomes. Therefore, the proposed approach is an improvement over the conventional deterministic method and can provides a more rational, objective and unbiased tool for flood susceptibility evaluation.
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The potential for meta-analysis to support decision analysis in ecology.
Mengersen, Kerrie; MacNeil, M Aaron; Caley, M Julian
2015-06-01
Meta-analysis and decision analysis are underpinned by well-developed methods that are commonly applied to a variety of problems and disciplines. While these two fields have been closely linked in some disciplines such as medicine, comparatively little attention has been paid to the potential benefits of linking them in ecology, despite reasonable expectations that benefits would be derived from doing so. Meta-analysis combines information from multiple studies to provide more accurate parameter estimates and to reduce the uncertainty surrounding them. Decision analysis involves selecting among alternative choices using statistical information that helps to shed light on the uncertainties involved. By linking meta-analysis to decision analysis, improved decisions can be made, with quantification of the costs and benefits of alternate decisions supported by a greater density of information. Here, we briefly review concepts of both meta-analysis and decision analysis, illustrating the natural linkage between them and the benefits from explicitly linking one to the other. We discuss some examples in which this linkage has been exploited in the medical arena and how improvements in precision and reduction of structural uncertainty inherent in a meta-analysis can provide substantive improvements to decision analysis outcomes by reducing uncertainty in expected loss and maximising information from across studies. We then argue that these significant benefits could be translated to ecology, in particular to the problem of making optimal ecological decisions in the face of uncertainty. Copyright © 2013 John Wiley & Sons, Ltd.
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Health care priority setting: principles, practice and challenges
Mitton, Craig; Donaldson, Cam
2004-01-01
Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated. PMID:15104792
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What is lacking in current decision aids on cancer screening?
Jimbo, Masahito; Rana, Gurpreet K.; Hawley, Sarah; Holmes-Rovner, Margaret; Kelly-Blake, Karen; Nease, Donald E.; Ruffin, Mack T.
2013-01-01
Recent guidelines on cancer screening have given not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians’ support, must decide whether to get screened or not, which modality to use, and how often to get screened. Decision aids could potentially lead to better shared decision making regarding screening between the patient and the clinician. We reviewed 73 decision aids on screening for breast, cervical, colorectal, and prostate cancers. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need for more research, and determine how the decision aids can be currently applied in the real world setting. Most studies used sound study design. Significant variation existed in setting, theoretical framework, and measured outcomes. Just over a third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted in which patient attributes were measured as outcomes. Few studies actually measured shared decision making. Little information was available on the feasibility and outcomes of integrating decision aids into practice. We discuss the implications for future research, as well as what the clinicians can do now to incorporate decision aids into their practice. PMID:23504675
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Azria, E; Tsatsaris, V; Moriette, G; Hirsch, E; Schmitz, T; Cabrol, D; Goffinet, F
2007-05-01
Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those children remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care" is crucial. This work is focused on this problematic of decision-making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.
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Interpreting support vector machine models for multivariate group wise analysis in neuroimaging
Gaonkar, Bilwaj; Shinohara, Russell T; Davatzikos, Christos
2015-01-01
Machine learning based classification algorithms like support vector machines (SVMs) have shown great promise for turning a high dimensional neuroimaging data into clinically useful decision criteria. However, tracing imaging based patterns that contribute significantly to classifier decisions remains an open problem. This is an issue of critical importance in imaging studies seeking to determine which anatomical or physiological imaging features contribute to the classifier’s decision, thereby allowing users to critically evaluate the findings of such machine learning methods and to understand disease mechanisms. The majority of published work addresses the question of statistical inference for support vector classification using permutation tests based on SVM weight vectors. Such permutation testing ignores the SVM margin, which is critical in SVM theory. In this work we emphasize the use of a statistic that explicitly accounts for the SVM margin and show that the null distributions associated with this statistic are asymptotically normal. Further, our experiments show that this statistic is a lot less conservative as compared to weight based permutation tests and yet specific enough to tease out multivariate patterns in the data. Thus, we can better understand the multivariate patterns that the SVM uses for neuroimaging based classification. PMID:26210913
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Labudda, Kirsten; Woermann, Friedrich G; Mertens, Markus; Pohlmann-Eden, Bernd; Markowitsch, Hans J; Brand, Matthias
2008-06-01
Recent functional neuroimaging and lesion studies demonstrate the involvement of the orbitofrontal/ventromedial prefrontal cortex as a key structure in decision making processes. This region seems to be particularly crucial when contingencies between options and consequences are unknown but have to be learned by the use of feedback following previous decisions (decision making under ambiguity). However, little is known about the neural correlates of decision making under risk conditions in which information about probabilities and potential outcomes is given. In the present study, we used functional magnetic resonance imaging to measure blood-oxygenation-level-dependent (BOLD) responses in 12 subjects during a decision making task. This task provided explicit information about probabilities and associated potential incentives. The responses were compared to BOLD signals in a control condition without information about incentives. In contrast to previous decision making studies, we completely removed the outcome phase following a decision to exclude the potential influence of feedback previously received on current decisions. The results indicate that the integration of information about probabilities and incentives leads to activations within the dorsolateral prefrontal cortex, the posterior parietal lobe, the anterior cingulate and the right lingual gyrus. We assume that this pattern of activation is due to the involvement of executive functions, conflict detection mechanisms and arithmetic operations during the deliberation phase of decisional processes that are based on explicit information.
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Wolfslehner, Bernhard; Seidl, Rupert
2010-12-01
The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.
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NASA Astrophysics Data System (ADS)
Wolfslehner, Bernhard; Seidl, Rupert
2010-12-01
The decision-making environment in forest management (FM) has changed drastically during the last decades. Forest management planning is facing increasing complexity due to a widening portfolio of forest goods and services, a societal demand for a rational, transparent decision process and rising uncertainties concerning future environmental conditions (e.g., climate change). Methodological responses to these challenges include an intensified use of ecosystem models to provide an enriched, quantitative information base for FM planning. Furthermore, multi-criteria methods are increasingly used to amalgamate information, preferences, expert judgments and value expressions, in support of the participatory and communicative dimensions of modern forestry. Although the potential of combining these two approaches has been demonstrated in a number of studies, methodological aspects in interfacing forest ecosystem models (FEM) and multi-criteria decision analysis (MCDA) are scarcely addressed explicitly. In this contribution we review the state of the art in FEM and MCDA in the context of FM planning and highlight some of the crucial issues when combining ecosystem and preference modeling. We discuss issues and requirements in selecting approaches suitable for supporting FM planning problems from the growing body of FEM and MCDA concepts. We furthermore identify two major challenges in a harmonized application of FEM-MCDA: (i) the design and implementation of an indicator-based analysis framework capturing ecological and social aspects and their interactions relevant for the decision process, and (ii) holistic information management that supports consistent use of different information sources, provides meta-information as well as information on uncertainties throughout the planning process.
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Griffey, Richard T; Lo, Helen G; Burdick, Elisabeth; Keohane, Carol; Bates, David W
2012-01-01
To evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs). A prospective controlled trial was conducted over 26 weeks. The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/10/06), OFF (10/10/06-11/28/06), and ON (11/28/06-1/16/07) in consecutive blocks during the study period. In patients ≥65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations. The primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review. 2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p≤0.0001). 673 (43%) visits were reviewed for ADEs. The rate of ADEs was lower during ON (8/237; 3.4%) compared with OFF (31/436; 7.1%) periods (p=0.02). The remaining secondary outcomes showed no difference. Single institution study, retrospective chart review for ADEs. Though overall agreement with recommendations was low, real-time computerized decision support resulted in greater acceptance of medication recommendations. Fewer ADEs were observed when computerized decision support was active.
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A Decision Support System for effective use of probability forecasts
NASA Astrophysics Data System (ADS)
De Kleermaeker, Simone; Verkade, Jan
2013-04-01
Often, water management decisions are based on hydrological forecasts. These forecasts, however, are affected by inherent uncertainties. It is increasingly common for forecasting agencies to make explicit estimates of these uncertainties and thus produce probabilistic forecasts. Associated benefits include the decision makers' increased awareness of forecasting uncertainties and the potential for risk-based decision-making. Also, a stricter separation of responsibilities between forecasters and decision maker can be made. However, simply having probabilistic forecasts available is not sufficient to realise the associated benefits. Additional effort is required in areas such as forecast visualisation and communication, decision making in uncertainty and forecast verification. Also, revised separation of responsibilities requires a shift in institutional arrangements and responsibilities. A recent study identified a number of additional issues related to the effective use of probability forecasts. When moving from deterministic to probability forecasting, a dimension is added to an already multi-dimensional problem; this makes it increasingly difficult for forecast users to extract relevant information from a forecast. A second issue is that while probability forecasts provide a necessary ingredient for risk-based decision making, other ingredients may not be present. For example, in many cases no estimates of flood damage, of costs of management measures and of damage reduction are available. This paper presents the results of the study, including some suggestions for resolving these issues and the integration of those solutions in a prototype decision support system (DSS). A pathway for further development of the DSS is outlined.
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2012-01-01
Background Deciding which health technologies to fund involves confronting some of the most difficult choices in medicine. As for other countries, the Israeli health system is faced each year with having to make these difficult decisions. The Public National Advisory Committee, known as ‘the Basket Committee’, selects new technologies for the basic list of health care that all Israelis are entitled to access, known as the ‘health basket’. We introduce a framework for health technology prioritization based explicitly on value for money that enables the main variables considered by decision-makers to be explicitly included. Although the framework’s exposition is in terms of the Basket Committee selecting new technologies for Israel’s health basket, we believe that the framework would also work well for other countries. Methods Our proposed prioritization framework involves comparing four main variables for each technology: 1. Incremental benefits, including ‘equity benefits’, to Israel’s population; 2. Incremental total cost to Israel’s health system; 3. Quality of evidence; and 4. Any additional ‘X-factors’ not elsewhere included, such as strategic or legal factors, etc. Applying methodology from multi-criteria decision analysis, the multiple dimensions comprising the first variable are aggregated via a points system. Results The four variables are combined for each technology and compared across the technologies in the ‘Value for Money (VfM) Chart’. The VfM Chart can be used to identify technologies that are good value for money, and, given a budget constraint, to select technologies that should be funded. This is demonstrated using 18 illustrative technologies. Conclusions The VfM Chart is an intuitively appealing decision-support tool for helping decision-makers to focus on the inherent tradeoffs involved in health technology prioritization. Such deliberations can be performed in a systematic and transparent fashion that can also be easily communicated to stakeholders, including the general public. Possible future research includes pilot-testing the VfM Chart using real-world data. Ideally, this would involve working with the Basket Committee. Likewise, the framework could be tested and applied by health technology prioritization agencies in other countries. PMID:23181391
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Golan, Ofra; Hansen, Paul
2012-11-26
Deciding which health technologies to fund involves confronting some of the most difficult choices in medicine. As for other countries, the Israeli health system is faced each year with having to make these difficult decisions. The Public National Advisory Committee, known as 'the Basket Committee', selects new technologies for the basic list of health care that all Israelis are entitled to access, known as the 'health basket'. We introduce a framework for health technology prioritization based explicitly on value for money that enables the main variables considered by decision-makers to be explicitly included. Although the framework's exposition is in terms of the Basket Committee selecting new technologies for Israel's health basket, we believe that the framework would also work well for other countries. Our proposed prioritization framework involves comparing four main variables for each technology: 1. Incremental benefits, including 'equity benefits', to Israel's population; 2. Incremental total cost to Israel's health system; 3. Quality of evidence; and 4. Any additional 'X-factors' not elsewhere included, such as strategic or legal factors, etc. Applying methodology from multi-criteria decision analysis, the multiple dimensions comprising the first variable are aggregated via a points system. The four variables are combined for each technology and compared across the technologies in the 'Value for Money (VfM) Chart'. The VfM Chart can be used to identify technologies that are good value for money, and, given a budget constraint, to select technologies that should be funded. This is demonstrated using 18 illustrative technologies. The VfM Chart is an intuitively appealing decision-support tool for helping decision-makers to focus on the inherent tradeoffs involved in health technology prioritization. Such deliberations can be performed in a systematic and transparent fashion that can also be easily communicated to stakeholders, including the general public. Possible future research includes pilot-testing the VfM Chart using real-world data. Ideally, this would involve working with the Basket Committee. Likewise, the framework could be tested and applied by health technology prioritization agencies in other countries.
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Leppin, Aaron L; Kunneman, Marleen; Hathaway, Julie; Fernandez, Cara; Montori, Victor M; Tilburt, Jon C
2018-02-01
Patients and clinicians do not often agree on whether a decision has been made about cancer care. This could be explained by factors related to communication quality and/or the type of decision being made. We used a self-developed coding scheme to code a random sample of 128 encounters in which patients and clinicians either agreed (n=64) or disagreed (n=64) that a cancer care decision was made and tested for associations between concordance and key communication behaviours. We also identified and characterized cancer care decisions by topic and level of patient involvement and looked for trends. We identified 378 cancer care decisions across 128 encounters. Explicit decisions were most commonly made about topics wherein decision control could be easily delegated to a clear and present expert (eg either the patient or the clinician). Related to this, level of patient involvement varied significantly by decision topic. Explicit decisions were rarely made in an observable way about social, non-clinical or self-management related topics, although patients and clinicians both reported having made a cancer care decision in encounters where no decisions were observed. We found no association between communication behaviours and concordance in our sample. What counts as a "decision" in cancer care may be constructed within disparate social roles that leave many agendas unaddressed and decisions unmade. Changing the content of conversations to encourage explicit decisions about self-management and life context-related topics may have greater value in enabling shared understanding than promoting communication behaviours among already high-performing communicators. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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Age and Social Support Seeking: Understanding the Role of Perceived Social Costs to Others.
Jiang, Li; Drolet, Aimee; Kim, Heejung S
2018-07-01
We examined age differences in the use of different types of social support and the reasons for these differences. We found that older adults (age 60+) seek explicit social support less compared with young adults (age 18-25), but there is no difference in implicit social support seeking. Concerns about the potential social costs of seeking explicit support mediate the age differences in explicit social support seeking. Whereas young adults view this strategy as conferring more benefits than costs, older adults have a more balanced view of the costs and benefits of explicit social support seeking. Older and young adults do not differ in perceptions of the relative costs versus benefits of implicit social support seeking. Finally, we found older adults benefit more from implicit (vs. explicit) social support emotionally than young adults, which further explains why age groups differ in their use of explicit versus implicit social support.
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Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten
2016-01-01
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making. Copyright © 2016. Published by Elsevier Inc.
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NASA Astrophysics Data System (ADS)
Meyer, Hanna; Authmann, Christian; Dreber, Niels; Hess, Bastian; Kellner, Klaus; Morgenthal, Theunis; Nauss, Thomas; Seeger, Bernhard; Tsvuura, Zivanai; Wiegand, Kerstin
2017-04-01
Bush encroachment is a syndrome of land degradation that occurs in many savannas including those of southern Africa. The increase in density, cover or biomass of woody vegetation often has negative effects on a range of ecosystem functions and services, which are hardly reversible. However, despite its importance, neither the causes of bush encroachment, nor the consequences of different resource management strategies to combat or mitigate related shifts in savanna states are fully understood. The project "IDESSA" (An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas) aims to improve the understanding of the complex interplays between land use, climate patterns and vegetation dynamics and to implement an integrative monitoring and decision-support system for the sustainable management of different savanna types. For this purpose, IDESSA follows an innovative approach that integrates local knowledge, botanical surveys, remote-sensing and machine-learning based time-series of atmospheric and land-cover dynamics, spatially explicit simulation modeling and analytical database management. The integration of the heterogeneous data will be implemented in a user oriented database infrastructure and scientific workflow system. Accessible via web-based interfaces, this database and analysis system will allow scientists to manage and analyze monitoring data and scenario computations, as well as allow stakeholders (e. g. land users, policy makers) to retrieve current ecosystem information and seasonal outlooks. We present the concept of the project and show preliminary results of the realization steps towards the integrative savanna management and decision-support system.
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Uyanik, Hatice; Shogren, Karrie A; Blanck, Peter
2017-12-01
Purpose This article reviews existing literature on positive psychology, supported decision-making (SDM), employment, and disability. It examines interventions and assessments that have been empirically evaluated for the enhancement of decision-making and overall well-being of people with disabilities. Additionally, conceptual themes present in the literature were explored. Methods A systematic review was conducted across two databases (ERIC and PsychINFO) using various combination of keywords of 'disabilit*', work rehabilitation and employment terms, positive psychology terms, and SDM components. Seven database searches were conducted with diverse combinations of keywords, which identified 1425 results in total to be screened for relevance using their titles and abstracts. Database search was supplemented with hand searches of oft-cited journals, ancestral search, and supplemental search from grey literature. Results Only four studies were identified in the literature targeting SDM and positive psychology related constructs in the employment and job development context. Results across the studies indicated small to moderate impacts of the assessment and interventions on decision-making and engagement outcomes. Conceptually there are thematic areas of potential overlap, although they are limited in the explicit integration of theory in supported decision-making, positive psychology, disability, and employment. Conclusion Results suggest a need for additional scholarship in this area that focuses on theory development and integration as well as empirical work. Such work should examine the potential utility of considering positive psychological interventions when planning for SDM in the context of career development activities to enhance positive outcomes related to decision-making, self-determination, and other positive psychological constructs.
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Booth, Pieter N; Law, Sheryl A; Ma, Jane; Buonagurio, John; Boyd, James; Turnley, Jessica
2017-09-01
This paper reviews literature on aesthetics and describes the development of vista and landscape aesthetics models. Spatially explicit variables were chosen to represent physical characteristics of natural landscapes that are important to aesthetic preferences. A vista aesthetics model evaluates the aesthetics of natural landscapes viewed from distances of more than 1000 m, and a landscape aesthetics model evaluates the aesthetic value of wetlands and forests within 1000 m from the viewer. Each of the model variables is quantified using spatially explicit metrics on a pixel-specific basis within EcoAIM™, a geographic information system (GIS)-based ecosystem services (ES) decision analysis support tool. Pixel values are "binned" into ranked categories, and weights are assigned to select variables to represent stakeholder preferences. The final aesthetic score is the weighted sum of all variables and is assigned ranked values from 1 to 10. Ranked aesthetic values are displayed on maps by patch type and integrated within EcoAIM. The response of the aesthetic scoring in the models was tested by comparing current conditions in a discrete area of the facility with a Development scenario in the same area. The Development scenario consisted of two 6-story buildings and a trail replacing natural areas. The results of the vista aesthetic model indicate that the viewshed area variable had the greatest effect on the aesthetics overall score. Results from the landscape aesthetics model indicate a 10% increase in overall aesthetics value, attributed to the increase in landscape diversity. The models are sensitive to the weights assigned to certain variables by the user, and these weights should be set to reflect regional landscape characteristics as well as stakeholder preferences. This demonstration project shows that natural landscape aesthetics can be evaluated as part of a nonmonetary assessment of ES, and a scenario-building exercise provides end users with a tradeoff analysis in support of natural resource management decisions. Integr Environ Assess Manag 2017;13:926-938. © 2017 SETAC. © 2017 SETAC.
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Azria, E; Tsatsaris, V; Moriette, G; Hirsch, E; Schmitz, T; Cabrol, D; Goffinet, F
2007-05-01
Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those childs remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care?" is crucial. This work is focused on this problematic of decision making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.
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Dalyander, P Soupy; Meyers, Michelle; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark; Ford, Mark
2016-12-01
Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework. Published by Elsevier Ltd.
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Dalyander, P. Soupy; Meyers, Michelle B.; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark R.; Ford, Mark
2016-01-01
Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework.
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Urdahl, Hege; Manca, Andrea; Sculpher, Mark J
2008-01-01
Background To support decision making many countries have now introduced some formal assessment process to evaluate whether health technologies represent good ‘value for money’. These often take the form of decision models which can be used to explore elements of importance to generalisability of study results across clinical settings and jurisdictions. The objectives of the present review were to assess: (i) whether the published studies clearly defined the decision-making audience for the model; (ii) the transparency of the reporting in terms of study question, structure and data inputs; (iii) the relevance of the data inputs used in the model to the stated decision-maker or jurisdiction; and (iv) how fully the robustness of the model's results to variation in data inputs between locations was assessed. Methods Articles reporting decision-analytic models in the area of osteoporosis were assessed to establish the extent to which the information provided enabled decision makers in different countries/jurisdictions to fully appreciate the variability of results according to location, and the relevance to their own. Results Of the 18 articles included in the review, only three explicitly stated the decision-making audience. It was not possible to infer a decision-making audience in eight studies. Target population was well reported, as was resource and cost data, and clinical data used for estimates of relative risk reduction. However, baseline risk was rarely adapted to the relevant jurisdiction, and when no decision-maker was explicit it was difficult to assess whether the reported cost and resource use data was in fact relevant. A few studies used sensitivity analysis to explore elements of generalisability, such as compliance rates and baseline fracture risk rates, although such analyses were generally restricted to evaluating parameter uncertainty. Conclusion This review found that variability in cost-effectiveness across locations is addressed to a varying extent in modelling studies in the field of osteoporosis, limiting their use for decision-makers across different locations. Transparency of reporting is expected to increase as methodology develops, and decision-makers publish “reference case” type guidance. PMID:17129074
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Ramirez, Jason J.; Dennhardt, Ashley A.; Baldwin, Scott A.; Murphy, James G.; Lindgren, Kristen P.
2016-01-01
Behavioral economic demand curve indices of alcohol consumption reflect decisions to consume alcohol at varying costs. Although these indices predict alcohol-related problems beyond established predictors, little is known about the determinants of elevated demand. Two cognitive constructs that may underlie alcohol demand are alcohol-approach inclinations and drinking identity. The aim of this study was to evaluate implicit and explicit measures of these constructs as predictors of alcohol demand curve indices. College student drinkers (N = 223, 59% female) completed implicit and explicit measures of drinking identity and alcohol-approach inclinations at three timepoints separated by three-month intervals, and completed the Alcohol Purchase Task to assess demand at Time 3. Given no change in our alcohol-approach inclinations and drinking identity measures over time, random intercept-only models were used to predict two demand indices: Amplitude, which represents maximum hypothetical alcohol consumption and expenditures, and Persistence, which represents sensitivity to increasing prices. When modeled separately, implicit and explicit measures of drinking identity and alcohol-approach inclinations positively predicted demand indices. When implicit and explicit measures were included in the same model, both measures of drinking identity predicted Amplitude, but only explicit drinking identity predicted Persistence. In contrast, explicit measures of alcohol-approach inclinations, but not implicit measures, predicted both demand indices. Therefore, there was more support for explicit, versus implicit, measures as unique predictors of alcohol demand. Overall, drinking identity and alcohol-approach inclinations both exhibit positive associations with alcohol demand and represent potentially modifiable cognitive constructs that may underlie elevated demand in college student drinkers. PMID:27379444
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Forest climate change Vulnerability and Adaptation Assessment in Himalayas
NASA Astrophysics Data System (ADS)
Chitale, V. S.; Shrestha, H. L.; Agarwal, N. K.; Choudhurya, D.; Gilani, H.; Dhonju, H. K.; Murthy, M. S. R.
2014-11-01
Forests offer an important basis for creating and safeguarding more climate-resilient communities over Hindu Kush Himalayan region. The forest ecosystem vulnerability assessment to climate change and developing knowledge base to identify and support relevant adaptation strategies is realized as an urgent need. The multi scale adaptation strategies portray increasing complexity with the increasing levels in terms of data requirements, vulnerability understanding and decision making to choose a particular adaptation strategy. We present here how such complexities could be addressed and adaptation decisions could be either directly supported by open source remote sensing based forestry products or geospatial analysis and modelled products. The forest vulnerability assessment under climate change scenario coupled with increasing forest social dependence was studied using IPCC Landscape scale Vulnerability framework in Chitwan-Annapurna Landscape (CHAL) situated in Nepal. Around twenty layers of geospatial information on climate, forest biophysical and forest social dependence data was used to assess forest vulnerability and associated adaptation needs using self-learning decision tree based approaches. The increase in forest fires, evapotranspiration and reduction in productivity over changing climate scenario was observed. The adaptation measures on enhancing productivity, improving resilience, reducing or avoiding pressure with spatial specificity are identified to support suitable decision making. The study provides spatial analytical framework to evaluate multitude of parameters to understand vulnerabilities and assess scope for alternative adaptation strategies with spatial explicitness.
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2015-11-20
noticed erythematous rash on the girl’s trunk. Physical examination reveals strawberry red tongue, red and cracked lips, and swollen red hands. The whites...as erythematous rash, and test results, such as revealed swollen red hands and strawberry red tongue, as well as indicates a possible di- agnosis...such as strawberry tongue (also known as Kawasaki disease). Although such queries are fairly long, only a fraction of concepts corresponding to an in
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Developing a Value Framework: The Need to Reflect the Opportunity Costs of Funding Decisions.
Sculpher, Mark; Claxton, Karl; Pearson, Steven D
2017-02-01
A growing number of health care systems internationally use formal economic evaluation methods to support health care funding decisions. Recently, a range of organizations have been advocating forms of analysis that have been termed "value frameworks." There has also been a push for analytical methods to reflect a fuller range of benefits of interventions through multicriteria decision analysis. A key principle that is invariably neglected in current and proposed frameworks is the need to reflect evidence on the opportunity costs that health systems face when making funding decisions. The mechanisms by which opportunity costs are realized vary depending on the system's financial arrangements, but they always mean that a decision to fund a specific intervention for a particular patient group has the potential to impose costs on others in terms of forgone benefits. These opportunity costs are rarely explicitly reflected in analysis to support decisions, but recent developments to quantify benefits forgone make more appropriate analyses feasible. Opportunity costs also need to be reflected in decisions if a broader range of attributes of benefit is considered, and opportunity costs are a key consideration in determining the appropriate level of total expenditure in a system. The principles by which opportunity costs can be reflected in analysis are illustrated in this article by using the example of the proposed methods for value-based pricing in the United Kingdom. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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Sleep Increases Explicit Solutions and Reduces Intuitive Judgments of Semantic Coherence
ERIC Educational Resources Information Center
Zander, Thea; Volz, Kirsten G.; Born, Jan; Diekelmann, Susanne
2017-01-01
Sleep fosters the generation of explicit knowledge. Whether sleep also benefits implicit intuitive decisions about underlying patterns is unclear. We examined sleep's role in explicit and intuitive semantic coherence judgments. Participants encoded sets of three words and after a sleep or wake period were required to judge the potential…
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Chassin, Laurie; Presson, Clark C.
2013-01-01
Introduction: This study examined the association between implicit and explicit attitudes toward smoking and support for tobacco control policies. Methods: Participants were from an ongoing longitudinal study of the natural history of smoking who also completed a web-based assessment of implicit attitudes toward smoking (N = 1,337). Multiple regression was used to test the association between covariates (sex, age, educational attainment, parent status, and smoking status), implicit attitude toward smoking, and explicit attitude toward smoking and support for tobacco control policies. The moderating effect of the covariates on the relation between attitudes and support for policies was also tested. Results: Females, those with higher educational attainment, parents, and nonsmokers expressed more support for tobacco control policy measures. For nonsmokers, only explicit attitude was significantly associated with support for policies. For smokers, both explicit and implicit attitudes were significantly associated with support. The effect of explicit attitude was stronger for those with lower educational attainment. Conclusions: Both explicit and implicit smoking attitudes are important for building support for tobacco control policies, particularly among smokers. More research is needed on how to influence explicit and implicit attitudes to inform policy advocacy campaigns. PMID:22581941
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Macy, Jonathan T; Chassin, Laurie; Presson, Clark C
2013-01-01
This study examined the association between implicit and explicit attitudes toward smoking and support for tobacco control policies. Participants were from an ongoing longitudinal study of the natural history of smoking who also completed a web-based assessment of implicit attitudes toward smoking (N = 1,337). Multiple regression was used to test the association between covariates (sex, age, educational attainment, parent status, and smoking status), implicit attitude toward smoking, and explicit attitude toward smoking and support for tobacco control policies. The moderating effect of the covariates on the relation between attitudes and support for policies was also tested. Females, those with higher educational attainment, parents, and nonsmokers expressed more support for tobacco control policy measures. For nonsmokers, only explicit attitude was significantly associated with support for policies. For smokers, both explicit and implicit attitudes were significantly associated with support. The effect of explicit attitude was stronger for those with lower educational attainment. Both explicit and implicit smoking attitudes are important for building support for tobacco control policies, particularly among smokers. More research is needed on how to influence explicit and implicit attitudes to inform policy advocacy campaigns.
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Drenth-van Maanen, A Clara; Leendertse, Anne J; Jansen, Paul A F; Knol, Wilma; Keijsers, Carolina J P W; Meulendijk, Michiel C; van Marum, Rob J
2018-04-01
Inappropriate prescribing is a major health care issue, especially regarding older patients on polypharmacy. Multiple implicit and explicit prescribing tools have been developed to improve prescribing, but these have hardly ever been used in combination. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) combines implicit prescribing tools with the explicit Screening Tool to Alert physicians to the Right Treatment and Screening Tool of Older People's potentially inappropriate Prescriptions criteria and has shared decision-making with the patient as a critical step. This article describes the STRIP and its ability to identify potentially inappropriate prescribing. The STRIP improved general practitioners' and final-year medical students' medication review skills. The Web-application STRIP Assistant was developed to enable health care providers to use the STRIP in daily practice and will be incorporated in clinical decision support systems. It is currently being used in the European Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly (OPERAM) project, a multicentre randomized controlled trial involving patients aged 75 years and older using multiple medications for multiple medical conditions. In conclusion, the STRIP helps health care providers to systematically identify potentially inappropriate prescriptions and medication-related problems and to change the patient's medication regimen in accordance with the patient's needs and wishes. This article describes the STRIP and the available evidence so far. The OPERAM study is investigating the effect of STRIP use on clinical and economic outcomes. © 2017 John Wiley & Sons, Ltd.
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Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making
Bechara, A.; Damasio, H.; Aitken, M. R. F.; Sahakian, B. J.; Robbins, T. W.
2008-01-01
The ventromedial prefrontal cortex (vmPFC) and insular cortex are implicated in distributed neural circuitry that supports emotional decision-making. Previous studies of patients with vmPFC lesions have focused primarily on decision-making under uncertainty, when outcome probabilities are ambiguous (e.g. the Iowa Gambling Task). It remains unclear whether vmPFC is also necessary for decision-making under risk, when outcome probabilities are explicit. It is not known whether the effect of insular damage is analogous to the effect of vmPFC damage, or whether these regions contribute differentially to choice behaviour. Four groups of participants were compared on the Cambridge Gamble Task, a well-characterized measure of risky decision-making where outcome probabilities are presented explicitly, thus minimizing additional learning and working memory demands. Patients with focal, stable lesions to the vmPFC (n = 20) and the insular cortex (n = 13) were compared against healthy subjects (n = 41) and a group of lesion controls (n = 12) with damage predominantly affecting the dorsal and lateral frontal cortex. The vmPFC and insular cortex patients showed selective and distinctive disruptions of betting behaviour. VmPFC damage was associated with increased betting regardless of the odds of winning, consistent with a role of vmPFC in biasing healthy individuals towards conservative options under risk. In contrast, patients with insular cortex lesions failed to adjust their bets by the odds of winning, consistent with a role of the insular cortex in signalling the probability of aversive outcomes. The insular group attained a lower point score on the task and experienced more ‘bankruptcies’. There were no group differences in probability judgement. These data confirm the necessary role of the vmPFC and insular regions in decision-making under risk. Poor decision-making in clinical populations can arise via multiple routes, with functionally dissociable effects of vmPFC and insular cortex damage. PMID:18390562
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Caeymaex, Laurence; Speranza, Mario; Vasilescu, Caroline; Danan, Claude; Bourrat, Marie-Michèle
2011-01-01
Background The importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents' opinions on the type of involvement report conflicting results. This study sought to explore parents' experience of the EOL DMP for their child in the NICU. Methods The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP. Findings Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child. Interpretation Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices. PMID:22194873
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Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making.
Clark, L; Bechara, A; Damasio, H; Aitken, M R F; Sahakian, B J; Robbins, T W
2008-05-01
The ventromedial prefrontal cortex (vmPFC) and insular cortex are implicated in distributed neural circuitry that supports emotional decision-making. Previous studies of patients with vmPFC lesions have focused primarily on decision-making under uncertainty, when outcome probabilities are ambiguous (e.g. the Iowa Gambling Task). It remains unclear whether vmPFC is also necessary for decision-making under risk, when outcome probabilities are explicit. It is not known whether the effect of insular damage is analogous to the effect of vmPFC damage, or whether these regions contribute differentially to choice behaviour. Four groups of participants were compared on the Cambridge Gamble Task, a well-characterized measure of risky decision-making where outcome probabilities are presented explicitly, thus minimizing additional learning and working memory demands. Patients with focal, stable lesions to the vmPFC (n = 20) and the insular cortex (n = 13) were compared against healthy subjects (n = 41) and a group of lesion controls (n = 12) with damage predominantly affecting the dorsal and lateral frontal cortex. The vmPFC and insular cortex patients showed selective and distinctive disruptions of betting behaviour. VmPFC damage was associated with increased betting regardless of the odds of winning, consistent with a role of vmPFC in biasing healthy individuals towards conservative options under risk. In contrast, patients with insular cortex lesions failed to adjust their bets by the odds of winning, consistent with a role of the insular cortex in signalling the probability of aversive outcomes. The insular group attained a lower point score on the task and experienced more 'bankruptcies'. There were no group differences in probability judgement. These data confirm the necessary role of the vmPFC and insular regions in decision-making under risk. Poor decision-making in clinical populations can arise via multiple routes, with functionally dissociable effects of vmPFC and insular cortex damage.
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Explicit and implicit processes in behavioural adaptation to road width.
Lewis-Evans, Ben; Charlton, Samuel G
2006-05-01
The finding that drivers may react to safety interventions in a way that is contrary to what was intended is the phenomenon of behavioural adaptation. This phenomenon has been demonstrated across various safety interventions and has serious implications for road safety programs the world over. The present research used a driving simulator to assess behavioural adaptation in drivers' speed and lateral displacement in response to manipulations of road width. Of interest was whether behavioural adaptation would occur and whether we could determine whether it was the result of explicit, conscious decisions or implicit perceptual processes. The results supported an implicit, zero perceived risk model of behavioural adaptation with reduced speeds on a narrowed road accompanied by increased ratings of risk and a marked inability of the participants to identify that any change in road width had occurred.
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Justification of automated decision-making: medical explanations as medical arguments.
Shankar, R. D.; Musen, M. A.
1999-01-01
People use arguments to justify their claims. Computer systems use explanations to justify their conclusions. We are developing WOZ, an explanation framework that justifies the conclusions of a clinical decision-support system. WOZ's central component is the explanation strategy that decides what information justifies a claim. The strategy uses Toulmin's argument structure to define pieces of information and to orchestrate their presentation. WOZ uses explicit models that abstract the core aspects of the framework such as the explanation strategy. In this paper, we present the use of arguments, the modeling of explanations, and the explanation process used in WOZ. WOZ exploits the wealth of naturally occurring arguments, and thus can generate convincing medical explanations. Images Figure 5 PMID:10566388
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The online community based decision making support system for mitigating biased decision making
NASA Astrophysics Data System (ADS)
Kang, Sunghyun; Seo, Jiwan; Choi, Seungjin; Kim, Junho; Han, Sangyong
2016-10-01
As the Internet technology and social media advance, various information and opinions are shared and distributed through the online communities. However, the existence of implicit and explicit bias of opinions may have a potential influence on the outcomes. Compared to the importance of mitigating biased information, the study in this field is relatively young and does not address many important issues. In this paper we propose the noble approach to mitigate the biased opinions using conventional machine learning methods. The proposed method extracts the useful features such as inclination and sentiment of the community members. They are classified based on their previous behavior, and the propensity of the members is understood. This information on each community and its members is very useful and improve the ability to make an unbiased decision. The proposed method presented in this paper is shown to have the ability to assist optimal, fair and good decision making while also reducing the influence of implicit bias.
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Design of decision support interventions for medication prescribing.
Horsky, Jan; Phansalkar, Shobha; Desai, Amrita; Bell, Douglas; Middleton, Blackford
2013-06-01
Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety. Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. Although HCI and usability principles are well established and robust, CDS and EHR system interfaces rarely conform to the best known design conventions and are seldom conceived and designed well enough to be truly versatile and dependable tools. These relatively novel interventions still require careful monitoring, research and analysis of its track record to mature. Clarity and specificity of alert content and optimal perceptual and cognitive attributes, for example, are essential for providing effective decision support to clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Non-Market Values in a Cost-Benefit World: Evidence from a Choice Experiment.
Eppink, Florian V; Winden, Matthew; Wright, Will C C; Greenhalgh, Suzie
2016-01-01
In support of natural resource and ecosystem service policy, monetary value estimates are often presented to decision makers along with other types of information. There is some evidence that, presented with such 'mixed' information, people prioritise monetary over non-monetary information. We conduct a discrete choice experiment among New Zealand decision makers in which we manipulate the information presented to participants. We find that providing explicit monetary information strengthens the pursuit of economic benefits as well as the avoidance of environmental damage. Cultural impacts, of which we provided only qualitative descriptions, did not affect respondents' choices. Our study provides further evidence that concerns regarding the use of monetary information in decisions with complex, multi-value impacts are valid. Further research is needed to validate our results and find ways to reduce any bias in monetary and non-market information.
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Non-Market Values in a Cost-Benefit World: Evidence from a Choice Experiment
Eppink, Florian V.; Winden, Matthew; Wright, Will C. C.; Greenhalgh, Suzie
2016-01-01
In support of natural resource and ecosystem service policy, monetary value estimates are often presented to decision makers along with other types of information. There is some evidence that, presented with such ‘mixed’ information, people prioritise monetary over non-monetary information. We conduct a discrete choice experiment among New Zealand decision makers in which we manipulate the information presented to participants. We find that providing explicit monetary information strengthens the pursuit of economic benefits as well as the avoidance of environmental damage. Cultural impacts, of which we provided only qualitative descriptions, did not affect respondents’ choices. Our study provides further evidence that concerns regarding the use of monetary information in decisions with complex, multi-value impacts are valid. Further research is needed to validate our results and find ways to reduce any bias in monetary and non-market information. PMID:27783657
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Affecting others: social appraisal and emotion contagion in everyday decision making.
Parkinson, Brian; Simons, Gwenda
2009-08-01
In a diary study of interpersonal affect transfer, 41 participants reported on decisions involving other people over 3 weeks. Reported anxiety and excitement were reliably related to the perceived anxiety and excitement of another person who was present during decision making. Risk and importance appraisals partially mediated effects of other's anxiety on own anxiety as predicted by social appraisal theory. However, other's emotion remained a significant independent predictor of own emotion after controlling for appraisals, supporting the additional impact of more direct forms of affect transfer such as emotion contagion. Significant affect-transfer effects remained even after controlling for participants' perceptions of the other's emotion in addition to all measured appraisals, confirming that affect transfer does not require explicit registration of someone else's feelings. This research provides some of the clearest evidence for the operation of both social appraisal and automatic affect transfer in everyday social life.
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Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature
Roman, Tamlyn Eslie; Cleary, Susan; McIntyre, Diane
2017-01-01
Background: The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. Methods: A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. Results: The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. Conclusion: The literature supports Bossert’s conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning. PMID:28812832
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Decision making for breast cancer prevention among women at elevated risk.
Padamsee, Tasleem J; Wills, Celia E; Yee, Lisa D; Paskett, Electra D
2017-03-24
Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.
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Kramer, Daniel B; Stevens, Kara; Williams, Nicholas E; Sistla, Seeta A; Roddy, Adam B; Urquhart, Gerald R
2017-01-01
Anthropogenic threats to natural systems can be exacerbated due to connectivity between marine, freshwater, and terrestrial ecosystems, complicating the already daunting task of governance across the land-sea interface. Globalization, including new access to markets, can change social-ecological, land-sea linkages via livelihood responses and adaptations by local people. As a first step in understanding these trans-ecosystem effects, we examined exit and entry decisions of artisanal fishers and smallholder farmers on the rapidly globalizing Caribbean coast of Nicaragua. We found that exit and entry decisions demonstrated clear temporal and spatial patterns and that these decisions differed by livelihood. In addition to household characteristics, livelihood exit and entry decisions were strongly affected by new access to regional and global markets. The natural resource implications of these livelihood decisions are potentially profound as they provide novel linkages and spatially-explicit feedbacks between terrestrial and marine ecosystems. Our findings support the need for more scientific inquiry in understanding trans-ecosystem tradeoffs due to linked-livelihood transitions as well as the need for a trans-ecosystem approach to natural resource management and development policy in rapidly changing coastal regions.
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Watershed System Model: The Essentials to Model Complex Human-Nature System at the River Basin Scale
NASA Astrophysics Data System (ADS)
Li, Xin; Cheng, Guodong; Lin, Hui; Cai, Ximing; Fang, Miao; Ge, Yingchun; Hu, Xiaoli; Chen, Min; Li, Weiyue
2018-03-01
Watershed system models are urgently needed to understand complex watershed systems and to support integrated river basin management. Early watershed modeling efforts focused on the representation of hydrologic processes, while the next-generation watershed models should represent the coevolution of the water-land-air-plant-human nexus in a watershed and provide capability of decision-making support. We propose a new modeling framework and discuss the know-how approach to incorporate emerging knowledge into integrated models through data exchange interfaces. We argue that the modeling environment is a useful tool to enable effective model integration, as well as create domain-specific models of river basin systems. The grand challenges in developing next-generation watershed system models include but are not limited to providing an overarching framework for linking natural and social sciences, building a scientifically based decision support system, quantifying and controlling uncertainties, and taking advantage of new technologies and new findings in the various disciplines of watershed science. The eventual goal is to build transdisciplinary, scientifically sound, and scale-explicit watershed system models that are to be codesigned by multidisciplinary communities.
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The neural basis for establishing a focal point in pure coordination games
Rascovsky, Katya; Khella, M. Catherine; Clark, Robin; Grossman, Murray
2012-01-01
When making a decision, humans often have to ‘coordinate’—reach the same conclusion—as another individual without explicitly communicating. Relatively, little is known about the neural basis for coordination. Moreover, previous fMRI investigations have supported conflicting hypotheses. One account proposes that individuals coordinate using a ‘gut feeling’ and that this is supported by insula recruitment. Another account proposes that individuals recruit strategic decision-making mechanisms in prefrontal cortex in order to coordinate. We investigate the neural basis for coordination in individuals with behavioral-variant frontotemporal dementia (bvFTD) who have limitations in social decision-making associated with disease in prefrontal cortex. We demonstrate that bvFTD are impaired at establishing a focal point in a semantic task (e.g. ‘Tell me any boy's name’) that requires coordination relative to a similar, control semantic task that does not. Additionally, coordination limitations in bvFTD are related to cortical thinning in prefrontal cortex. These findings are consistent with behavioral economic models proposing that, beyond a ‘gut feeling’, strategic decision-making contributes to the coordination process, including a probabilistic mechanism that evaluates the salience of a response (e.g. is ‘John’ a frequent boy's name), a hierarchical mechanism that iteratively models an opponent's likely response and a mechanism involved in social perspective taking. PMID:22009019
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An Ecosystem Service Evaluation Tool to Support Ridge-to-Reef Management and Conservation in Hawaii
NASA Astrophysics Data System (ADS)
Oleson, K.; Callender, T.; Delevaux, J. M. S.; Falinski, K. A.; Htun, H.; Jin, G.
2014-12-01
Faced with increasing anthropogenic stressors and diverse stakeholders, local managers are adopting a ridge-to-reef and multi-objective management approach to restore declining coral reef health state. An ecosystem services framework, which integrates ecological indicators and stakeholder values, can foster more applied and integrated research, data collection, and modeling, and thus better inform the decision-making process and realize decision outcomes grounded in stakeholders' values. Here, we describe a research program that (i) leverages remotely sensed and empirical data to build an ecosystem services-based decision-support tool geared towards ridge-to-reef management; and (ii) applies it as part of a structured, value-based decision-making process to inform management in west Maui, a NOAA coral reef conservation priority site. The tool links terrestrial and marine biophysical models in a spatially explicit manner to quantify and map changes in ecosystem services delivery resulting from management actions, projected climate change impacts, and adaptive responses. We couple model outputs with localized valuation studies to translate ecosystem service outcomes into benefits and their associated socio-cultural and/or economic values. Managers can use this tool to run scenarios during their deliberations to evaluate trade-offs, cost-effectiveness, and equity implications of proposed policies. Ultimately, this research program aims at improving the effectiveness, efficiency, and equity outcomes of ecosystem-based management. This presentation will describe our approach, summarize initial results from the terrestrial modeling and economic valuations for west Maui, and highlight how this decision support tool benefits managers in west Maui.
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Campbell, Chadwick K; Gómez, Anu Manchikanti; Dworkin, Shari; Wilson, Patrick A; Grisham, Kirk K; McReynolds, Jaih; Vielehr, Peter; Hoff, Colleen
2014-05-01
Among gay and bisexual men, primary partners are a leading source of HIV infection. Trust, intimacy, and advancements in HIV treatment may impact same-sex male (SSM) couples' decisions to engage in unprotected anal intercourse (UAI). This qualitative study explored how Black, White and interracial couples discussed, and made decisions regarding condoms. Qualitative interviews were conducted with 48 SSM couples in the New York and San Francisco metropolitan areas. Stratified purposive sampling was used to include Black (n = 16), White (n = 17), and interracial (Black-White) (n = 15) couples. Twenty-six couples were concordant HIV-negative and 22 were HIV-discordant. Interviews were recorded, transcribed, coded, and analyzed using a grounded theory approach. Some couples described explicit processes, which involved active discussion, while others described implicit processes, where condom-use decisions occurred without any explicit discussion. These processes also differed by race and HIV status. Black couples tended to report condom-use as "just understood." White, HIV-discordant couples decided not to use condoms, with some identifying the HIV-positive partner's suppressed viral load and high CD4 count as deciding factors. After an unplanned episode of UAI, White, HIV-negative couples tended to discontinue condom use while Black HIV-negative couples decided to revert to using condoms. HIV prevention efforts focused on same-sex, male couples must consider the explicit/implicit nature of condom decision-making processes. Understanding differences in these processes and considering relationship dynamics, across race and HIV status, can promote the development of innovative couple-level, HIV prevention interventions.
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Evidence and Options for Informed Decision-Making to Achive Arctic Sustainability
NASA Astrophysics Data System (ADS)
Berkman, P. A.
2017-12-01
This presentation will consider the development of evidence and options for informed decision-making that will need to operate across generations to achieve Arctic sustainability (Figure). Context of these Arctic decisions is global, recognizing that we live in an interconnected civilization on a planetary scale, as revealed unambiguously with evidence from the `world' wars in the first half of the 20thcentury. First, for clarification, data and evidence are not the same. Data is generated from information and observations to answer specific questions, posed with methods from the natural and social sciences as well as indigenous knowledge. These data reveal patterns and trends in our societies and natural world, underscoring the evidence for decisions to address impacts, issues and resources within, across and beyond the boundaries of nations - recognizing that nations still are the principal jurisdictional unit. However, for this decision-support process to be effective, options (without advocacy) - which can be used or ignored explicitly - must be generated from the evidence, taking into consideration stakeholder perspectives and governance records in a manner that will contribute to informed decision-making. The resulting decisions will involve built elements that require capitalization and technology as well as governance mechanisms coming from diverse jurisdictional authorities. The innovation required is to balance economic prosperity, environmental protection and societal well-being. These three pillars of sustainability further involve stability, balancing urgencies of the moment and of future generations, recognizing that children born today will be alive in the 22nd century. Consequently, options for informed decisions must operate across a continuum of urgencies from security time scales to sustainability time scales. This decision-support process is holistic (international, interdisciplinary and inclusive), reflecting the applications of science diplomacy to balance national interests and common interests for the benefit of all on Earth.
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Evaluation of Algorithms for a Miles-in-Trail Decision Support Tool
NASA Technical Reports Server (NTRS)
Bloem, Michael; Hattaway, David; Bambos, Nicholas
2012-01-01
Four machine learning algorithms were prototyped and evaluated for use in a proposed decision support tool that would assist air traffic managers as they set Miles-in-Trail restrictions. The tool would display probabilities that each possible Miles-in-Trail value should be used in a given situation. The algorithms were evaluated with an expected Miles-in-Trail cost that assumes traffic managers set restrictions based on the tool-suggested probabilities. Basic Support Vector Machine, random forest, and decision tree algorithms were evaluated, as was a softmax regression algorithm that was modified to explicitly reduce the expected Miles-in-Trail cost. The algorithms were evaluated with data from the summer of 2011 for air traffic flows bound to the Newark Liberty International Airport (EWR) over the ARD, PENNS, and SHAFF fixes. The algorithms were provided with 18 input features that describe the weather at EWR, the runway configuration at EWR, the scheduled traffic demand at EWR and the fixes, and other traffic management initiatives in place at EWR. Features describing other traffic management initiatives at EWR and the weather at EWR achieved relatively high information gain scores, indicating that they are the most useful for estimating Miles-in-Trail. In spite of a high variance or over-fitting problem, the decision tree algorithm achieved the lowest expected Miles-in-Trail costs when the algorithms were evaluated using 10-fold cross validation with the summer 2011 data for these air traffic flows.
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Influence diagrams as oil spill decision science tools
Making inferences on risks to ecosystem services (ES) from ecological crises can be more reliably handled using decision science tools. Influence diagrams (IDs) are probabilistic networks that explicitly represent the decisions related to a problem and evidence of their influence...
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Xia, Bisheng; Qian, Xin; Yao, Hong
2017-11-01
Although the risk-explicit interval linear programming (REILP) model has solved the problem of having interval solutions, it has an equity problem, which can lead to unbalanced allocation between different decision variables. Therefore, an improved REILP model is proposed. This model adds an equity objective function and three constraint conditions to overcome this equity problem. In this case, pollution reduction is in proportion to pollutant load, which supports balanced development between different regional economies. The model is used to solve the problem of pollution load allocation in a small transboundary watershed. Compared with the REILP original model result, our model achieves equity between the upstream and downstream pollutant loads; it also overcomes the problem of greatest pollution reduction, where sources are nearest to the control section. The model provides a better solution to the problem of pollution load allocation than previous versions.
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International trade versus public health during the FCTC negotiations, 1999-2003.
Mamudu, Hadii M; Hammond, Ross; Glantz, Stanton A
2011-01-01
To examine why the Framework Convention on Tobacco Control did not include an explicit trade provision and delineate the central arguments in the debate over trade provision during the negotiations. Triangulate interviews with participants in the FCTC negotiations, the FCTC negotiations documents, and tobacco industry documents. An explicit FCTC trade provision on relation between international trade and public health became a contentious issue during the negotiations. As a result, two conflicting positions, health-over-trade and opposition to health-over-trade emerged. Opposition to explicit trade language giving health priority was by both tobacco industry and countries that generally supported strong FCTC provisions because of concerns over 'disguised protectionism' and setting a precedent whereby governments could forfeit their obligations under pre-existing treaties. Owing to lack of consensus among political actors involved in the negotiations, a compromise position eliminating any mention of trade emerged, which was predicated on belief among some in the public health community that public health would prevail in future trade versus health conflicts. The absence of an explicit FCTC trade provision was due to a political compromise rather than the impact of international trade agreements and decisions on public health and lack of consensus among health advocates. This failure to include an explicit trade provision in the FCTC suggests that the public health community should become more involved in trade and health issues at all levels of governance and press the FCTC Conference of the Parties for clarification of this critical issue.
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Simic, Vladimir
2015-01-01
End-of-life vehicles (ELVs) are vehicles that have reached the end of their useful lives and are no longer registered or licensed for use. The ELV recycling problem has become very serious in the last decade and more and more efforts are made in order to reduce the impact of ELVs on the environment. This paper proposes the fuzzy risk explicit interval linear programming model for ELV recycling planning in the EU. It has advantages in reflecting uncertainties presented in terms of intervals in the ELV recycling systems and fuzziness in decision makers' preferences. The formulated model has been applied to a numerical study in which different decision maker types and several ELV types under two EU ELV Directive legislative cases were examined. This study is conducted in order to examine the influences of the decision maker type, the α-cut level, the EU ELV Directive and the ELV type on decisions about vehicle hulks procuring, storing unprocessed hulks, sorting generated material fractions, allocating sorted waste flows and allocating sorted metals. Decision maker type can influence quantity of vehicle hulks kept in storages. The EU ELV Directive and decision maker type have no influence on which vehicle hulk type is kept in the storage. Vehicle hulk type, the EU ELV Directive and decision maker type do not influence the creation of metal allocation plans, since each isolated metal has its regular destination. The valid EU ELV Directive eco-efficiency quotas can be reached even when advanced thermal treatment plants are excluded from the ELV recycling process. The introduction of the stringent eco-efficiency quotas will significantly reduce the quantities of land-filled waste fractions regardless of the type of decision makers who will manage vehicle recycling system. In order to reach these stringent quotas, significant quantities of sorted waste need to be processed in advanced thermal treatment plants. Proposed model can serve as the support for the European vehicle recycling managers in creating more successful ELV recycling plans. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Voting Intention and Choices: Are Voters Always Rational and Deliberative?
Lee, I-Ching; Chen, Eva E.; Tsai, Chia-Hung; Yen, Nai-Shing; Chen, Arbee L. P.; Lin, Wei-Chieh
2016-01-01
Human rationality–the ability to behave in order to maximize the achievement of their presumed goals (i.e., their optimal choices)–is the foundation for democracy. Research evidence has suggested that voters may not make decisions after exhaustively processing relevant information; instead, our decision-making capacity may be restricted by our own biases and the environment. In this paper, we investigate the extent to which humans in a democratic society can be rational when making decisions in a serious, complex situation–voting in a local political election. We believe examining human rationality in a political election is important, because a well-functioning democracy rests largely upon the rational choices of individual voters. Previous research has shown that explicit political attitudes predict voting intention and choices (i.e., actual votes) in democratic societies, indicating that people are able to reason comprehensively when making voting decisions. Other work, though, has demonstrated that the attitudes of which we may not be aware, such as our implicit (e.g., subconscious) preferences, can predict voting choices, which may question the well-functioning democracy. In this study, we systematically examined predictors on voting intention and choices in the 2014 mayoral election in Taipei, Taiwan. Results indicate that explicit political party preferences had the largest impact on voting intention and choices. Moreover, implicit political party preferences interacted with explicit political party preferences in accounting for voting intention, and in turn predicted voting choices. Ethnic identity and perceived voting intention of significant others were found to predict voting choices, but not voting intention. In sum, to the comfort of democracy, voters appeared to engage mainly explicit, controlled processes in making their decisions; but findings on ethnic identity and perceived voting intention of significant others may suggest otherwise. PMID:26886266
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Voting Intention and Choices: Are Voters Always Rational and Deliberative?
Lee, I-Ching; Chen, Eva E; Tsai, Chia-Hung; Yen, Nai-Shing; Chen, Arbee L P; Lin, Wei-Chieh
2016-01-01
Human rationality--the ability to behave in order to maximize the achievement of their presumed goals (i.e., their optimal choices)--is the foundation for democracy. Research evidence has suggested that voters may not make decisions after exhaustively processing relevant information; instead, our decision-making capacity may be restricted by our own biases and the environment. In this paper, we investigate the extent to which humans in a democratic society can be rational when making decisions in a serious, complex situation-voting in a local political election. We believe examining human rationality in a political election is important, because a well-functioning democracy rests largely upon the rational choices of individual voters. Previous research has shown that explicit political attitudes predict voting intention and choices (i.e., actual votes) in democratic societies, indicating that people are able to reason comprehensively when making voting decisions. Other work, though, has demonstrated that the attitudes of which we may not be aware, such as our implicit (e.g., subconscious) preferences, can predict voting choices, which may question the well-functioning democracy. In this study, we systematically examined predictors on voting intention and choices in the 2014 mayoral election in Taipei, Taiwan. Results indicate that explicit political party preferences had the largest impact on voting intention and choices. Moreover, implicit political party preferences interacted with explicit political party preferences in accounting for voting intention, and in turn predicted voting choices. Ethnic identity and perceived voting intention of significant others were found to predict voting choices, but not voting intention. In sum, to the comfort of democracy, voters appeared to engage mainly explicit, controlled processes in making their decisions; but findings on ethnic identity and perceived voting intention of significant others may suggest otherwise.
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Marckmann, G; In der Schmitten, J
2014-05-01
Under the current conditions in the health care system, physicians inevitably have to take responsibility for the cost dimension of their decisions on the level of single cases. This article, therefore, discusses the question how physicians can integrate cost considerations into their clinical decisions at the microlevel in a medically rational and ethically justified way. We propose a four-step model for "ethical cost-consciousness": (1) forego ineffective interventions as required by good evidence-based medicine, (2) respect individual patient preferences, (3) minimize the diagnostic and therapeutic effort to achieve a certain treatment goal, and (4) forego expensive interventions that have only a small or unlikely (net) benefit for the patient. Steps 1-3 are ethically justified by the principles of beneficence, nonmaleficence, and respect for autonomy, step 4 by the principles of justice. For decisions on step 4, explicit cost-conscious guidelines should be developed locally or regionally. Following the four-step model can contribute to ethically defensible, cost-conscious decision-making at the microlevel. In addition, physicians' rationing decisions should meet basic standards of procedural fairness. Regular cost-case discussions and clinical ethics consultation should be available as decision support. Implementing step 4, however, requires first of all a clear political legitimation with the corresponding legal framework.
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Knowledge discovery from data as a framework to decision support in medical domains
Gibert, Karina
2009-01-01
Introduction Knowledge discovery from data (KDD) is a multidisciplinary discipline which appeared in 1996 for “non trivial identifying of valid, novel, potentially useful, ultimately understandable patterns in data”. Pre-treatment of data and post-processing is as important as the data exploitation (Data Mining) itself. Different analysis techniques can be properly combined to produce explicit knowledge from data. Methods Hybrid KDD methodologies combining Artificial Intelligence with Statistics and visualization have been used to identify patterns in complex medical phenomena: experts provide prior knowledge (pK); it biases the search of distinguishable groups of homogeneous objects; support-interpretation tools (CPG) assisted experts in conceptualization and labelling of discovered patterns, consistently with pK. Results Patterns of dependency in mental disabilities supported decision-making on legislation of the Spanish Dependency Law in Catalonia. Relationships between type of neurorehabilitation treatment and patterns of response for brain damage are assessed. Patterns of the perceived QOL along time are used in spinal cord lesion to improve social inclusion. Conclusion Reality is more and more complex and classical data analyses are not powerful enough to model it. New methodologies are required including multidisciplinarity and stressing on production of understandable models. Interaction with the experts is critical to generate meaningful results which can really support decision-making, particularly convenient transferring the pK to the system, as well as interpreting results in close interaction with experts. KDD is a valuable paradigm, particularly when facing very complex domains, not well understood yet, like many medical phenomena.
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Bringing ecosystem services into integrated water resources management.
Liu, Shuang; Crossman, Neville D; Nolan, Martin; Ghirmay, Hiyoba
2013-11-15
In this paper we propose an ecosystem service framework to support integrated water resource management and apply it to the Murray-Darling Basin in Australia. Water resources in the Murray-Darling Basin have been over-allocated for irrigation use with the consequent degradation of freshwater ecosystems. In line with integrated water resource management principles, Australian Government reforms are reducing the amount of water diverted for irrigation to improve ecosystem health. However, limited understanding of the broader benefits and trade-offs associated with reducing irrigation diversions has hampered the planning process supporting this reform. Ecosystem services offer an integrative framework to identify the broader benefits associated with integrated water resource management in the Murray-Darling Basin, thereby providing support for the Government to reform decision-making. We conducted a multi-criteria decision analysis for ranking regional potentials to provide ecosystem services at river basin scale. We surveyed the wider public about their understanding of, and priorities for, managing ecosystem services and then integrated the results with spatially explicit indicators of ecosystem service provision. The preliminary results of this work identified the sub-catchments with the greatest potential synergies and trade-offs of ecosystem service provision under the integrated water resources management reform process. With future development, our framework could be used as a decision support tool by those grappling with the challenge of the sustainable allocation of water between irrigation and the environment. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.
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Cohen-Hatton, Sabrina R; Honey, R C
2015-12-01
Decisions made by operational commanders at emergency incidents have been characterized as involving a period of information gathering followed by courses of action that are often generated without explicit plan formulation. We examined the efficacy of goal-oriented training in engendering explicit planning that would enable better communication at emergency incidents. While standard training mirrored current operational guidance, goal-oriented training incorporated "decision controls" that highlighted the importance of evaluating goals, anticipated consequences, and risk/benefit analyses once a potential course of action has been identified. In Experiment 1, 3 scenarios (a house fire, road traffic collision, and skip fire) were presented in a virtual environment, and in Experiment 2 they were recreated on the fireground. In Experiment 3, the house fire was recreated as a "live burn," and incident commanders and their crews responded to this scenario as an emergency incident. In all experiments, groups given standard training showed the reported tendency to move directly from information gathering to action, whereas those given goal-oriented training were more likely to develop explicit plans and show anticipatory situational awareness. These results indicate that training can be readily modified to promote explicit plan formulation that could facilitate plan sharing between incident commanders and their teams. (c) 2015 APA, all rights reserved).
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NASA Astrophysics Data System (ADS)
Pasqualini, D.; Witkowski, M.
2005-12-01
The Critical Infrastructure Protection / Decision Support System (CIP/DSS) project, supported by the Science and Technology Office, has been developing a risk-informed Decision Support System that provides insights for making critical infrastructure protection decisions. The system considers seventeen different Department of Homeland Security defined Critical Infrastructures (potable water system, telecommunications, public health, economics, etc.) and their primary interdependencies. These infrastructures have been modeling in one model called CIP/DSS Metropolitan Model. The modeling approach used is a system dynamics modeling approach. System dynamics modeling combines control theory and the nonlinear dynamics theory, which is defined by a set of coupled differential equations, which seeks to explain how the structure of a given system determines its behavior. In this poster we present a system dynamics model for one of the seventeen critical infrastructures, a generic metropolitan potable water system (MPWS). Three are the goals: 1) to gain a better understanding of the MPWS infrastructure; 2) to identify improvements that would help protect MPWS; and 3) to understand the consequences, interdependencies, and impacts, when perturbations occur to the system. The model represents raw water sources, the metropolitan water treatment process, storage of treated water, damage and repair to the MPWS, distribution of water, and end user demand, but does not explicitly represent the detailed network topology of an actual MPWS. The MPWS model is dependent upon inputs from the metropolitan population, energy, telecommunication, public health, and transportation models as well as the national water and transportation models. We present modeling results and sensitivity analysis indicating critical choke points, negative and positive feedback loops in the system. A general scenario is also analyzed where the potable water system responds to a generic disruption.
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2011-01-01
Background Clinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders. Methods Semi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Experiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement. Conclusions This study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options. PMID:22151735
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Insights from life history theory for an explicit treatment of trade-offs in conservation biology.
Charpentier, Anne
2015-06-01
As economic and social contexts become more embedded within biodiversity conservation, it becomes obvious that resources are a limiting factor in conservation. This recognition is leading conservation scientists and practitioners to increasingly frame conservation decisions as trade-offs between conflicting societal objectives. However, this framing is all too often done in an intuitive way, rather than by addressing trade-offs explicitly. In contrast, the concept of trade-off is a keystone in evolutionary biology, where it has been investigated extensively. I argue that insights from evolutionary theory can provide methodological and theoretical support to evaluating and quantifying trade-offs in biodiversity conservation. I reviewed the diverse ways in which trade-offs have emerged within the context of conservation and how advances from evolutionary theory can help avoid the main pitfalls of an implicit approach. When studying both evolutionary trade-offs (e.g., reproduction vs. survival) and conservation trade-offs (e.g., biodiversity conservation vs. agriculture), it is crucial to correctly identify the limiting resource, hold constant the amount of this resource when comparing different scenarios, and choose appropriate metrics to quantify the extent to which the objectives have been achieved. Insights from studies in evolutionary theory also reveal how an inadequate selection of conservation solutions may result from considering suboptimal rather than optional solutions when examining whether a trade-off exits between 2 objectives. Furthermore, the shape of a trade-off curve (i.e., whether the relationship between 2 objectives follows a concave, convex, or linear form) is known to affect crucially the definition of optimal solutions in evolutionary biology and very likely affects decisions in biodiversity conservation planning too. This interface between evolutionary biology and biodiversity conservation can therefore provide methodological guidance to support decision makers in the difficult task of choosing among conservation solutions. © 2015 Society for Conservation Biology.
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Decisions among the Undecided: Implicit Attitudes Predict Future Voting Behavior of Undecided Voters
Lundberg, Kristjen B.; Payne, B. Keith
2014-01-01
Implicit attitudes have been suggested as a key to unlock the hidden preferences of undecided voters. Past research, however, offered mixed support for this hypothesis. The present research used a large nationally representative sample and a longitudinal design to examine the predictive utility of implicit and explicit attitude measures in the 2008 U.S. presidential election. In our analyses, explicit attitudes toward candidates predicted voting better for decided than undecided voters, but implicit candidate attitudes were predictive of voting for both decided and undecided voters. Extending our examination to implicit and explicit racial attitudes, we found the same pattern. Taken together, these results provide convergent evidence that implicit attitudes predict voting about as well for undecided as for decided voters. We also assessed a novel explanation for these effects by evaluating whether implicit attitudes may predict the choices of undecided voters, in part, because they are neglected when people introspect about their confidence. Consistent with this idea, we found that the extremity of explicit but not implicit attitudes was associated with greater confidence. These analyses shed new light on the utility of implicit measures in predicting future behavior among individuals who feel undecided. Considering the prior studies together with this new evidence, the data seem to be consistent that implicit attitudes may be successful in predicting the behavior of undecided voters. PMID:24489666
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Roberts, Megan E.; Bernstein, Michael H.; Colby, Suzanne M.
2016-01-01
Purpose Adolescents susceptible to late-onset smoking (becoming regular smokers at age 18 or later) are an understudied population. Social support is a promising target for intervention, but it is important to distinguish between implicit social support (reminders that one belongs to a network of valued others) and explicit social support (seeking and receiving advice and emotional solace). This study aimed to test the potential protective influence of implicit and explicit social support on reducing the risk of late-onset smoking. Methods Fifty-eight smoking-susceptible youths (aged 16–18, 45% African American, 55% non-Hispanic White) completed an experimental session that included a video-recording task designed to elicit thoughts about implicit, explicit, or no social support. Youths reported their behavioral willingness and intentions (BW and BI) to smoke immediately following the social support manipulation; a random sample of 39 youths reported again at a 3-week follow-up. Results Following the manipulation, BW and BI for cigarette smoking were significantly higher among youths assigned to the explicit-support condition, compared to those in the implicit-support or control conditions. At follow-up, BW and BI were highest in the explicit-support condition and lowest in the implicit-support condition, but the differences were not significant. Conclusions Overall, findings indicated that for teens susceptible for late-onset smoking, eliciting thoughts about implicit social support produces lower risk for cigarette initiation than does eliciting thoughts about explicit social support. The present results and the video task that yielded them are important to researchers and practitioners interested in reducing the likelihood of late-onset smoking. PMID:27322670
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Roberts, Megan E; Bernstein, Michael H; Colby, Suzanne M
2016-11-01
Adolescents susceptible to late-onset smoking (becoming regular smokers at age 18 or later) are an understudied population. Social support is a promising target for intervention, but it is important to distinguish between implicit social support (reminders that one belongs to a network of valued others) and explicit social support (seeking and receiving advice and emotional solace). This study aimed to test the potential protective influence of implicit and explicit social support on reducing the risk of late-onset smoking. Fifty-eight smoking-susceptible youths (aged 16-18, 45% African American, 55% non-Hispanic White) completed an experimental session that included a video-recording task designed to elicit thoughts about implicit, explicit, or no social support. Youths reported their behavioral willingness and intentions (BW and BI) to smoke immediately following the social support manipulation; a random sample of 39 youths reported again at a 3-week follow-up. Following the manipulation, BW and BI for cigarette smoking were significantly higher among youths assigned to the explicit-support condition, compared to those in the implicit-support or control conditions. At follow-up, BW and BI were highest in the explicit-support condition and lowest in the implicit-support condition, but the differences were not significant. Overall, findings indicated that for teens susceptible for late-onset smoking, eliciting thoughts about implicit social support produces lower risk for cigarette initiation than does eliciting thoughts about explicit social support. The present results and the video task that yielded them are important to researchers and practitioners interested in reducing the likelihood of late-onset smoking. Copyright © 2016 Elsevier Ltd. All rights reserved.
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van der Steen, Jenny T; Hertogh, Cees M P M; de Graas, Tjomme; Nakanishi, Miharu; Toscani, Franco; Arcand, Marcel
2013-02-01
Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Three themes emerged: (1) relationships among patient, physician and other professionals-the authority of the physician was more explicit in adapted versions; (2) patient rights and family position-adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia.
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Simulating rotational grazing management.
Cros, M J; Duru, M; Garcia, F; Martin-Clouaire, R
2001-09-01
Dairy systems predominantly based on rotational grazing are notoriously hard to manage. In order to ensure profitability, this type of production requires quite good organisation, planning, and operating capability on the part of the farmer. A simulation-based decision support system, called SEPATOU, has been developed for this purpose. At the core of the decision support approach lies an explicit and rigorous modelling of the management strategy that underlies a dairy farmer's decision-making behaviour (real or hypothetical). The SEPATOU system is a discrete-event simulator that reproduces the day-to-day dynamics of the farmer's decision process and the response of the controlled biophysical system for which models of grass growth, animal consumption, and milk production are used. SEPATOU provides the means to evaluate and compare tentative strategies by simulating their application throughout the production season under different hypothetical weather conditions. The relative worth of a strategy can be assessed by analysing the effects on the biophysical system and their variability across the representative range of possible conditions that is considered. The activities to be managed concern the type and amount of conserved feed, where to fertilise and how much, the choice of fields to harvest, and most importantly, which field to graze next. Typically, SEPATOU is designed to be used by extension services and farming system scientists. It is implemented in C++ and is currently undergoing a validation process with the intended users.
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Stevens, Kara; Williams, Nicholas E.; Sistla, Seeta A.; Roddy, Adam B.; Urquhart, Gerald R.
2017-01-01
Anthropogenic threats to natural systems can be exacerbated due to connectivity between marine, freshwater, and terrestrial ecosystems, complicating the already daunting task of governance across the land-sea interface. Globalization, including new access to markets, can change social-ecological, land-sea linkages via livelihood responses and adaptations by local people. As a first step in understanding these trans-ecosystem effects, we examined exit and entry decisions of artisanal fishers and smallholder farmers on the rapidly globalizing Caribbean coast of Nicaragua. We found that exit and entry decisions demonstrated clear temporal and spatial patterns and that these decisions differed by livelihood. In addition to household characteristics, livelihood exit and entry decisions were strongly affected by new access to regional and global markets. The natural resource implications of these livelihood decisions are potentially profound as they provide novel linkages and spatially-explicit feedbacks between terrestrial and marine ecosystems. Our findings support the need for more scientific inquiry in understanding trans-ecosystem tradeoffs due to linked-livelihood transitions as well as the need for a trans-ecosystem approach to natural resource management and development policy in rapidly changing coastal regions. PMID:29077748
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Pieterse, Arwen H; de Vries, Marieke; Kunneman, Marleen; Stiggelbout, Anne M; Feldman-Stewart, Deb
2013-01-01
Healthcare decisions, particularly those involving weighing benefits and harms that may significantly affect quality and/or length of life, should reflect patients' preferences. To support patients in making choices, patient decision aids and values clarification methods (VCM) in particular have been developed. VCM intend to help patients to determine the aspects of the choices that are important to their selection of a preferred option. Several types of VCM exist. However, they are often designed without clear reference to theory, which makes it difficult for their development to be systematic and internally coherent. Our goal was to provide theory-informed recommendations for the design of VCM. Process theories of decision making specify components of decision processes, thus, identify particular processes that VCM could aim to facilitate. We conducted a review of the MEDLINE and PsycINFO databases and of references to theories included in retrieved papers, to identify process theories of decision making. We selected a theory if (a) it fulfilled criteria for a process theory; (b) provided a coherent description of the whole process of decision making; and (c) empirical evidence supports at least some of its postulates. Four theories met our criteria: Image Theory, Differentiation and Consolidation theory, Parallel Constraint Satisfaction theory, and Fuzzy-trace Theory. Based on these, we propose that VCM should: help optimize mental representations; encourage considering all potentially appropriate options; delay selection of an initially favoured option; facilitate the retrieval of relevant values from memory; facilitate the comparison of options and their attributes; and offer time to decide. In conclusion, our theory-based design recommendations are explicit and transparent, providing an opportunity to test each in a systematic manner. Copyright © 2012 Elsevier Ltd. All rights reserved.
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The role of risk aversion in non-conscious decision making.
Wang, Shuo; Krajbich, Ian; Adolphs, Ralph; Tsuchiya, Naotsugu
2012-01-01
To what extent can people choose advantageously without knowing why they are making those choices? This hotly debated question has capitalized on the Iowa Gambling Task (IGT), in which people often learn to choose advantageously without appearing to know why. However, because the IGT is unconstrained in many respects, this finding remains debated and other interpretations are possible (e.g., risk aversion, ambiguity aversion, limits of working memory, or insensitivity to reward/punishment can explain the finding of the IGT). Here we devised an improved variant of the IGT in which the deck-payoff contingency switches after subjects repeatedly choose from a good deck, offering the statistical power of repeated within-subject measures based on learning the reward contingencies associated with each deck. We found that participants exhibited low confidence in their choices, as probed with post-decision wagering, despite high accuracy in selecting advantageous decks in the task, which is putative evidence for non-conscious decision making. However, such a behavioral dissociation could also be explained by risk aversion, a tendency to avoid risky decisions under uncertainty. By explicitly measuring risk aversion for each individual, we predicted subjects' post-decision wagering using Bayesian modeling. We found that risk aversion indeed does play a role, but that it did not explain the entire effect. Moreover, independently measured risk aversion was uncorrelated with risk aversion exhibited during our version of the IGT, raising the possibility that the latter risk aversion may be non-conscious. Our findings support the idea that people can make optimal choices without being fully aware of the basis of their decision. We suggest that non-conscious decision making may be mediated by emotional feelings of risk that are based on mechanisms distinct from those that support cognitive assessment of risk.
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The Role of Risk Aversion in Non-Conscious Decision Making
Wang, Shuo; Krajbich, Ian; Adolphs, Ralph; Tsuchiya, Naotsugu
2012-01-01
To what extent can people choose advantageously without knowing why they are making those choices? This hotly debated question has capitalized on the Iowa Gambling Task (IGT), in which people often learn to choose advantageously without appearing to know why. However, because the IGT is unconstrained in many respects, this finding remains debated and other interpretations are possible (e.g., risk aversion, ambiguity aversion, limits of working memory, or insensitivity to reward/punishment can explain the finding of the IGT). Here we devised an improved variant of the IGT in which the deck-payoff contingency switches after subjects repeatedly choose from a good deck, offering the statistical power of repeated within-subject measures based on learning the reward contingencies associated with each deck. We found that participants exhibited low confidence in their choices, as probed with post-decision wagering, despite high accuracy in selecting advantageous decks in the task, which is putative evidence for non-conscious decision making. However, such a behavioral dissociation could also be explained by risk aversion, a tendency to avoid risky decisions under uncertainty. By explicitly measuring risk aversion for each individual, we predicted subjects’ post-decision wagering using Bayesian modeling. We found that risk aversion indeed does play a role, but that it did not explain the entire effect. Moreover, independently measured risk aversion was uncorrelated with risk aversion exhibited during our version of the IGT, raising the possibility that the latter risk aversion may be non-conscious. Our findings support the idea that people can make optimal choices without being fully aware of the basis of their decision. We suggest that non-conscious decision making may be mediated by emotional feelings of risk that are based on mechanisms distinct from those that support cognitive assessment of risk. PMID:22375133
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Environmental decision-making and the influences of various stressors, such as landscape and climate changes on water quantity and quality, requires the application of environmental modeling. Spatially explicit environmental and watershed-scale models using GIS as a base framewor...
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Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans
2017-02-23
As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort.
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A pattern-based analysis of clinical computer-interpretable guideline modeling languages.
Mulyar, Nataliya; van der Aalst, Wil M P; Peleg, Mor
2007-01-01
Languages used to specify computer-interpretable guidelines (CIGs) differ in their approaches to addressing particular modeling challenges. The main goals of this article are: (1) to examine the expressive power of CIG modeling languages, and (2) to define the differences, from the control-flow perspective, between process languages in workflow management systems and modeling languages used to design clinical guidelines. The pattern-based analysis was applied to guideline modeling languages Asbru, EON, GLIF, and PROforma. We focused on control-flow and left other perspectives out of consideration. We evaluated the selected CIG modeling languages and identified their degree of support of 43 control-flow patterns. We used a set of explicitly defined evaluation criteria to determine whether each pattern is supported directly, indirectly, or not at all. PROforma offers direct support for 22 of 43 patterns, Asbru 20, GLIF 17, and EON 11. All four directly support basic control-flow patterns, cancellation patterns, and some advance branching and synchronization patterns. None support multiple instances patterns. They offer varying levels of support for synchronizing merge patterns and state-based patterns. Some support a few scenarios not covered by the 43 control-flow patterns. CIG modeling languages are remarkably close to traditional workflow languages from the control-flow perspective, but cover many fewer workflow patterns. CIG languages offer some flexibility that supports modeling of complex decisions and provide ways for modeling some decisions not covered by workflow management systems. Workflow management systems may be suitable for clinical guideline applications.
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Ali-Khan, Sarah E; Black, Lee; Palmour, Nicole; Hallett, Michael T; Avard, Denise
2015-01-01
There have been multiple calls for explicit integration of ethical, legal, and social issues (ELSI) in health technology assessment (HTA) and addressing ELSI has been highlighted as key in optimizing benefits in the Omics/Personalized Medicine field. This study examines HTAs of an early clinical example of Personalized Medicine (gene expression profile tests [GEP] for breast cancer prognosis) aiming to: (i) identify ELSI; (ii) assess whether ELSIs are implicitly or explicitly addressed; and (iii) report methodology used for ELSI integration. A systematic search for HTAs (January 2004 to September 2012), followed by descriptive and qualitative content analysis. Seventeen HTAs for GEP were retrieved. Only three (18%) explicitly presented ELSI, and only one reported methodology. However, all of the HTAs included implicit ELSI. Eight themes of implicit and explicit ELSI were identified. "Classical" ELSI including privacy, informed consent, and concerns about limited patient/clinician genetic literacy were always presented explicitly. Some ELSI, including the need to understand how individual patients' risk tolerances affect clinical decision-making after reception of GEP results, were presented both explicitly and implicitly in HTAs. Others, such as concern about evidentiary deficiencies for clinical utility of GEP tests, occurred only implicitly. Despite a wide variety of important ELSI raised, these were rarely explicitly addressed in HTAs. Explicit treatment would increase their accessibility to decision-makers, and may augment HTA efficiency maximizing their utility. This is particularly important where complex Personalized Medicine applications are rapidly expanding choices for patients, clinicians and healthcare systems.
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Ethnic bias and clinical decision-making among New Zealand medical students: an observational study.
Harris, Ricci; Cormack, Donna; Stanley, James; Curtis, Elana; Jones, Rhys; Lacey, Cameron
2018-01-23
Health professional racial/ethnic bias may impact on clinical decision-making and contribute to subsequent ethnic health inequities. However, limited research has been undertaken among medical students. This paper presents findings from the Bias and Decision-Making in Medicine (BDMM) study, which sought to examine ethnic bias (Māori (indigenous peoples) compared with New Zealand European) among medical students and associations with clinical decision-making. All final year New Zealand (NZ) medical students in 2014 and 2015 (n = 888) were invited to participate in a cross-sectional online study. Key components included: two chronic disease vignettes (cardiovascular disease (CVD) and depression) with randomized patient ethnicity (Māori or NZ European) and questions on patient management; implicit bias measures (an ethnicity preference Implicit Association Test (IAT) and an ethnicity and compliant patient IAT); and, explicit ethnic bias questions. Associations between ethnic bias and clinical decision-making responses to vignettes were tested using linear regression. Three hundred and two students participated (34% response rate). Implicit and explicit ethnic bias favoring NZ Europeans was apparent among medical students. In the CVD vignette, no significant differences in clinical decision-making by patient ethnicity were observed. There were also no differential associations by patient ethnicity between any measures of ethnic bias (implicit or explicit) and patient management responses in the CVD vignette. In the depression vignette, some differences in the ranking of recommended treatment options were observed by patient ethnicity and explicit preference for NZ Europeans was associated with increased reporting that NZ European patients would benefit from treatment but not Māori (slope difference 0.34, 95% CI 0.08, 0.60; p = 0.011), although this was the only significant finding in these analyses. NZ medical students demonstrated ethnic bias, although overall this was not associated with clinical decision-making. This study both adds to the small body of literature internationally on racial/ethnic bias among medical students and provides relevant and important information for medical education on indigenous health and ethnic health inequities in New Zealand.
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Patkar, Vivek; Acosta, Dionisio; Davidson, Tim; Jones, Alison; Fox, John
2012-01-01
Objectives The cancer multidisciplinary team (MDT) meeting (MDM) is regarded as the best platform to reduce unwarranted variation in cancer care through evidence-compliant management. However, MDMs are often overburdened with many different agendas and hence struggle to achieve their full potential. The authors developed an interactive clinical decision support system called MATE (Multidisciplinary meeting Assistant and Treatment sElector) to facilitate explicit evidence-based decision making in the breast MDMs. Design Audit study and a questionnaire survey. Setting Breast multidisciplinary unit in a large secondary care teaching hospital. Participants All members of the breast MDT at the Royal Free Hospital, London, were consulted during the process of MATE development and implementation. The emphasis was on acknowledging the clinical needs and practical constraints of the MDT and fitting the system around the team's workflow rather than the other way around. Delegates, who attended MATE workshop at the England Cancer Networks' Development Programme conference in March 2010, participated in the questionnaire survey. Outcome measures The measures included evidence-compliant care, measured by adherence to clinical practice guidelines, and promoting research, measured by the patient identification rate for ongoing clinical trials. Results MATE identified 61% more patients who were potentially eligible for recruitment into clinical trials than the MDT, and MATE recommendations demonstrated better concordance with clinical practice guideline than MDT recommendations (97% of MATE vs 93.2% of MDT; N=984). MATE is in routine use in breast MDMs at the Royal Free Hospital, London, and wider evaluations are being considered. Conclusions Sophisticated decision support systems can enhance the conduct of MDMs in a way that is acceptable to and valued by the clinical team. Further rigorous evaluations are required to examine cost-effectiveness and measure the impact on patient outcomes. The decision support technology used in MATE is generic and if found useful can be applied across medicine. PMID:22734113
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Equity in healthcare resource allocation decision making: A systematic review.
Lane, Haylee; Sarkies, Mitchell; Martin, Jennifer; Haines, Terry
2017-02-01
To identify elements of endorsed definitions of equity in healthcare and classify domains of these definitions so that policy makers, managers, clinicians, and politicians can form an operational definition of equity that reflects the values and preferences of the society they serve. Systematic review where verbatim text describing explicit and implicit definitions of equity were extracted and subjected to a thematic analysis. The full holdings of the AMED, CINAHL plus, OVID Medline, Scopus, PsychInfo and ProQuest (ProQuest Health & Medical Complete, ProQuest Nursing and Allied Health Source, ProQuest Social Science Journals) were individually searched in April 2015. Studies were included if they provided an original, explicit or implicit definition of equity in regards to healthcare resource allocation decision making. Papers that only cited earlier definitions of equity and provided no new information or extensions to this definition were excluded. The search strategy yielded 74 papers appropriate for this review; 60 of these provided an explicit definition of equity, with a further 14 papers discussing implicit elements of equity that the authors endorsed in regards to healthcare resource allocation decision making. FIVE KEY THEMES EMERGED: i) Equalisation across the health service supply/access/outcome chain, ii) Need or potential to benefit, iii) Groupings of equalisation, iv) Caveats to equalisation, and v) Close enough is good enough. There is great inconsistency in definitions of equity endorsed by different authors. Operational definitions of equity need to be more explicit in addressing these five thematic areas before they can be directly applied to healthcare resource allocation decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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International trade versus public health during the FCTC negotiations, 1999-2003
Mamudu, Hadii M; Hammond, Ross; Glantz, Stanton A
2011-01-01
Objective To examine why the Framework Convention on Tobacco Control did not include an explicit trade provision and delineate the central arguments in the debate over trade provision during the negotiations. Methods Triangulate interviews with participants in the FCTC negotiations, the FCTC negotiations documents, and tobacco industry documents. Results An explicit FCTC trade provision on relation between international trade and public health became a contentious issue during the negotiations. As a result, two conflicting positions, health-over-trade and opposition to health-over-trade emerged. Opposition to explicit trade language giving health priority was by both tobacco industry and countries that generally supported strong FCTC provisions because of concerns over ‘disguised protectionism’ and setting a precedent whereby governments could forfeit their obligations under pre-existing treaties. Owing to lack of consensus among political actors involved in the negotiations, a compromise position eliminating any mention of trade emerged, which was predicated on belief among some in the public health community that public health would prevail in future trade versus health conflicts. Conclusion The absence of an explicit FCTC trade provision was due to a political compromise rather than the impact of international trade agreements and decisions on public health and lack of consensus among health advocates. This failure to include an explicit trade provision in the FCTC suggests that the public health community should become more involved in trade and health issues at all levels of governance and press the FCTC Conference of the Parties for clarification of this critical issue. PMID:20943828
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Effective Monitoring and Control of Outsourced Software Development Projects
NASA Astrophysics Data System (ADS)
Ponisio, Laura; Vruggink, Peter
In our study of four outsourcing projects we discover mechanisms to support managerial decision making during software development processes. We report on Customer Office, a framework used in practice that facilitates reasoning about projects by highlighting information paths and making co-ordination issues explicit. The results suggest a key role of modularisation and standardisation to assist in value creation, by facilitating information flow and keeping the overview of the project. The practical implications of our findings are guidelines for managing outsourcing projects such as to have a modularised view of the project based on knowledge domains and to standardise co-ordination operations.
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Background / Question / Methods Planning for the recovery of threatened species is increasingly informed by spatially-explicit population models. However, using simulation model results to guide land management decisions can be difficult due to the volume and complexity of model...
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A Naturalistic Inquiry into Praxis When Education Instructors Use Explicit Metacognitive Modeling
ERIC Educational Resources Information Center
Shannon, Nancy Gayle
2014-01-01
This naturalistic inquiry brought together six education instructors in one small teacher preparation program to explore what happens to educational instructors' praxis when the education instructors use explicit metacognitive modeling to reveal their thinking behind their pedagogical decision-making. The participants, while teaching an…
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Scheibehenne, Benjamin; Clark, Luke
2016-01-01
Abstract The current study assessed peripheral responses during decision making under explicit risk, and tested whether intraindividual variability in choice behavior can be explained by fluctuations in peripheral arousal. Electrodermal activity (EDA) and heart rate (HR) were monitored in healthy volunteers (N = 68) during the Roulette Betting Task. In this task, participants were presented with risky gambles to bet on, with the chances of winning varying across trials. Hierarchical Bayesian analyses demonstrated that EDA and HR acceleration responses during the decision phase were sensitive to the chances of winning. Interindividual differences in this peripheral reactivity during risky decision making were related to trait sensitivity to punishment and trait sensitivity to reward. Moreover, trial‐by‐trial variation in EDA and HR acceleration responses predicted a small portion of intraindividual variability in betting choices. Our results show that psychophysiological responses are sensitive to explicit risk and can help explain intraindividual heterogeneity in choice behavior. PMID:26927730
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Territory surveillance and prey management: Wolves keep track of space and time.
Schlägel, Ulrike E; Merrill, Evelyn H; Lewis, Mark A
2017-10-01
Identifying behavioral mechanisms that underlie observed movement patterns is difficult when animals employ sophisticated cognitive-based strategies. Such strategies may arise when timing of return visits is important, for instance to allow for resource renewal or territorial patrolling. We fitted spatially explicit random-walk models to GPS movement data of six wolves ( Canis lupus ; Linnaeus, 1758) from Alberta, Canada to investigate the importance of the following: (1) territorial surveillance likely related to renewal of scent marks along territorial edges, to reduce intraspecific risk among packs, and (2) delay in return to recently hunted areas, which may be related to anti-predator responses of prey under varying prey densities. The movement models incorporated the spatiotemporal variable "time since last visit," which acts as a wolf's memory index of its travel history and is integrated into the movement decision along with its position in relation to territory boundaries and information on local prey densities. We used a model selection framework to test hypotheses about the combined importance of these variables in wolf movement strategies. Time-dependent movement for territory surveillance was supported by all wolf movement tracks. Wolves generally avoided territory edges, but this avoidance was reduced as time since last visit increased. Time-dependent prey management was weak except in one wolf. This wolf selected locations with longer time since last visit and lower prey density, which led to a longer delay in revisiting high prey density sites. Our study shows that we can use spatially explicit random walks to identify behavioral strategies that merge environmental information and explicit spatiotemporal information on past movements (i.e., "when" and "where") to make movement decisions. The approach allows us to better understand cognition-based movement in relation to dynamic environments and resources.
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McCurtin, Arlene; Healy, Chiara
2017-02-01
Speech-language pathologists (SLPs) are assumed to use evidence-based practice to inform treatment decisions. However, the reasoning underpinning treatment selections is not well known. Understanding why SLPs choose the treatments they do may be clarified by exploring the reasoning tied to specific treatments such as dysphagia interventions. An electronic survey methodology was utilised. Participants were accessed via the gatekeepers of two national dysphagia special interest groups representing adult and paediatric populations. Information was elicited on the dysphagia therapies and techniques used and on the reasoning for using/not using therapies. Data was analysed using descriptive and non-parametric statistics. The survey had a 74.8% response rate (n = 116). Consensus in both treatment selections and reasoning supporting treatment decisions was evident. Three favoured interventions (texture modification, thickening liquids, positioning changes) were identified. The reasoning supporting treatment choices centred primarily on client suitability and clinician knowledge. Knowledge reflected both absent knowledge (e.g. training) and accumulated knowledge (clinical experience). Dysphagia practice appears highly-defined, being characterised by group consensus regarding both preferred treatments and the reasoning underpinning treatment selections. Treatment selections are based on two core criteria: client suitability and the SLPs experience/knowledge. Explicit scientific reasoning is less influential than practice-centric influences.
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Conflicting and complementary ethics of animal welfare considerations in reintroductions.
Harrington, Lauren A; Moehrenschlager, Axel; Gelling, Merryl; Atkinson, Rob P D; Hughes, Joelene; Macdonald, David W
2013-06-01
Despite differences in focus, goals, and strategies between conservation biology and animal welfare, both are inextricably linked in many ways, and greater consideration of animal welfare, although important in its own right, also has considerable potential to contribute to conservation success. Nevertheless, animal welfare and animal ethics are not always considered explicitly within conservation practice. We systematically reviewed the recent scientific peer-reviewed and online gray literature on reintroductions of captive-bred and wild-caught animals (mammals, birds, amphibians, and reptiles) to quantify the occurrence of animal welfare issues. We considered monitoring that could be indicative of the animal's welfare status and supportive management actions that could improve animal welfare (regardless of whether the aim was explicitly animal-welfare orientated). Potential welfare issues (of variable nature and extent) were recorded in 67% of 199 projects reviewed; the most common were mortality >50%, dispersal or loss of animals, disease, and human conflict. Most (>70%) projects monitored survival, 18% assessed body condition, and 2% monitored stress levels. Animal welfare, explicitly, was referred to in 6% of projects. Supportive actions, most commonly use of on-site prerelease pens and provision of supplemental food or water, were implemented in 79% of projects, although the extent and duration of support varied. Practitioners can address animal-welfare issues in reintroductions by considering the potential implications for individual animals at all stages of the release process using the decision tree presented. We urge practitioners to report potential animal-welfare issues, describe mitigation actions, and evaluate their efficacy to facilitate transparent evaluation of common moral dilemmas and to advance communal strategies for dealing with them. Currently, comparative mortality rates, health risks, postrelease stress, effectiveness of supportive measures, and behavior of individuals warrant further research to improve animal welfare in reintroductions and to increase success of such projects. © 2013 Society for Conservation Biology.
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Phylogenetic classification of bony fishes.
Betancur-R, Ricardo; Wiley, Edward O; Arratia, Gloria; Acero, Arturo; Bailly, Nicolas; Miya, Masaki; Lecointre, Guillaume; Ortí, Guillermo
2017-07-06
Fish classifications, as those of most other taxonomic groups, are being transformed drastically as new molecular phylogenies provide support for natural groups that were unanticipated by previous studies. A brief review of the main criteria used by ichthyologists to define their classifications during the last 50 years, however, reveals slow progress towards using an explicit phylogenetic framework. Instead, the trend has been to rely, in varying degrees, on deep-rooted anatomical concepts and authority, often mixing taxa with explicit phylogenetic support with arbitrary groupings. Two leading sources in ichthyology frequently used for fish classifications (JS Nelson's volumes of Fishes of the World and W. Eschmeyer's Catalog of Fishes) fail to adopt a global phylogenetic framework despite much recent progress made towards the resolution of the fish Tree of Life. The first explicit phylogenetic classification of bony fishes was published in 2013, based on a comprehensive molecular phylogeny ( www.deepfin.org ). We here update the first version of that classification by incorporating the most recent phylogenetic results. The updated classification presented here is based on phylogenies inferred using molecular and genomic data for nearly 2000 fishes. A total of 72 orders (and 79 suborders) are recognized in this version, compared with 66 orders in version 1. The phylogeny resolves placement of 410 families, or ~80% of the total of 514 families of bony fishes currently recognized. The ordinal status of 30 percomorph families included in this study, however, remains uncertain (incertae sedis in the series Carangaria, Ovalentaria, or Eupercaria). Comments to support taxonomic decisions and comparisons with conflicting taxonomic groups proposed by others are presented. We also highlight cases were morphological support exist for the groups being classified. This version of the phylogenetic classification of bony fishes is substantially improved, providing resolution for more taxa than previous versions, based on more densely sampled phylogenetic trees. The classification presented in this study represents, unlike any other, the most up-to-date hypothesis of the Tree of Life of fishes.
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Schiebener, Johannes; García-Arias, María; García-Villamisar, Domingo; Cabanyes-Truffino, Javier; Brand, Matthias
2015-01-01
Previous studies have shown that children and adolescents often tend toward risky decisions despite explicit knowledge about the potential negative consequences. This phenomenon has been suggested to be associated with the immaturity of brain areas involved in cognitive control functions. Particularly, "frontal lobe functions," such as executive functions and reasoning, mature until young adulthood and are thought to be involved in age-related changes in decision making under explicit risk conditions. We investigated 112 participants, aged 8-19 years, with a frequently used task assessing decisions under risk, the Game of Dice Task (GDT). Additionally, we administered the Modified Card Sorting Test assessing executive functioning (categorization, cognitive flexibility, and strategy maintenance) as well as the Ravens Progressive Matrices assessing reasoning. The results showed that risk taking in the GDT decreased with increasing age and this effect was not moderated by reasoning but by executive functions: Particularly, young persons with weak executive functioning showed very risky decision making. Thus, the individual maturation of executive functions, associated with areas in the prefrontal cortex, seems to be an important factor in young peoples' behavior in risky decision-making situations.
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McGowan, Conor P.; Allan, Nathan; Servoss, Jeff; Hedwall, Shaula J.; Wooldridge, Brian
2017-01-01
Assessment of a species' status is a key part of management decision making for endangered and threatened species under the U.S. Endangered Species Act. Predicting the future state of the species is an essential part of species status assessment, and projection models can play an important role in developing predictions. We built a stochastic simulation model that incorporated parametric and environmental uncertainty to predict the probable future status of the Sonoran desert tortoise in the southwestern United States and North Central Mexico. Sonoran desert tortoise was a Candidate species for listing under the Endangered Species Act, and decision makers wanted to use model predictions in their decision making process. The model accounted for future habitat loss and possible effects of climate change induced droughts to predict future population growth rates, abundances, and quasi-extinction probabilities. Our model predicts that the population will likely decline over the next few decades, but there is very low probability of quasi-extinction less than 75 years into the future. Increases in drought frequency and intensity may increase extinction risk for the species. Our model helped decision makers predict and characterize uncertainty about the future status of the species in their listing decision. We incorporated complex ecological processes (e.g., climate change effects on tortoises) in transparent and explicit ways tailored to support decision making processes related to endangered species.
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Reiter-Theil, Stella; Mertz, Marcel; Schürmann, Jan; Stingelin Giles, Nicola; Meyer-Zehnder, Barbara
2011-09-01
In this paper we assume that 'theory' is important for Clinical Ethics Support Services (CESS). We will argue that the underlying implicit theory should be reflected. Moreover, we suggest that the theoretical components on which any clinical ethics support (CES) relies should be explicitly articulated in order to enhance the quality of CES. A theoretical framework appropriate for CES will be necessarily complex and should include ethical (both descriptive and normative), metaethical and organizational components. The various forms of CES that exist in North-America and in Europe show their underlying theory more or less explicitly, with most of them referring to some kind of theoretical components including 'how-to' questions (methodology), organizational issues (implementation), problem analysis (phenomenology or typology of problems), and related ethical issues such as end-of-life decisions (major ethical topics). In order to illustrate and explain the theoretical framework that we are suggesting for our own CES project METAP, we will outline this project which has been established in a multi-centre context in several healthcare institutions. We conceptualize three 'pillars' as the major components of our theoretical framework: (1) evidence, (2) competence, and (3) discourse. As a whole, the framework is aimed at developing a foundation of our CES project METAP. We conclude that this specific integration of theoretical components is a promising model for the fruitful further development of CES. © 2011 Blackwell Publishing Ltd.
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Implementation science: a role for parallel dual processing models of reasoning?
Sladek, Ruth M; Phillips, Paddy A; Bond, Malcolm J
2006-01-01
Background A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. Discussion Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. Summary It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice. PMID:16725023
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Implementation science: a role for parallel dual processing models of reasoning?
Sladek, Ruth M; Phillips, Paddy A; Bond, Malcolm J
2006-05-25
A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.
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La Morgia, Valentina; Paoloni, Daniele; Genovesi, Piero
2017-02-01
Eradication of invasive alien species supports the recovery of native biodiversity. A new European Union Regulation introduces obligations to eradicate the most harmful invasive species. However, eradications of charismatic mammals may encounter strong opposition. Considering the case study of the eastern grey squirrel (Sciurus carolinensis Gmelin, 1788) in central Italy, we developed a structured decision-making technique based on a Bayesian decision network model and explicitly considering the plurality of environmental values of invasive species management to reduce potential social conflicts. The model identified priority areas for management activities. These areas corresponded to the core of the grey squirrel range, but they also included peripheral zones, where rapid eradication is fundamental to prevent the spread of squirrels. However, when the model was expanded to integrate the attitude of citizens towards the project, the intervention strategy slightly changed. In some areas, the citizens' support was limited, and this resulted in a reduced overall utility of intervention. The suggested approach extends the scientific basis for management decisions, evaluated in terms of technical efficiency, feasibility and social impact. Here, the Bayesian decision network model analysed the potential technical and social consequences of management actions, and it responded to the need for transparency in the decision-making process, but it can easily be extended to consider further issues that are common in many mammal eradication programmes. Owing to its flexibility and comprehensiveness, it provides an innovative example of how to plan rapid eradication or control activities, as required by the new EU Regulation. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.
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Gurney, Georgina G.; Melbourne-Thomas, Jessica; Geronimo, Rollan C.; Aliño, Perry M.; Johnson, Craig R.
2013-01-01
Climate change has emerged as a principal threat to coral reefs, and is expected to exacerbate coral reef degradation caused by more localised stressors. Management of local stressors is widely advocated to bolster coral reef resilience, but the extent to which management of local stressors might affect future trajectories of reef state remains unclear. This is in part because of limited understanding of the cumulative impact of multiple stressors. Models are ideal tools to aid understanding of future reef state under alternative management and climatic scenarios, but to date few have been sufficiently developed to be useful as decision support tools for local management of coral reefs subject to multiple stressors. We used a simulation model of coral reefs to investigate the extent to which the management of local stressors (namely poor water quality and fishing) might influence future reef state under varying climatic scenarios relating to coral bleaching. We parameterised the model for Bolinao, the Philippines, and explored how simulation modelling can be used to provide decision support for local management. We found that management of water quality, and to a lesser extent fishing, can have a significant impact on future reef state, including coral recovery following bleaching-induced mortality. The stressors we examined interacted antagonistically to affect reef state, highlighting the importance of considering the combined impact of multiple stressors rather than considering them individually. Further, by providing explicit guidance for management of Bolinao's reef system, such as which course of management action will most likely to be effective over what time scales and at which sites, we demonstrated the utility of simulation models for supporting management. Aside from providing explicit guidance for management of Bolinao's reef system, our study offers insights which could inform reef management more broadly, as well as general understanding of reef systems. PMID:24260347
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Gurney, Georgina G; Melbourne-Thomas, Jessica; Geronimo, Rollan C; Aliño, Perry M; Johnson, Craig R
2013-01-01
Climate change has emerged as a principal threat to coral reefs, and is expected to exacerbate coral reef degradation caused by more localised stressors. Management of local stressors is widely advocated to bolster coral reef resilience, but the extent to which management of local stressors might affect future trajectories of reef state remains unclear. This is in part because of limited understanding of the cumulative impact of multiple stressors. Models are ideal tools to aid understanding of future reef state under alternative management and climatic scenarios, but to date few have been sufficiently developed to be useful as decision support tools for local management of coral reefs subject to multiple stressors. We used a simulation model of coral reefs to investigate the extent to which the management of local stressors (namely poor water quality and fishing) might influence future reef state under varying climatic scenarios relating to coral bleaching. We parameterised the model for Bolinao, the Philippines, and explored how simulation modelling can be used to provide decision support for local management. We found that management of water quality, and to a lesser extent fishing, can have a significant impact on future reef state, including coral recovery following bleaching-induced mortality. The stressors we examined interacted antagonistically to affect reef state, highlighting the importance of considering the combined impact of multiple stressors rather than considering them individually. Further, by providing explicit guidance for management of Bolinao's reef system, such as which course of management action will most likely to be effective over what time scales and at which sites, we demonstrated the utility of simulation models for supporting management. Aside from providing explicit guidance for management of Bolinao's reef system, our study offers insights which could inform reef management more broadly, as well as general understanding of reef systems.
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ERIC Educational Resources Information Center
Klapwijk, Eduard T.; Aghajani, Moji; Lelieveld, Gert-Jan; van Lang, Natasja D. J.; Popma, Arne; van der Wee, Nic J. A.; Colins, Olivier F.; Vermeiren, Robert R. J. M.
2017-01-01
Little is known about how emotions expressed by others influence social decisions and associated brain responses in autism spectrum disorders (ASD). We investigated the neural mechanisms underlying fairness decisions in response to explicitly expressed emotions of others in boys with ASD and typically developing (TD) boys. Participants with ASD…
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Decisions from Experience: Why Small Samples?
ERIC Educational Resources Information Center
Hertwig, Ralph; Pleskac, Timothy J.
2010-01-01
In many decisions we cannot consult explicit statistics telling us about the risks involved in our actions. In lieu of such data, we can arrive at an understanding of our dicey options by sampling from them. The size of the samples that we take determines, ceteris paribus, how good our choices will be. Studies of decisions from experience have…
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Exploring the Content of Intraoperative Teaching.
Pernar, Luise I M; Peyre, Sarah E; Hasson, Rian M; Lipsitz, Stuart; Corso, Katherine; Ashley, Stanley W; Breen, Elizabeth M
2016-01-01
Much teaching to surgical residents takes place in the operating room (OR). The explicit content of what is taught in the OR, however, has not previously been described. This study investigated the content of what is taught in the OR, specifically during laparoscopic cholecystectomies (LCs), for which a cognitive task analysis (CTA), explicitly delineating individual steps, was available in the literature. A checklist of necessary technical and decision-making steps to be executed during performance of LCs, anchored in the previously published CTA, was developed. A convenience sample of LCs was identified over a 12-month period from February 2011 to February 2012. Using the checklist, a trained observer recorded explicit teaching that occurred regarding these steps during each observed case. All observations were tallied and analyzed. In all, 51 LCs were observed; 14 surgery attendings and 33 residents participated in the observed cases. Of 1042 observable teaching points, only 560 (53.7%) were observed during the study period. As a proportion of all observable steps, technical steps were observed more frequently, 377 (67.3%), than decision-making steps, 183 (32.7%). Also when focusing on technical and decision-making steps alone, technical steps were taught more frequently (60.9% vs 43.3%). Only approximately half of all possible observable teaching steps were explicitly taught during LCs in this study. Technical steps were more frequently taught than decision-making steps. These findings may have important implications: a better understanding of the content of intraoperative teaching would allow educators to steer residents' preoperative preparation, modulate intraoperative instruction by members of the surgical faculty, and guide residents to the most appropriate teaching venues. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Explicit and spontaneous retrieval of emotional scenes: electrophysiological correlates.
Weymar, Mathias; Bradley, Margaret M; El-Hinnawi, Nasryn; Lang, Peter J
2013-10-01
When event-related potentials (ERP) are measured during a recognition task, items that have previously been presented typically elicit a larger late (400-800 ms) positive potential than new items. Recent data, however, suggest that emotional, but not neutral, pictures show ERP evidence of spontaneous retrieval when presented in a free-viewing task (Ferrari, Bradley, Codispoti, Karlsson, & Lang, 2012). In two experiments, we further investigated the brain dynamics of implicit and explicit retrieval. In Experiment 1, brain potentials were measured during a semantic categorization task, which did not explicitly probe episodic memory, but which, like a recognition task, required an active decision and a button press, and were compared to those elicited during recognition and free viewing. Explicit recognition prompted a late enhanced positivity for previously presented, compared with new, pictures regardless of hedonic content. In contrast, only emotional pictures showed an old-new difference when the task did not explicitly probe episodic memory, either when making an active categorization decision regarding picture content, or when simply viewing pictures. In Experiment 2, however, neutral pictures did prompt a significant old-new ERP difference during subsequent free viewing when emotionally arousing pictures were not included in the encoding set. These data suggest that spontaneous retrieval is heightened for salient cues, perhaps reflecting heightened attention and elaborative processing at encoding.
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Explicit and spontaneous retrieval of emotional scenes: Electrophysiological correlates
Weymar, Mathias; Bradley, Margaret M.; El-Hinnawi, Nasryn; Lang, Peter J.
2014-01-01
When event-related potentials are measured during a recognition task, items that have previously been presented typically elicit a larger late (400–800 ms) positive potential than new items. Recent data, however, suggest that emotional, but not neutral, pictures show ERP evidence of spontaneous retrieval when presented in a free-viewing task (Ferrari, Bradley, Codispoti & Lang, 2012). In two experiments, we further investigated the brain dynamics of implicit and explicit retrieval. In Experiment 1, brain potentials were measured during a semantic categorization task, which did not explicitly probe episodic memory, but which, like a recognition task, required an active decision and a button press, and were compared to those elicited during recognition and free viewing. Explicit recognition prompted a late enhanced positivity for previously presented, compared to new, pictures regardless of hedonic content. In contrast, only emotional pictures showed an old-new difference when the task did not explicitly probe episodic memory, either when either making an active categorization decision regarding picture content, or when simply viewing pictures. In Experiment 2, however, neutral pictures did prompt a significant old-new ERP difference during subsequent free viewing when emotionally arousing pictures were not included in the encoding set. These data suggest that spontaneous retrieval is heightened for salient cues, perhaps reflecting heightened attention and elaborative processing at encoding. PMID:23795588
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2003-01-01
media factors affecting: • Shared Understanding – explicit and operational knowledge • Decision-Making – what information format best helps decision...Passing the Bubble: Cognitive Efficiency of Augmented Video for Collaborative Transfer of Situational Understanding Collaboration and Knowledge ...operational knowledge ? • Informed Decision-Making – what information format is best to pass the bubble to a decision-maker 1/14/2003 ONR David Kirsh
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Gonzalez-Redin, Julen; Luque, Sandra; Poggio, Laura; Smith, Ron; Gimona, Alessandro
2016-01-01
An integrated methodology, based on linking Bayesian belief networks (BBN) with GIS, is proposed for combining available evidence to help forest managers evaluate implications and trade-offs between forest production and conservation measures to preserve biodiversity in forested habitats. A Bayesian belief network is a probabilistic graphical model that represents variables and their dependencies through specifying probabilistic relationships. In spatially explicit decision problems where it is difficult to choose appropriate combinations of interventions, the proposed integration of a BBN with GIS helped to facilitate shared understanding of the human-landscape relationships, while fostering collective management that can be incorporated into landscape planning processes. Trades-offs become more and more relevant in these landscape contexts where the participation of many and varied stakeholder groups is indispensable. With these challenges in mind, our integrated approach incorporates GIS-based data with expert knowledge to consider two different land use interests - biodiversity value for conservation and timber production potential - with the focus on a complex mountain landscape in the French Alps. The spatial models produced provided different alternatives of suitable sites that can be used by policy makers in order to support conservation priorities while addressing management options. The approach provided provide a common reasoning language among different experts from different backgrounds while helped to identify spatially explicit conflictive areas. Copyright © 2015 Elsevier Inc. All rights reserved.
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Bernheim, Ruth Gaare; Stefanak, Matthew; Brandenburg, Terry; Pannone, Aaron; Melnick, Alan
2013-01-01
As public health departments around the country undergo accreditation using the Public Health Accreditation Board standards, the process provides a new opportunity to integrate ethics metrics into day-to-day public health practice. While the accreditation standards do not explicitly address ethics, ethical tools and considerations can enrich the accreditation process by helping health departments and their communities understand what ethical principles underlie the accreditation standards and how to use metrics based on these ethical principles to support decision making in public health practice. We provide a crosswalk between a public health essential service, Public Health Accreditation Board community engagement domain standards, and the relevant ethical principles in the Public Health Code of Ethics (Code). A case study illustrates how the accreditation standards and the ethical principles in the Code together can enhance the practice of engaging the community in decision making in the local health department.
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NASA Astrophysics Data System (ADS)
Whitney, Cory W.; Lanzanova, Denis; Muchiri, Caroline; Shepherd, Keith D.; Rosenstock, Todd S.; Krawinkel, Michael; Tabuti, John R. S.; Luedeling, Eike
2018-03-01
Governments around the world have agreed to end hunger and food insecurity and to improve global nutrition, largely through changes to agriculture and food systems. However, they are faced with a lot of uncertainty when making policy decisions, since any agricultural changes will influence social and biophysical systems, which could yield either positive or negative nutrition outcomes. We outline a holistic probability modeling approach with Bayesian Network (BN) models for nutritional impacts resulting from agricultural development policy. The approach includes the elicitation of expert knowledge for impact model development, including sensitivity analysis and value of information calculations. It aims at a generalizable methodology that can be applied in a wide range of contexts. To showcase this approach, we develop an impact model of Vision 2040, Uganda's development strategy, which, among other objectives, seeks to transform the country's agricultural landscape from traditional systems to large-scale commercial agriculture. Model results suggest that Vision 2040 is likely to have negative outcomes for the rural livelihoods it intends to support; it may have no appreciable influence on household hunger but, by influencing preferences for and access to quality nutritional foods, may increase the prevalence of micronutrient deficiency. The results highlight the trade-offs that must be negotiated when making decisions regarding agriculture for nutrition, and the capacity of BNs to make these trade-offs explicit. The work illustrates the value of BNs for supporting evidence-based agricultural development decisions.
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Kinsey, Katharine; Firth, Jill; Elwyn, Glyn; Edwards, Adrian; Brain, Katherine; Marrin, Katy; Nye, Alan; Wood, Fiona
2017-12-01
Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option Grids ™ are a type of decision support tool specifically designed to be used during clinical encounters. To explore patients' views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison with usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Semi-structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients' understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Interviews suggested that the Option Grid facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the Option Grid facilitated greater engagement in shared decision making. The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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Free and Open Source GIS Tools: Role and Relevance in the Environmental Assessment Community
The presence of an explicit geographical context in most environmental decisions can complicate assessment and selection of management options. These decisions typically involve numerous data sources, complex environmental and ecological processes and their associated models, ris...
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Climate Modeling and Analysis with Decision Makers in Mind
NASA Astrophysics Data System (ADS)
Jones, A. D.; Jagannathan, K.; Calvin, K. V.; Lamarque, J. F.; Ullrich, P. A.
2016-12-01
There is a growing need for information about future climate conditions to support adaptation planning across a wide range of sectors and stakeholder communities. However, our principal tools for understanding future climate - global Earth system models - were not developed with these user needs in mind, nor have we developed transparent methods for evaluating and communicating the credibility of various climate information products with respect to the climate characteristics that matter most to decision-makers. Several recent community engagements have identified a need for "co-production" of knowledge among stakeholders and scientists. Here we highlight some of the barriers to communication and collaboration that must be overcome to improve the dialogue among researchers and climate adaptation practitioners in a meaningful way. Solutions to this challenge are two-fold: 1) new institutional arrangements and collaborative mechanisms designed to improve coordination and understanding among communities, and 2) a research agenda that explicitly incorporates stakeholder needs into model evaluation, development, and experimental design. We contrast the information content in global-scale model evaluation exercises with that required for in specific decision contexts, such as long-term agricultural management decisions. Finally, we present a vision for advancing the science of model evaluation in the context of predicting decision-relevant hydroclimate regime shifts in North America.
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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.
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Gong, Jian; Yang, Jianxin; Tang, Wenwu
2015-11-09
Land use and land cover change is driven by multiple influential factors from environmental and social dimensions in a land system. Land use practices of human decision-makers modify the landscape of the land system, possibly leading to landscape fragmentation, biodiversity loss, or environmental pollution-severe environmental or ecological impacts. While landscape-level ecological risk assessment supports the evaluation of these impacts, investigations on how these ecological risks induced by land use practices change over space and time in response to alternative policy intervention remain inadequate. In this article, we conducted spatially explicit landscape ecological risk analysis in Ezhou City, China. Our study area is a national ecologically representative region experiencing drastic land use and land cover change, and is regulated by multiple policies represented by farmland protection, ecological conservation, and urban development. We employed landscape metrics to consider the influence of potential landscape-level disturbance for the evaluation of landscape ecological risks. Using spatiotemporal simulation, we designed scenarios to examine spatiotemporal patterns in landscape ecological risks in response to policy intervention. Our study demonstrated that spatially explicit landscape ecological risk analysis combined with simulation-driven scenario analysis is of particular importance for guiding the sustainable development of ecologically vulnerable land systems.
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Gong, Jian; Yang, Jianxin; Tang, Wenwu
2015-01-01
Land use and land cover change is driven by multiple influential factors from environmental and social dimensions in a land system. Land use practices of human decision-makers modify the landscape of the land system, possibly leading to landscape fragmentation, biodiversity loss, or environmental pollution—severe environmental or ecological impacts. While landscape-level ecological risk assessment supports the evaluation of these impacts, investigations on how these ecological risks induced by land use practices change over space and time in response to alternative policy intervention remain inadequate. In this article, we conducted spatially explicit landscape ecological risk analysis in Ezhou City, China. Our study area is a national ecologically representative region experiencing drastic land use and land cover change, and is regulated by multiple policies represented by farmland protection, ecological conservation, and urban development. We employed landscape metrics to consider the influence of potential landscape-level disturbance for the evaluation of landscape ecological risks. Using spatiotemporal simulation, we designed scenarios to examine spatiotemporal patterns in landscape ecological risks in response to policy intervention. Our study demonstrated that spatially explicit landscape ecological risk analysis combined with simulation-driven scenario analysis is of particular importance for guiding the sustainable development of ecologically vulnerable land systems. PMID:26569270
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Derosiere, Gerard; Zénon, Alexandre; Alamia, Andrea; Duque, Julie
2017-02-01
In the present study, we investigated the functional contribution of the human primary motor cortex (M1) to motor decisions. Continuous theta burst stimulation (cTBS) was used to alter M1 activity while participants performed a decision-making task in which the reward associated with the subjects' responses (right hand finger movements) depended on explicit and implicit value-based rules. Subjects performed the task over two consecutive days and cTBS occurred in the middle of Day 2, once the subjects were just about to implement implicit rules, in addition to the explicit instructions, to choose their responses, as evident in the control group (cTBS over the right somatosensory cortex). Interestingly, cTBS over the left M1 prevented subjects from implementing the implicit value-based rule while its implementation was enhanced in the group receiving cTBS over the right M1. Hence, cTBS had opposite effects depending on whether it was applied on the contralateral or ipsilateral M1. The use of the explicit value-based rule was unaffected by cTBS in the three groups of subject. Overall, the present study provides evidence for a functional contribution of M1 to the implementation of freshly acquired implicit rules, possibly through its involvement in a cortico-subcortical network controlling value-based motor decisions. Copyright © 2016 Elsevier Inc. All rights reserved.
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Using Drugs to End Life without an Explicit Request of the Patient
ERIC Educational Resources Information Center
Rietjens, Judith A.C.; Bilsen, Johan; Fischer, Susanne; van der Heide, Agnes; van der Maas, Paul J.; Miccinessi, Guido; Norup, Michael; Onwuteaka-Philipsen, Bregje D.; Vrakking, Astrid M.; van der Wal, Gerrit.
2007-01-01
A small proportion of deaths result from the use of drugs with the intention to hasten death without an explicit request of the patient. Additional insight into its characteristics is needed for evaluating this practice. In the Netherlands in 2001, questionnaires were mailed to physicians that addressed the decision making that preceded their…
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Leveraging human decision making through the optimal management of centralized resources
NASA Astrophysics Data System (ADS)
Hyden, Paul; McGrath, Richard G.
2016-05-01
Combining results from mixed integer optimization, stochastic modeling and queuing theory, we will advance the interdisciplinary problem of efficiently and effectively allocating centrally managed resources. Academia currently fails to address this, as the esoteric demands of each of these large research areas limits work across traditional boundaries. The commercial space does not currently address these challenges due to the absence of a profit metric. By constructing algorithms that explicitly use inputs across boundaries, we are able to incorporate the advantages of using human decision makers. Key improvements in the underlying algorithms are made possible by aligning decision maker goals with the feedback loops introduced between the core optimization step and the modeling of the overall stochastic process of supply and demand. A key observation is that human decision-makers must be explicitly included in the analysis for these approaches to be ultimately successful. Transformative access gives warfighters and mission owners greater understanding of global needs and allows for relationships to guide optimal resource allocation decisions. Mastery of demand processes and optimization bottlenecks reveals long term maximum marginal utility gaps in capabilities.
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Mutual influence in shared decision making: a collaborative study of patients and physicians.
Lown, Beth A; Clark, William D; Hanson, Janice L
2009-06-01
To explore how patients and physicians describe attitudes and behaviours that facilitate shared decision making. Background Studies have described physician behaviours in shared decision making, explored decision aids for informing patients and queried whether patients and physicians want to share decisions. Little attention has been paid to patients' behaviors that facilitate shared decision making or to the influence of patients and physicians on each other during this process. Qualitative analysis of data from four research work groups, each composed of patients with chronic conditions and primary care physicians. Eighty-five patients and physicians identified six categories of paired physician/patient themes, including act in a relational way; explore/express patient's feelings and preferences; discuss information and options; seek information, support and advice; share control and negotiate a decision; and patients act on their own behalf and physicians act on behalf of the patient. Similar attitudes and behaviours were described for both patients and physicians. Participants described a dynamic process in which patients and physicians influence each other throughout shared decision making. This study is unique in that clinicians and patients collaboratively defined and described attitudes and behaviours that facilitate shared decision making and expand previous descriptions, particularly of patient attitudes and behaviours that facilitate shared decision making. Study participants described relational, contextual and affective behaviours and attitudes for both patients and physicians, and explicitly discussed sharing control and negotiation. The complementary, interactive behaviours described in the themes for both patients and physicians illustrate mutual influence of patients and physicians on each other.
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Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature.
Roman, Tamlyn Eslie; Cleary, Susan; McIntyre, Diane
2017-02-27
The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. The literature supports Bossert's conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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A new fit-for-purpose model testing framework: Decision Crash Tests
NASA Astrophysics Data System (ADS)
Tolson, Bryan; Craig, James
2016-04-01
Decision-makers in water resources are often burdened with selecting appropriate multi-million dollar strategies to mitigate the impacts of climate or land use change. Unfortunately, the suitability of existing hydrologic simulation models to accurately inform decision-making is in doubt because the testing procedures used to evaluate model utility (i.e., model validation) are insufficient. For example, many authors have identified that a good standard framework for model testing called the Klemes Crash Tests (KCTs), which are the classic model validation procedures from Klemeš (1986) that Andréassian et al. (2009) rename as KCTs, have yet to become common practice in hydrology. Furthermore, Andréassian et al. (2009) claim that the progression of hydrological science requires widespread use of KCT and the development of new crash tests. Existing simulation (not forecasting) model testing procedures such as KCTs look backwards (checking for consistency between simulations and past observations) rather than forwards (explicitly assessing if the model is likely to support future decisions). We propose a fundamentally different, forward-looking, decision-oriented hydrologic model testing framework based upon the concept of fit-for-purpose model testing that we call Decision Crash Tests or DCTs. Key DCT elements are i) the model purpose (i.e., decision the model is meant to support) must be identified so that model outputs can be mapped to management decisions ii) the framework evaluates not just the selected hydrologic model but the entire suite of model-building decisions associated with model discretization, calibration etc. The framework is constructed to directly and quantitatively evaluate model suitability. The DCT framework is applied to a model building case study on the Grand River in Ontario, Canada. A hypothetical binary decision scenario is analysed (upgrade or not upgrade the existing flood control structure) under two different sets of model building decisions. In one case, we show the set of model building decisions has a low probability to correctly support the upgrade decision. In the other case, we show evidence suggesting another set of model building decisions has a high probability to correctly support the decision. The proposed DCT framework focuses on what model users typically care about: the management decision in question. The DCT framework will often be very strict and will produce easy to interpret results enabling clear unsuitability determinations. In the past, hydrologic modelling progress has necessarily meant new models and model building methods. Continued progress in hydrologic modelling requires finding clear evidence to motivate researchers to disregard unproductive models and methods and the DCT framework is built to produce this kind of evidence. References: Andréassian, V., C. Perrin, L. Berthet, N. Le Moine, J. Lerat, C. Loumagne, L. Oudin, T. Mathevet, M.-H. Ramos, and A. Valéry (2009), Crash tests for a standardized evaluation of hydrological models. Hydrology and Earth System Sciences, 13, 1757-1764. Klemeš, V. (1986), Operational testing of hydrological simulation models. Hydrological Sciences Journal, 31 (1), 13-24.
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Evidence-based medicine: medical librarians providing evidence at the point of care.
Yaeger, Lauren H; Kelly, Betsy
2014-01-01
Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.
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Predictive monitoring research: Summary of the PREMON system
NASA Technical Reports Server (NTRS)
Doyle, Richard J.; Sellers, Suzanne M.; Atkinson, David J.
1987-01-01
Traditional approaches to monitoring are proving inadequate in the face of two important issues: the dynamic adjustment of expectations about sensor values when the behavior of the device is too complex to enumerate beforehand, and the selective but effective interpretation of sensor readings when the number of sensors becomes overwhelming. This system addresses these issues by building an explicit model of a device and applying common-sense theories of physics to model causality in the device. The resulting causal simulation of the device supports planning decisions about how to efficiently yet reliably utilize a limited number of sensors to verify correct operation of the device.
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Self-determination, the right to die, and culture: a literature review.
McCormick, Andrew J
2011-04-01
Self-determination is a primary ethical principle underlying social work practice in health care settings. Since the 1970s, a right-to-die movement that shares the social work commitment to self-determination has grown and influences end-of-life care decisions. However, the role of culture is notably absent in discussions of the right to die. A literature review was conducted to explore self-determination and the role of culture in the context of the history of the right-to-die movement. A total of 54 articles met the criteria for inclusion in the review. Of the total, 21 related to self-determination, and 12 related to ethnicity and culture at the end of life. A history based on the review of the right-to-die movement is presented. The review found that social workers support passively hastening death and that views of self-determination are affected by both law and culture. In response, social workers will face three tasks: (1) becoming more public in their support for client self-determination as an important standard in end-of-life care, (2) being more explicit in support of diverse cultural traditions in end-of-life decision making, and (3) expanding their traditional educational and bridging roles between families and medical personnel.
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Nonexplicit change detection in complex dynamic settings: what eye movements reveal.
Vachon, François; Vallières, Benoît R; Jones, Dylan M; Tremblay, Sébastien
2012-12-01
We employed a computer-controlled command-and-control (C2) simulation and recorded eye movements to examine the extent and nature of the inability to detect critical changes in dynamic displays when change detection is implicit (i.e., requires no explicit report) to the operator's task. Change blindness-the failure to notice significant changes to a visual scene-may have dire consequences on performance in C2 and surveillance operations. Participants performed a radar-based risk-assessment task involving multiple subtasks. Although participants were not required to explicitly report critical changes to the operational display, change detection was critical in informing decision making. Participants' eye movements were used as an index of visual attention across the display. Nonfixated (i.e., unattended) changes were more likely to be missed than were fixated (i.e., attended) changes, supporting the idea that focused attention is necessary for conscious change detection. The finding of significant pupil dilation for changes undetected but fixated suggests that attended changes can nonetheless be missed because of a failure of attentional processes. Change blindness in complex dynamic displays takes the form of failures in establishing task-appropriate patterns of attentional allocation. These findings have implications in the design of change-detection support tools for dynamic displays and work procedure in C2 and surveillance.
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Combining Bayesian Networks and Agent Based Modeling to develop a decision-support model in Vietnam
NASA Astrophysics Data System (ADS)
Nong, Bao Anh; Ertsen, Maurits; Schoups, Gerrit
2016-04-01
Complexity and uncertainty in natural resources management have been focus themes in recent years. Within these debates, with the aim to define an approach feasible for water management practice, we are developing an integrated conceptual modeling framework for simulating decision-making processes of citizens, in our case in the Day river area, Vietnam. The model combines Bayesian Networks (BNs) and Agent-Based Modeling (ABM). BNs are able to combine both qualitative data from consultants / experts / stakeholders, and quantitative data from observations on different phenomena or outcomes from other models. Further strengths of BNs are that the relationship between variables in the system is presented in a graphical interface, and that components of uncertainty are explicitly related to their probabilistic dependencies. A disadvantage is that BNs cannot easily identify the feedback of agents in the system once changes appear. Hence, ABM was adopted to represent the reaction among stakeholders under changes. The modeling framework is developed as an attempt to gain better understanding about citizen's behavior and factors influencing their decisions in order to reduce uncertainty in the implementation of water management policy.
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O'Connor, Annette M.; Wells, George A.; Tugwell, Peter; Laupacis, Andreas; Elmslie, Tom; Drake, Elizabeth
1999-03-01
OBJECTIVE: To evaluate the incremental effect of a graphic weigh-scale values clarification exercise to explicitly consider the personal importance of the benefits versus the risks in a woman's decision aid regarding postmenopausal hormone therapy. DESIGN: Randomized controlled trial. Intervention Decision aid including information on options, benefits and risks, and their probabilities either followed by: (1) a graphic weigh-scale values clarification exercise to explicitly consider the personal importance of each benefit and risk; or (2) a summary of the main benefits and risks to implicitly consider benefits versus the risks. SAMPLE: Two-hundred and one women aged 50-69 years from Ottawa, Canada, who had never used hormone therapy. OUTCOME: Perceived clarity of values, a sub-scale of the decisional conflict scale; congruence between personal values of benefits and risks (measured on 0-10 importance rating scale) and choices (accept, decline, unsure regarding preventive hormone therapy [HRT]) using discriminant function analysis. RESULTS: There were no statistically significant differences between interventions in perceived clarity of values and overall congruence between values and choices. Amongst those choosing HRT, there was a trend in those exposed to the graphic weigh-scale exercise to have better congruence between values and choices compared to implicit values clarification (P = 0.06). CONCLUSION: The use of the graphic weigh-scale exercise in a decision aid conveys no overall short-term benefit. Further study is needed to specifically determine effects in those changing the status quo and on the quality of patient-practitioner communication and persistence with decisions.
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Adaptive and Rational Anticipations in Risk Management Systems and Economy
NASA Astrophysics Data System (ADS)
Dubois, Daniel M.; Holmberg, Stig C.
2010-11-01
The global financial crisis of year 2009 is explained as a result of uncoordinated risk management decisions in business firms and economic organisations. The underlying reason for this can be found in the current financial system. As the financial market has lost much of its direct coupling to the concrete economy it provides misleading information to economic decision makers at all levels. Hence, the financial system has moved from a state of moderate and slow cyclical fluctuations into a state of fast and chaotic ones. Those misleading decisions can further be described, but not explained, by help of adaptive and rational expectations from macroeconomic theory. In this context, AE, the Adaptive Expectations are related to weak passive Exo-anticipation, and RE, the Rational expectations can be related to a strong, active and design oriented anticipation. The shortcomings of conventional cures, which builds on a reactive paradigm, have already been demonstrated in economic literature and are here further underlined by help of Ashby's "Law of Requisite Variety", Weaver's distinction between systems of "Disorganized Complexity" and those of "Organized Complexity", and Klir's "Reconstructability Analysis". Anticipatory decision-making is hence here proposed as a replacement to current expectation based and passive risk management. An anticipatory model of the business cycle is presented for supporting that proposition. The model, which is an extension of the Kaldor-Kalecki model, includes both retardation and anticipation. While cybernetics with the feedback process in control system deals with an explicit goal or purpose given to a system, the anticipatory system discussed here deals with a behaviour for which the future state of the system is built by the system itself, without explicit goal. A system with weak anticipation is based on a predictive model of the system, while a system with strong anticipation builds its own future by itself. Numerical simulations on computer confirm the feasibility of this approach. Hence, functional differential equations with both retardation and anticipation are found to be useful tools for modelling financial systems.
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Coates, Peter S.; Casazza, Michael L.; Brussee, Brianne E.; Ricca, Mark A.; Gustafson, K. Benjamin; Overton, Cory T.; Sanchez-Chopitea, Erika; Kroger, Travis; Mauch, Kimberly; Niell, Lara; Howe, Kristy; Gardner, Scott; Espinosa, Shawn; Delehanty, David J.
2014-01-01
Greater sage-grouse (Centrocercus urophasianus, hereafter referred to as “sage-grouse”) populations are declining throughout the sagebrush (Artemisia spp.) ecosystem, including millions of acres of potential habitat across the West. Habitat maps derived from empirical data are needed given impending listing decisions that will affect both sage-grouse population dynamics and human land-use restrictions. This report presents the process for developing spatially explicit maps describing relative habitat suitability for sage-grouse in Nevada and northeastern California. Maps depicting habitat suitability indices (HSI) values were generated based on model-averaged resource selection functions informed by more than 31,000 independent telemetry locations from more than 1,500 radio-marked sage-grouse across 12 project areas in Nevada and northeastern California collected during a 15-year period (1998–2013). Modeled habitat covariates included land cover composition, water resources, habitat configuration, elevation, and topography, each at multiple spatial scales that were relevant to empirically observed sage-grouse movement patterns. We then present an example of how the HSI can be delineated into categories. Specifically, we demonstrate that the deviation from the mean can be used to classify habitat suitability into three categories of habitat quality (high, moderate, and low) and one non-habitat category. The classification resulted in an agreement of 93–97 percent for habitat versus non-habitat across a suite of independent validation datasets. Lastly, we provide an example of how space use models can be integrated with habitat models to help inform conservation planning. In this example, we combined probabilistic breeding density with a non-linear probability of occurrence relative to distance to nearest lek (traditional breeding ground) using count data to calculate a composite space use index (SUI). The SUI was then classified into two categories of use (high and low-to-no) and intersected with the HSI categories to create potential management prioritization scenarios based oninformation about sage-grouse occupancy coupled with habitat suitability. This provided an example of a conservation planning application that uses the intersection of the spatially-explicit HSI and empirically-based SUI to identify potential spatially explicit strategies for sage-grouse management. Importantly, the reported categories for the HSI and SUI can be reclassified relatively easily to employ alternative conservation thresholds that may be identified through decision-making processes with stake-holders, managers, and biologists. Moreover, the HSI/SUI interface map can be updated readily as new data become available.
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Trickey, Heather; Newburn, Mary
2014-01-01
Three important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante-natal education and post-natal support. TOC suggests that long-standing unresolved problems or 'undesirable effects' in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision-making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early-weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother-centred models of support for all forms of infant feeding. © 2012 John Wiley & Sons Ltd.
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Fujino, Junya; Tei, Shisei; Jankowski, Kathryn F; Kawada, Ryosaku; Murai, Toshiya; Takahashi, Hidehiko
2017-12-26
We are constantly exposed to socially conflicting situations in everyday life, and cognitive flexibility is essential for adaptively coping with such difficulties. Flexible goal choice and pursuit are not exclusively conscious, and therefore cognitive flexibility involves both explicit and implicit forms of processing. However, it is unclear how individual differences in explicit and implicit aspects of flexibility are associated with neural activity in a resting state. Here, we measured intrinsic fractional amplitude of low-frequency fluctuations (fALFF) by resting-state functional magnetic resonance imaging (RS-fMRI) as an indicator of regional brain spontaneous activity, together with explicit and implicit aspects of cognitive flexibility using the Cognitive Flexibility Scale (CFS) and Implicit Association Test (IAT). Consistent with the dual processing theory, there was a strong association between explicit aspects of flexibility (CFS score) and "rationalism" thinking style and between implicit aspects (IAT effect) and "experientialism." The level of explicit flexibility was also correlated with fALFF values in the left lateral prefrontal cortex, whereas the level of implicit flexibility was correlated with fALFF values in the right cerebellum. Furthermore, the fALFF values in both regions predicted individual preference for flexible decision-making strategy in a vignettes simulation task. These results add to our understanding of the neural mechanisms underlying flexible decision-making for solving social conflicts. More generally, our findings highlight the utility of RS-fMRI combined with both explicit and implicit psychometric measures for better understanding individual differences in social cognition. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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The concept of Final Ecosystem Goods and Services (FEGS) explicitly connects ecosystem services to the people that benefit from them. This report presents a number of practical strategies for incorporating FEGS, and more broadly ecosystem services, into the decision-making proces...
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Education Finance: Legal Bombshells in West Virginia.
ERIC Educational Resources Information Center
Meckley, Richard
1983-01-01
Discusses the history, legal arguments, decision, and fiscal implications of "Pauley v. Bailey," in which a West Virginia circuit court judge's ruling gave explicit and detailed descriptions of a thorough and efficient K-12 education system. Briefly reviews two West Virginia supreme court decisions concerning property assessment…
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Value judgements in the decision-making process for the elderly patient.
Ubachs-Moust, J; Houtepen, R; Vos, R; ter Meulen, R
2008-12-01
The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician's decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic "ageist" pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician-patient relationship, creating confidence and trust, which are at the heart of medical practice.
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NASA Astrophysics Data System (ADS)
Alexandridis, Konstantinos T.
This dissertation adopts a holistic and detailed approach to modeling spatially explicit agent-based artificial intelligent systems, using the Multi Agent-based Behavioral Economic Landscape (MABEL) model. The research questions that addresses stem from the need to understand and analyze the real-world patterns and dynamics of land use change from a coupled human-environmental systems perspective. Describes the systemic, mathematical, statistical, socio-economic and spatial dynamics of the MABEL modeling framework, and provides a wide array of cross-disciplinary modeling applications within the research, decision-making and policy domains. Establishes the symbolic properties of the MABEL model as a Markov decision process, analyzes the decision-theoretic utility and optimization attributes of agents towards comprising statistically and spatially optimal policies and actions, and explores the probabilogic character of the agents' decision-making and inference mechanisms via the use of Bayesian belief and decision networks. Develops and describes a Monte Carlo methodology for experimental replications of agent's decisions regarding complex spatial parcel acquisition and learning. Recognizes the gap on spatially-explicit accuracy assessment techniques for complex spatial models, and proposes an ensemble of statistical tools designed to address this problem. Advanced information assessment techniques such as the Receiver-Operator Characteristic curve, the impurity entropy and Gini functions, and the Bayesian classification functions are proposed. The theoretical foundation for modular Bayesian inference in spatially-explicit multi-agent artificial intelligent systems, and the ensembles of cognitive and scenario assessment modular tools build for the MABEL model are provided. Emphasizes the modularity and robustness as valuable qualitative modeling attributes, and examines the role of robust intelligent modeling as a tool for improving policy-decisions related to land use change. Finally, the major contributions to the science are presented along with valuable directions for future research.
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On acquiring decision making skills for endovascular interventions.
Lanzer, Peter; Prechelt, Lutz
2008-11-01
To improve interventional training we propose a staged rational approach for decision making and skill acquisition. Education and training for endovascular interventions should start to develop the learners' decision-making skills by learning from explicit representations of master interventionist's tacit decision-making knowledge through implementation of the notions of generic interventional modules, interventional strategic and tactical designs. We hope that these suggestions will encourage action, stimulate dialogue and advance the precision of our learning, procedures, practice and patient care.
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Decision support system based on DPSIR framework for a low flow Mediterranean river basin
NASA Astrophysics Data System (ADS)
Bangash, Rubab Fatima; Kumar, Vikas; Schuhmacher, Marta
2013-04-01
The application of decision making practices are effectively enhanced by adopting a procedural approach setting out a general methodological framework within which specific methods, models and tools can be integrated. Integrated Catchment Management is a process that recognizes the river catchment as a basic organizing unit for understanding and managing ecosystem process. Decision support system becomes more complex by considering unavoidable human activities within a catchment that are motivated by multiple and often competing criteria and/or constraints. DPSIR is a causal framework for describing the interactions between society and the environment. This framework has been adopted by the European Environment Agency and the components of this model are: Driving forces, Pressures, States, Impacts and Responses. The proposed decision support system is a two step framework based on DPSIR. Considering first three component of DPSIR, Driving forces, Pressures and States, hydrological and ecosystem services models are developed. The last two components, Impact and Responses, helped to develop Bayesian Network to integrate the models. This decision support system also takes account of social, economic and environmental aspects. A small river of Catalonia (Northeastern Spain), Francoli River with a low flow (~2 m3/s) is selected for integration of catchment assessment models and to improve knowledge transfer from research to the stakeholders with a view to improve decision making process. DHI's MIKE BASIN software is used to evaluate the low-flow Francolí River with respect to the water bodies' characteristics and also to assess the impact of human activities aiming to achieve good water status for all waters to comply with the WFD's River Basin Management Plan. Based on ArcGIS, MIKE BASIN is a versatile decision support tool that provides a simple and powerful framework for managers and stakeholders to address multisectoral allocation and environmental issues in river basins. While InVEST is a spatially explicit tool, used to model and map a suite of ecosystem services caused by land cover changes or climate change impacts. Moreover, results obtained from low-flow hydrological simulation and ecosystem services models serves as useful tools to develop decision support system based on DPSIR framework by integrating models. Bayesian Networks is used as a knowledge integration and visualization tool to summarize the outcomes of hydrological and ecosystem services models at the "Response" stage of DPSIR. Bayesian Networks provide a framework for modelling the logical relationship between catchment variables and decision objectives by quantifying the strength of these relationships using conditional probabilities. Participatory nature of this framework can provide better communication of water research, particularly in the context of a perceived lack of future awareness-raising with the public that helps to develop more sustainable water management strategies. Acknowledgements The present study was financially supported by Spanish Ministry of Economy and Competitiveness for its financial support through the project SCARCE (Consolider-Ingenio 2010 CSD2009-00065). R. F. Bangash also received PhD fellowship from AGAUR (Commissioner for Universities and Research of the Department of Innovation, Universities and Enterprise of the "Generalitat de Catalunya" and the European Social Fund).
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[Shared decision-making in medical practice--patient-centred communication skills].
van Staveren, Remke
2011-01-01
Most patients (70%) want to participate actively in important healthcare decisions, the rest (30%) prefer the doctor to make the decision for them. Shared decision-making provides more patient satisfaction, a better quality of life and contributes to a better doctor-patient relationship. Patients making their own decision generally make a well considered and medically sensible choice. In shared decision-making the doctor asks many open questions, gives and requests much information, asks if the patient wishes to participate in the decision-making and explicitly takes into account patient circumstances and preferences. Shared decision-making should remain an individual choice and should not become a new dogma.
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An integrated GIS-based, multi-attribute decision model deployed in a web-based platform is presented enabling an iterative, spatially explicit and collaborative analysis of relevant and available information for repurposing vacant land. The process incorporated traditional and ...
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ERIC Educational Resources Information Center
Superfine, Benjamin Michael
2010-01-01
Judicial decisions focusing on equal educational opportunity involve significant issues of educational governance and often involve explicit questions about the extent to which authority to make educational decisions should be centralized or decentralized across various institutions and entities. This review aims at clarifying scholars'…
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Reflections on New Configurations in Campus Governance.
ERIC Educational Resources Information Center
Wise, W. Max
Changes in college government generally incorporate the following features: (1) they provide structural means for the expression of opinion, (often the right to vote) to representatives of groups hitherto underrepresented or unrepresented on decision-making bodies; (2) they are intended to make the decision-making process more explicit, and more…
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Making inferences on risks to ecosystem services (ES) from ecological crises may be improved using decision science tools. Influence diagrams (IDs) are probabilistic networks that explicitly represent the decisions related to a problem and evidence of their influence on desired o...
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NASA Technical Reports Server (NTRS)
Carpenter, J. R.; Markley, F. L.; Alfriend, K. T.; Wright, C.; Arcido, J.
2011-01-01
Sequential probability ratio tests explicitly allow decision makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models 1he null hypothesis 1ha1 the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming highly-elliptical orbit formation flying mission.
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Strategic processing in long-term repetition priming in the lexical decision task.
Kessler, Yoav; Moscovitch, Morris
2013-04-01
In a lexical decision task, faster reaction times (RTs) for old than new items is taken as evidence for an implicit memory involvement in this task. In contrast, the present study shows the involvement of both implicit and explicit memory in repetition priming. We propose a dual route model, in which lexical decisions can be made using one of two parallel processing routes: a lexical route, in which the lexical properties of the stimulus are used to determine whether it is a word or not, and a strategic route that builds on the inherent correlation between "wordness" and "oldness" in the experiment. Eliminating the strategic route by removing this correlation diminishes the priming effect at the slow end of the RT distribution, but not at the fast end. This dissociation is interpreted as evidence for the involvement of both implicit and explicit memory in repetition priming.
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Sequential Probability Ratio Test for Spacecraft Collision Avoidance Maneuver Decisions
NASA Technical Reports Server (NTRS)
Carpenter, J. Russell; Markley, F. Landis
2013-01-01
A document discusses sequential probability ratio tests that explicitly allow decision-makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models the null hypotheses that the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming, highly elliptical orbit formation flying mission.
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A theoretical approach to artificial intelligence systems in medicine.
Spyropoulos, B; Papagounos, G
1995-10-01
The various theoretical models of disease, the nosology which is accepted by the medical community and the prevalent logic of diagnosis determine both the medical approach as well as the development of the relevant technology including the structure and function of the A.I. systems involved. A.I. systems in medicine, in addition to the specific parameters which enable them to reach a diagnostic and/or therapeutic proposal, entail implicitly theoretical assumptions and socio-cultural attitudes which prejudice the orientation and the final outcome of the procedure. The various models -causal, probabilistic, case-based etc. -are critically examined and their ethical and methodological limitations are brought to light. The lack of a self-consistent theoretical framework in medicine, the multi-faceted character of the human organism as well as the non-explicit nature of the theoretical assumptions involved in A.I. systems restrict them to the role of decision supporting "instruments" rather than regarding them as decision making "devices". This supporting role and, especially, the important function which A.I. systems should have in the structure, the methods and the content of medical education underscore the need of further research in the theoretical aspects and the actual development of such systems.
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Decision analysis in clinical cardiology: When is coronary angiography required in aortic stenosis
DOE Office of Scientific and Technical Information (OSTI.GOV)
Georgeson, S.; Meyer, K.B.; Pauker, S.G.
1990-03-15
Decision analysis offers a reproducible, explicit approach to complex clinical decisions. It consists of developing a model, typically a decision tree, that separates choices from chances and that specifies and assigns relative values to outcomes. Sensitivity analysis allows exploration of alternative assumptions. Cost-effectiveness analysis shows the relation between dollars spent and improved health outcomes achieved. In a tutorial format, this approach is applied to the decision whether to perform coronary angiography in a patient who requires aortic valve replacement for critical aortic stenosis.
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Schoene-Seifert, Bettina; Uerpmann, Anna Lena; Gerß, Joachim; Herr, David
2016-04-01
Whether health care professionals should respect a properly executed advance directive (AD) refusing life support in late-stage dementia even if the patient seems contented, is an ethically contested issue. We undertook a nationwide survey to assess this problem and to test a practical solution. Nationwide survey using a questionnaire among 4 stakeholder groups. Germany. Adult Germans (n = 735), among them: dementia-experienced physicians (n = 161), dementia-experienced nurses (n = 191), next of kin (n = 197), and dementia-inexperienced adults (n = 186). Participants were asked about their attitudes on medical decision-making in a vignette case of treatable pneumonia, for their agreement or disagreement on standard ethical arguments in this debate, and for their views on modified versions of the case. One such modification was an explicit anticipation of the conflict in question by the patients themselves. Of our 735 eligible respondents, 25% were unwilling to follow the patient's AD. Standard arguments for and against respecting the directive were endorsed to different degrees. Respondents' unwillingness to follow the directive was significantly decreased (to 16.3%, P < .001), if the advance refusal of pneumonia treatment explicitly indicated that it applied to a patient who appears content in his demented state. Only 8.7% of respondents would disregard an advance refusal of tube feeding. Persons executing ADs forbidding life support in late-stage dementia run some risk that these will not be followed if they later appear "happy" in their dementia. It seems ethically and practically advisable to incorporate an explicit meta-directive for this conflict. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert
2015-04-16
Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.
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Cognitive and behavioural dispositions in offspring at high risk for alcoholism.
Kumar, Rajesh; Kumar, Keshav Janakiprasad; Benegal, Vivek
2018-06-01
Offspring with family history of alcoholism are considered to be at high risk for alcoholism. The present study sought to expand our understanding of cognitive and behavioural dispositions associated with executive control and self-regulation in alcohol naïve offspring with and without family history of alcoholism. Sample comprised of alcohol naive offspring in two groups: (i) at high risk (n = 34) and (ii) at low risk for alcoholism (n = 34). Both groups were matched on age (+/-1 year), education (+/-1 year) and gender. Measures used were: Mini-International Neuropsychiatric Interview, Family Interview for Genetic Studies, Socio-demographic Data Sheet, Annett's Handedness Questionnaire, Barratt's Impulsiveness Scale-version 11, Digit Span Test, Spatial Span Test, Tower of London, Wisconsin Card Sorting Test, Iowa Gambling Task (IGT) and Game of Dice Task (GDT). Results showed that alcohol naive offspring at high risk for alcoholism reported significantly high impulsivity and demonstrated significant differences on executive functions and decision making tasks. Correlation analysis revealed that high impulsivity was significantly associated with poor performance on explicit decision making task (GDT) and executive function task (WCST). There was no significant correlation between two decision making tasks (IGT and GDT) in both groups and performance on IGT was not significantly associated with impulsivity and executive functions. The present study indicates cognitive and behavioural dispositions in alcohol naive offspring at high risk for alcoholism and support the sub-optimal balance between reflective and impulsive system responsible for addiction. Furthermore, present study supports separability between two different types of decision making tasks. Copyright © 2018 Elsevier B.V. All rights reserved.
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ERIC Educational Resources Information Center
Colangelo, A.; Buchanan, L.
2005-01-01
We report evidence for dissociation between explicit and implicit access to word representations in a deep dyslexic patient (JO). JO read aloud a series of ambiguous (e.g., bank) and unambiguous (e.g., food) words and performed a lexical decision task using these same items. When required to explicitly access the items (i.e., naming), JO showed…
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A biased activation theory of the cognitive and attentional modulation of emotion.
Rolls, Edmund T
2013-01-01
Cognition can influence emotion by biasing neural activity in the first cortical region in which the reward value and subjective pleasantness of stimuli is made explicit in the representation, the orbitofrontal cortex (OFC). The same effect occurs in a second cortical tier for emotion, the anterior cingulate cortex (ACC). Similar effects are found for selective attention, to for example the pleasantness vs. the intensity of stimuli, which modulates representations of reward value and affect in the orbitofrontal and anterior cingulate cortices. The mechanisms for the effects of cognition and attention on emotion are top-down biased competition and top-down biased activation. Affective and mood states can in turn influence memory and perception, by backprojected biasing influences. Emotion-related decision systems operate to choose between gene-specified rewards such as taste, touch, and beauty. Reasoning processes capable of planning ahead with multiple steps held in working memory in the explicit system can allow the gene-specified rewards not to be selected, or to be deferred. The stochastic, noisy, dynamics of decision-making systems in the brain may influence whether decisions are made by the selfish-gene-specified reward emotion system, or by the cognitive reasoning system that explicitly calculates reward values that are in the interests of the individual, the phenotype.
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NASA Astrophysics Data System (ADS)
Moglia, Magnus; Sharma, Ashok K.; Maheepala, Shiroma
2012-07-01
SummaryPlanning of regional and urban water resources, and in particular with Integrated Urban Water Management approaches, often considers inter-relationships between human uses of water, the health of the natural environment as well as the cost of various management strategies. Decision makers hence typically need to consider a combination of social, environmental and economic goals. The types of strategies employed can include water efficiency measures, water sensitive urban design, stormwater management, or catchment management. Therefore, decision makers need to choose between different scenarios and to evaluate them against a number of criteria. This type of problem has a discipline devoted to it, i.e. Multi-Criteria Decision Analysis, which has often been applied in water management contexts. This paper describes the application of Subjective Logic in a basic Bayesian Network to a Multi-Criteria Decision Analysis problem. By doing this, it outlines a novel methodology that explicitly incorporates uncertainty and information reliability. The application of the methodology to a known case study context allows for exploration. By making uncertainty and reliability of assessments explicit, it allows for assessing risks of various options, and this may help in alleviating cognitive biases and move towards a well formulated risk management policy.
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The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions
Hirsh, Adam T.; Hollingshead, Nicole A.; Ashburn-Nardo, Leslie; Kroenke, Kurt
2015-01-01
Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and non-opioid analgesics) decisions for 12 virtual patients with acute pain. Race (Black/White) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers’ decisions, such that decisions varied as a function of ambiguity for White but not Black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however providers’ implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between White and Black patients are, in part, attributable to the nature (i.e., ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors. PMID:25828370
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[A spatially explicit analysis of traffic accidents involving pedestrians and cyclists in Berlin].
Lakes, Tobia
2017-12-01
In many German cities and counties, sustainable mobility concepts that strengthen pedestrian and cyclist traffic are promoted. From the perspectives of urban development, traffic planning and public healthcare, a spatially differentiated analysis of traffic accident data is decisive. 1) The identification of spatial and temporal patterns of the distribution of accidents involving cyclists and pedestrians, 2) the identification of hotspots and exploration of possible underlying causes and 3) the critical discussion of benefits and challenges of the results and the derivation of conclusions. Spatio-temporal distributions of data from accident statistics in Berlin involving pedestrians and cyclists from 2011 to 2015 were analysed with geographic information systems (GIS). While the total number of accidents remains relatively stable for pedestrian and cyclist accidents, the spatial distribution analysis shows, however, that there are significant spatial clusters (hotspots) of traffic accidents with a strong concentration in the inner city area. In a critical discussion, the benefits of geographic concepts are identified, such as spatially explicit health data (in this case traffic accident data), the importance of the integration of other data sources for the evaluation of the health impact of areas (traffic accident statistics of the police), and the possibilities and limitations of spatial-temporal data analysis (spatial point-density analyses) for the derivation of decision-supported recommendations and for the evaluation of policy measures of health prevention and of health-relevant urban development.
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Computational neuroanatomy: ontology-based representation of neural components and connectivity.
Rubin, Daniel L; Talos, Ion-Florin; Halle, Michael; Musen, Mark A; Kikinis, Ron
2009-02-05
A critical challenge in neuroscience is organizing, managing, and accessing the explosion in neuroscientific knowledge, particularly anatomic knowledge. We believe that explicit knowledge-based approaches to make neuroscientific knowledge computationally accessible will be helpful in tackling this challenge and will enable a variety of applications exploiting this knowledge, such as surgical planning. We developed ontology-based models of neuroanatomy to enable symbolic lookup, logical inference and mathematical modeling of neural systems. We built a prototype model of the motor system that integrates descriptive anatomic and qualitative functional neuroanatomical knowledge. In addition to modeling normal neuroanatomy, our approach provides an explicit representation of abnormal neural connectivity in disease states, such as common movement disorders. The ontology-based representation encodes both structural and functional aspects of neuroanatomy. The ontology-based models can be evaluated computationally, enabling development of automated computer reasoning applications. Neuroanatomical knowledge can be represented in machine-accessible format using ontologies. Computational neuroanatomical approaches such as described in this work could become a key tool in translational informatics, leading to decision support applications that inform and guide surgical planning and personalized care for neurological disease in the future.
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The conscious, the unconscious, and familiarity.
Scott, Ryan B; Dienes, Zoltán
2008-09-01
This article examines the role of subjective familiarity in the implicit and explicit learning of artificial grammars. Experiment 1 found that objective measures of similarity (including fragment frequency and repetition structure) predicted ratings of familiarity, that familiarity ratings predicted grammaticality judgments, and that the extremity of familiarity ratings predicted confidence. Familiarity was further shown to predict judgments in the absence of confidence, hence contributing to above-chance guessing. Experiment 2 found that confidence developed as participants refined their knowledge of the distribution of familiarity and that differences in familiarity could be exploited prior to confidence developing. Experiment 3 found that familiarity was consciously exploited to make grammaticality judgments including those made without confidence and that familiarity could in some instances influence participants' grammaticality judgments apparently without their awareness. All 3 experiments found that knowledge distinct from familiarity was derived only under deliberate learning conditions. The results provide decisive evidence that familiarity is the essential source of knowledge in artificial grammar learning while also supporting a dual-process model of implicit and explicit learning. (c) 2008 APA, all rights reserved.
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Two-dimensional habitat modeling in the Yellowstone/Upper Missouri River system
Waddle, T. J.; Bovee, K.D.; Bowen, Z.H.
1997-01-01
This study is being conducted to provide the aquatic biology component of a decision support system being developed by the U.S. Bureau of Reclamation. In an attempt to capture the habitat needs of Great Plains fish communities we are looking beyond previous habitat modeling methods. Traditional habitat modeling approaches have relied on one-dimensional hydraulic models and lumped compositional habitat metrics to describe aquatic habitat. A broader range of habitat descriptors is available when both composition and configuration of habitats is considered. Habitat metrics that consider both composition and configuration can be adapted from terrestrial biology. These metrics are most conveniently accessed with spatially explicit descriptors of the physical variables driving habitat composition. Two-dimensional hydrodynamic models have advanced to the point that they may provide the spatially explicit description of physical parameters needed to address this problem. This paper reports progress to date on applying two-dimensional hydraulic and habitat models on the Yellowstone and Missouri Rivers and uses examples from the Yellowstone River to illustrate the configurational metrics as a new tool for assessing riverine habitats.
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Pieterse, Arwen H; Henselmans, Inge; de Haes, Hanneke C J M; Koning, Caro C E; Geijsen, Elisabeth D; Smets, Ellen M A
2011-12-01
To assess clinicians' use of shared decision making (SDM) skills, enabling patient treatment evaluations (appraisals); and varieties of patient appraisals and clinicians' preceding and following utterances. Two coders rated videotaped initial visits of 25 early-stage prostate cancer patients to their radiation oncologist. SDM skills were assessed using the Decision Analysis System for Oncology (DAS-O); appraisals and clinicians' utterances were labeled using qualitative methodology. Clinicians offered a treatment choice to 10 patients. They informed 15/25 about pros and 20/25 about cons of options. Patients expressed 67 appraisals (median/visit=2; range, 0-12). Half of appraisals were favorable and one-fourth was unfavorable toward treatment options. One-fifth referred to explicit tradeoffs. One-third of appraisals followed clinician requests; 58% followed clinician information. Clinicians approved almost half of appraisals. They contested, ignored or highlighted a minority. Clinicians infrequently offered patients a choice or explored appraisals. Most appraisals supported rather than challenged treatment options. Clinicians most often legitimized appraisals, thereby helping patients to feel good about the decision. Exploring appraisals may help patients in forming more stable preferences, thus benefiting patients in the long run. Clinicians should request patient appraisals and ascertain whether these seem well-informed before making treatment recommendations. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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Sexual and reproductive health care for adolescents: legal rights and policy challenges.
English, Abigail
2007-12-01
Laws developed over the past half century have significantly improved adolescents' access to essential sexual and reproductive health care. These laws allow many adolescent minors to give their own consent, protect confidentiality, and provide financial support for the care. The consent requirements for adolescents to receive health care are contained primarily in state court decisions and in statutes known as "state minor consent laws," which are based on either the minor's status or the services sought. Confidentiality protections for adolescents' health information are contained in these minor consent laws, in the federal medical privacy regulations known as the "HIPAA Privacy Rule," and in state medical privacy laws. Other significant laws include statutes providing for the emancipation of minors, court decisions delineating the mature minor doctrine, regulations protecting adolescents' access to confidential family planning services in publicly funded programs, and court decisions interpreting the constitutional right of privacy. Special considerations apply to consent and confidentiality questions pertaining to family planning, contraception, and pregnancy-related care for minors. In addition to the explicit provisions of state minor consent laws, many of the most important considerations are articulated in court decisions based on the constitutional right of privacy and the confidentiality requirements that are part of the federal Title X Family Planning Program and Medicaid.
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On the effects of scale for ecosystem services mapping
Grêt-Regamey, Adrienne; Weibel, Bettina; Bagstad, Kenneth J.; Ferrari, Marika; Geneletti, Davide; Klug, Hermann; Schirpke, Uta; Tappeiner, Ulrike
2014-01-01
Ecosystems provide life-sustaining services upon which human civilization depends, but their degradation largely continues unabated. Spatially explicit information on ecosystem services (ES) provision is required to better guide decision making, particularly for mountain systems, which are characterized by vertical gradients and isolation with high topographic complexity, making them particularly sensitive to global change. But while spatially explicit ES quantification and valuation allows the identification of areas of abundant or limited supply of and demand for ES, the accuracy and usefulness of the information varies considerably depending on the scale and methods used. Using four case studies from mountainous regions in Europe and the U.S., we quantify information gains and losses when mapping five ES - carbon sequestration, flood regulation, agricultural production, timber harvest, and scenic beauty - at coarse and fine resolution (250 m vs. 25 m in Europe and 300 m vs. 30 m in the U.S.). We analyze the effects of scale on ES estimates and their spatial pattern and show how these effects are related to different ES, terrain structure and model properties. ES estimates differ substantially between the fine and coarse resolution analyses in all case studies and across all services. This scale effect is not equally strong for all ES. We show that spatially explicit information about non-clustered, isolated ES tends to be lost at coarse resolution and against expectation, mainly in less rugged terrain, which calls for finer resolution assessments in such contexts. The effect of terrain ruggedness is also related to model properties such as dependency on land use-land cover data. We close with recommendations for mapping ES to make the resulting maps more comparable, and suggest a four-step approach to address the issue of scale when mapping ES that can deliver information to support ES-based decision making with greater accuracy and reliability.
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On the Effects of Scale for Ecosystem Services Mapping
Grêt-Regamey, Adrienne; Weibel, Bettina; Bagstad, Kenneth J.; Ferrari, Marika; Geneletti, Davide; Klug, Hermann; Schirpke, Uta; Tappeiner, Ulrike
2014-01-01
Ecosystems provide life-sustaining services upon which human civilization depends, but their degradation largely continues unabated. Spatially explicit information on ecosystem services (ES) provision is required to better guide decision making, particularly for mountain systems, which are characterized by vertical gradients and isolation with high topographic complexity, making them particularly sensitive to global change. But while spatially explicit ES quantification and valuation allows the identification of areas of abundant or limited supply of and demand for ES, the accuracy and usefulness of the information varies considerably depending on the scale and methods used. Using four case studies from mountainous regions in Europe and the U.S., we quantify information gains and losses when mapping five ES - carbon sequestration, flood regulation, agricultural production, timber harvest, and scenic beauty - at coarse and fine resolution (250 m vs. 25 m in Europe and 300 m vs. 30 m in the U.S.). We analyze the effects of scale on ES estimates and their spatial pattern and show how these effects are related to different ES, terrain structure and model properties. ES estimates differ substantially between the fine and coarse resolution analyses in all case studies and across all services. This scale effect is not equally strong for all ES. We show that spatially explicit information about non-clustered, isolated ES tends to be lost at coarse resolution and against expectation, mainly in less rugged terrain, which calls for finer resolution assessments in such contexts. The effect of terrain ruggedness is also related to model properties such as dependency on land use-land cover data. We close with recommendations for mapping ES to make the resulting maps more comparable, and suggest a four-step approach to address the issue of scale when mapping ES that can deliver information to support ES-based decision making with greater accuracy and reliability. PMID:25549256
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On the effects of scale for ecosystem services mapping.
Grêt-Regamey, Adrienne; Weibel, Bettina; Bagstad, Kenneth J; Ferrari, Marika; Geneletti, Davide; Klug, Hermann; Schirpke, Uta; Tappeiner, Ulrike
2014-01-01
Ecosystems provide life-sustaining services upon which human civilization depends, but their degradation largely continues unabated. Spatially explicit information on ecosystem services (ES) provision is required to better guide decision making, particularly for mountain systems, which are characterized by vertical gradients and isolation with high topographic complexity, making them particularly sensitive to global change. But while spatially explicit ES quantification and valuation allows the identification of areas of abundant or limited supply of and demand for ES, the accuracy and usefulness of the information varies considerably depending on the scale and methods used. Using four case studies from mountainous regions in Europe and the U.S., we quantify information gains and losses when mapping five ES - carbon sequestration, flood regulation, agricultural production, timber harvest, and scenic beauty - at coarse and fine resolution (250 m vs. 25 m in Europe and 300 m vs. 30 m in the U.S.). We analyze the effects of scale on ES estimates and their spatial pattern and show how these effects are related to different ES, terrain structure and model properties. ES estimates differ substantially between the fine and coarse resolution analyses in all case studies and across all services. This scale effect is not equally strong for all ES. We show that spatially explicit information about non-clustered, isolated ES tends to be lost at coarse resolution and against expectation, mainly in less rugged terrain, which calls for finer resolution assessments in such contexts. The effect of terrain ruggedness is also related to model properties such as dependency on land use-land cover data. We close with recommendations for mapping ES to make the resulting maps more comparable, and suggest a four-step approach to address the issue of scale when mapping ES that can deliver information to support ES-based decision making with greater accuracy and reliability.
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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…
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Performance Assessment in Serious Games: Compensating for the Effects of Randomness
ERIC Educational Resources Information Center
Westera, Wim
2016-01-01
This paper is about performance assessment in serious games. We conceive serious gaming as a process of player-lead decision taking. Starting from combinatorics and item-response theory we provide an analytical model that makes explicit to what extent observed player performances (decisions) are blurred by chance processes (guessing behaviors). We…
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Integrating Public Input into Healthcare Priority-Setting Decisions
ERIC Educational Resources Information Center
Mitton, Craig; Smith, Neale; Peacock, Stuart; Evoy, Brian; Abelson, Julia
2011-01-01
Decision makers are pressed to involve the public in priority setting. However, public input is only one form of evidence. So, how can information from the public be combined with other knowledge? The authors qualitatively analysed articles that explicitly address this question. We identified the other forms of information that tend to be used in…
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The role of colour in implicit and explicit memory performance.
Vernon, David; Lloyd-Jones, Toby J
2003-07-01
We present two experiments that examine the effects of colour transformation between study and test (from black and white to colour and vice versa, of from incorrectly coloured to correctly coloured and vice versa) on implicit and explicit measures of memory for diagnostically coloured natural objects (e.g., yellow banana). For naming and coloured-object decision (i.e., deciding whether an object is correctly coloured), there were shorter response times to correctly coloured-objects than to black-and-white and incorrectly coloured-objects. Repetition priming was equivalent for the different stimulus types. Colour transformation did not influence priming of picture naming, but for coloured-object decision priming was evident only for objects remaining the same from study to test. This was the case for both naming and coloured-object decision as study tasks. When participants were asked to consciously recognize objects that they had named or made coloured-object decisions to previously, whilst ignoring their colour, colour transformation reduced recognition efficiency. We discuss these results in terms of the flexibility of object representations that mediate priming and recognition.
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Griffith, Jennifer M; Fichter, Marlie; Fowler, Floyd J; Lewis, Carmen; Pignone, Michael P
2008-01-01
Background An important question in the development of decision aids about colon cancer (CRC) screening is whether to include an explicit discussion of the option of not being screened. We examined the effect of including or not including an explicit discussion of the option of deciding not to be screened in a CRC screening decision aid on subjective measures of decision aid content; interest in screening; and knowledge. Methods Adults ages 50–85 were assigned to view one of two versions of the decision aid. The two versions differed only in the inclusion of video segments of two men, one of whom decided against being screened. Participants completed questionnaires before and after viewing the decision aid to compare subjective measures of content, screening interest and intent, and knowledge between groups. Likert response categories (5-point) were used for subjective measures of content (eg. clarity, balance in favor/against screening, and overall rating), and screening interest. Knowledge was measured with a three item index and individual questions. Higher scores indicated favorable responses for subjective measures, greater interest, and better knowledge. For the subjective balance, lower numbers were associated with the impression of the decision aid favoring CRC screening. Results 57 viewed the "with" version which included the two segments and 49 viewed the "without" version. After viewing, participants found the "without" version to have better subjective clarity about benefits of screening ("with" 3.4, "without" 4.1, p < 0.01), and to have greater clarity about downsides of screening ("with" 3.2, "without" 3.6, p = 0.03). The "with" version was considered to be less strongly balanced in favor of screening. ("with" 1.8, "without" 1.6, p = 0.05); but the "without" version received a better overall rating ("with" 3.5, "without" 3.8, p = 0.03). Groups did not differ in screening interest after viewing a decision aid or knowledge. Conclusion A decision aid with the explicit discussion of the option of deciding not to be screened appears to increase the impression that the program was not as strongly in favor of screening, but decreases the impression of clarity and resulted in a lower overall rating. We did not observe clinically important or statistically significant differences in interest in screening or knowledge. PMID:18321377
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NASA Technical Reports Server (NTRS)
Peters, Mark; Boisvert, Ben; Escala, Diego
2009-01-01
Explicit integration of aviation weather forecasts with the National Airspace System (NAS) structure is needed to improve the development and execution of operationally effective weather impact mitigation plans and has become increasingly important due to NAS congestion and associated increases in delay. This article considers several contemporary weather-air traffic management (ATM) integration applications: the use of probabilistic forecasts of visibility at San Francisco, the Route Availability Planning Tool to facilitate departures from the New York airports during thunderstorms, the estimation of en route capacity in convective weather, and the application of mixed-integer optimization techniques to air traffic management when the en route and terminal capacities are varying with time because of convective weather impacts. Our operational experience at San Francisco and New York coupled with very promising initial results of traffic flow optimizations suggests that weather-ATM integrated systems warrant significant research and development investment. However, they will need to be refined through rapid prototyping at facilities with supportive operational users We have discussed key elements of an emerging aviation weather research area: the explicit integration of aviation weather forecasts with NAS structure to improve the effectiveness and timeliness of weather impact mitigation plans. Our insights are based on operational experiences with Lincoln Laboratory-developed integrated weather sensing and processing systems, and derivative early prototypes of explicit ATM decision support tools such as the RAPT in New York City. The technical components of this effort involve improving meteorological forecast skill, tailoring the forecast outputs to the problem of estimating airspace impacts, developing models to quantify airspace impacts, and prototyping automated tools that assist in the development of objective broad-area ATM strategies, given probabilistic weather forecasts. Lincoln Laboratory studies and prototype demonstrations in this area are helping to define the weather-assimilated decision-making system that is envisioned as a key capability for the multi-agency Next Generation Air Transportation System [1]. The Laboratory's work in this area has involved continuing, operations-based evolution of both weather forecasts and models for weather impacts on the NAS. Our experience has been that the development of usable ATM technologies that address weather impacts must proceed via rapid prototyping at facilities whose users are highly motivated to participate in system evolution.
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Incorporating User Preferences Within an Optimal Traffic Flow Management Framework
NASA Technical Reports Server (NTRS)
Rios, Joseph Lucio; Sheth, Kapil S.; Guiterrez-Nolasco, Sebastian Armardo
2010-01-01
The effectiveness of future decision support tools for Traffic Flow Management in the National Airspace System will depend on two major factors: computational burden and collaboration. Previous research has focused separately on these two aspects without consideration of their interaction. In this paper, their explicit combination is examined. It is shown that when user preferences are incorporated with an optimal approach to scheduling, runtime is not adversely affected. A benefit-cost ratio is used to measure the influence of user preferences on an optimal solution. This metric shows user preferences can be accommodated without inordinately, negatively affecting the overall system delay. Specifically, incorporating user preferences will increase delays proportionally to increased user satisfaction.
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Batterink, Laura; Neville, Helen
2011-11-01
The vast majority of word meanings are learned simply by extracting them from context rather than by rote memorization or explicit instruction. Although this skill is remarkable, little is known about the brain mechanisms involved. In the present study, ERPs were recorded as participants read stories in which pseudowords were presented multiple times, embedded in consistent, meaningful contexts (referred to as meaning condition, M+) or inconsistent, meaningless contexts (M-). Word learning was then assessed implicitly using a lexical decision task and explicitly through recall and recognition tasks. Overall, during story reading, M- words elicited a larger N400 than M+ words, suggesting that participants were better able to semantically integrate M+ words than M- words throughout the story. In addition, M+ words whose meanings were subsequently correctly recognized and recalled elicited a more positive ERP in a later time window compared with M+ words whose meanings were incorrectly remembered, consistent with the idea that the late positive component is an index of encoding processes. In the lexical decision task, no behavioral or electrophysiological evidence for implicit priming was found for M+ words. In contrast, during the explicit recognition task, M+ words showed a robust N400 effect. The N400 effect was dependent upon recognition performance, such that only correctly recognized M+ words elicited an N400. This pattern of results provides evidence that the explicit representations of word meanings can develop rapidly, whereas implicit representations may require more extensive exposure or more time to emerge.
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Meyniel, Florent; Safra, Lou; Pessiglione, Mathias
2014-01-01
A pervasive case of cost-benefit problem is how to allocate effort over time, i.e. deciding when to work and when to rest. An economic decision perspective would suggest that duration of effort is determined beforehand, depending on expected costs and benefits. However, the literature on exercise performance emphasizes that decisions are made on the fly, depending on physiological variables. Here, we propose and validate a general model of effort allocation that integrates these two views. In this model, a single variable, termed cost evidence, accumulates during effort and dissipates during rest, triggering effort cessation and resumption when reaching bounds. We assumed that such a basic mechanism could explain implicit adaptation, whereas the latent parameters (slopes and bounds) could be amenable to explicit anticipation. A series of behavioral experiments manipulating effort duration and difficulty was conducted in a total of 121 healthy humans to dissociate implicit-reactive from explicit-predictive computations. Results show 1) that effort and rest durations are adapted on the fly to variations in cost-evidence level, 2) that the cost-evidence fluctuations driving the behavior do not match explicit ratings of exhaustion, and 3) that actual difficulty impacts effort duration whereas expected difficulty impacts rest duration. Taken together, our findings suggest that cost evidence is implicitly monitored online, with an accumulation rate proportional to actual task difficulty. In contrast, cost-evidence bounds and dissipation rate might be adjusted in anticipation, depending on explicit task difficulty. PMID:24743711
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Part of the fabric and mostly right: an ethnography of ethics in clinical practice.
Doran, Evan; Fleming, Jennifer; Jordens, Christopher; Stewart, Cameron L; Letts, Julie; Kerridge, Ian H
2015-06-15
To describe how ethics is practised in a health care setting, and to ascertain whether there was interest in establishing clinical ethics support services. Observations and interviews undertaken between April and November 2012 in a large NSW urban hospital with newborn care, maternity and oncology departments and analysed by coding and categorising the data. Key themes in the participants' attitudes to professional ethics were identified. Ethics is not typically an explicit feature of clinical deliberations, and clinicians tend to apply basic ethical principles when ethical problems are identified. They also discuss difficult decisions with colleagues, and try to resolve ethical differences by discussion. Participants judged the ethics of clinical practice to be "mostly right", primarily because ethics is "part of the fabric" of everyday clinical work that aspires to "optimising care". Nevertheless, most clinicians would welcome ethics support because ethics is integral to health care practice, is not always "done well", and may be the source of conflict. Ethics is very much a part of the fabric of clinical practice, and the ethical challenges that arise in patient care in this particular setting are generally managed adequately. However, many clinicians have concerns about the ethical aspects of some practices and decisions, and believe that access to expert ethics support would be useful. Helping clinicians to provide ethically sound patient care should be a priority for health care providers across Australia.
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Toward an applied technology for quality measurement in health care.
Berwick, D M
1988-01-01
Cost containment, financial incentives to conserve resources, the growth of for-profit hospitals, an aggressive malpractice environment, and demands from purchasers are among the forces today increasing the need for improved methods that measure quality in health care. At the same time, increasingly sophisticated databases and the existence of managed care systems yield new opportunities to observe and correct quality problems. Research on targets of measurement (structure, process, and outcome) and methods of measurement (implicit, explicit, and sentinel methods) has not yet produced managerially useful applied technology for quality measurement in real-world settings. Such an applied technology would have to be cheaper, faster, more flexible, better reported, and more multidimensional than the majority of current research on quality assurance. In developing a new applied technology for the measurement of health care quality, quantitative disciplines have much to offer, such as decision support systems, criteria based on rigorous decision analyses, utility theory, tools for functional status measurement, and advances in operations research.
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Emotion words and categories: evidence from lexical decision.
Scott, Graham G; O'Donnell, Patrick J; Sereno, Sara C
2014-05-01
We examined the categorical nature of emotion word recognition. Positive, negative, and neutral words were presented in lexical decision tasks. Word frequency was additionally manipulated. In Experiment 1, "positive" and "negative" categories of words were implicitly indicated by the blocked design employed. A significant emotion-frequency interaction was obtained, replicating past research. While positive words consistently elicited faster responses than neutral words, only low frequency negative words demonstrated a similar advantage. In Experiments 2a and 2b, explicit categories ("positive," "negative," and "household" items) were specified to participants. Positive words again elicited faster responses than did neutral words. Responses to negative words, however, were no different than those to neutral words, regardless of their frequency. The overall pattern of effects indicates that positive words are always facilitated, frequency plays a greater role in the recognition of negative words, and a "negative" category represents a somewhat disparate set of emotions. These results support the notion that emotion word processing may be moderated by distinct systems.
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Design and Evaluation of a Bacterial Clinical Infectious Diseases Ontology
Gordon, Claire L.; Pouch, Stephanie; Cowell, Lindsay G.; Boland, Mary Regina; Platt, Heather L.; Goldfain, Albert; Weng, Chunhua
2013-01-01
With antimicrobial resistance increasing worldwide, there is a great need to use automated antimicrobial decision support systems (ADSSs) to lower antimicrobial resistance rates by promoting appropriate antimicrobial use. However, they are infrequently used mostly because of their poor interoperability with different health information technologies. Ontologies can augment portable ADSSs by providing an explicit knowledge representation for biomedical entities and their relationships, helping to standardize and integrate heterogeneous data resources. We developed a bacterial clinical infectious diseases ontology (BCIDO) using Protégé-OWL. BCIDO defines a controlled terminology for clinical infectious diseases along with domain knowledge commonly used in hospital settings for clinical infectious disease treatment decision-making. BCIDO has 599 classes and 2355 object properties. Terms were imported from or mapped to Systematized Nomenclature of Medicine, Unified Medical Language System, RxNorm and National Center for Bitechnology Information Organismal Classification where possible. Domain expert evaluation using the “laddering” technique, ontology visualization, and clinical notes and scenarios, confirmed the correctness and potential usefulness of BCIDO. PMID:24551353
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Interference effects of categorization on decision making.
Wang, Zheng; Busemeyer, Jerome R
2016-05-01
Many decision making tasks in life involve a categorization process, but the effects of categorization on subsequent decision making has rarely been studied. This issue was explored in three experiments (N=721), in which participants were shown a face stimulus on each trial and performed variations of categorization-decision tasks. On C-D trials, they categorized the stimulus and then made an action decision; on X-D trials, they were told the category and then made an action decision; on D-alone trials, they only made an action decision. An interference effect emerged in some of the conditions, such that the probability of an action on the D-alone trials (i.e., when there was no explicit categorization before the decision) differed from the total probability of the same action on the C-D or X-D trials (i.e., when there was explicit categorization before the decision). Interference effects are important because they indicate a violation of the classical law of total probability, which is assumed by many cognitive models. Across all three experiments, a complex pattern of interference effects systematically occurred for different types of stimuli and for different types of categorization-decision tasks. These interference effects present a challenge for traditional cognitive models, such as Markov and signal detection models, but a quantum cognition model, called the belief-action entanglement (BAE) model, predicted that these results could occur. The BAE model employs the quantum principles of superposition and entanglement to explain the psychological mechanisms underlying the puzzling interference effects. The model can be applied to many important and practical categorization-decision situations in life. Copyright © 2016 Elsevier B.V. All rights reserved.
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Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris
2013-01-01
Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.
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McQuirter, Megan; Castiglia, Luisa Luciani; Loiselle, Carmen G; Wong, Nora
2010-05-01
To explore the decision-making process of women with a BRCA1 or BRCA2 gene mutation who have chosen to undergo prophylactic mastectomy. Cross-sectional, qualitative, descriptive design. Participants were recruited from an outpatient cancer prevention center in the oncology and medical genetics departments of a large university-affiliated hospital in Montreal, Quebec, Canada. 10 women carrying a BRCA1 or BRCA2 mutation; 8 previously had had a prophylactic mastectomy and 2 were scheduled for surgery at the time of study. Semistructured, in-depth interviews were conducted. Field notes were written and audiotapes were transcribed verbatim. The textual data were coded and analyzed. Decision-making process for prophylactic mastectomy. Two broad findings emerged. First, several intrapersonal and contextual factors interacted throughout the process to move women either closer to choosing a prophylactic mastectomy or further from the decision. Second, all women reported experiencing a "pivotal point," an emotionally charged event when the decision to have a prophylactic mastectomy became definitive. Pivotal points for patients included either receiving a positive result for a genetic mutation or a breast cancer diagnosis for herself or a family member in the context of positive mutation status. Decision making about prophylactic mastectomy was an affective and intuitive process incorporating contexts and their relations rather than a rational, straight-forward process of weighing pros and cons. Supportive interventions for women in this population should explicitly address the individual and the inter-relationships of contextual factors that shape decision making about prophylactic mastectomy while recognizing important affective components involved.
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The Role of Ethics Committees and Ethics Consultation in Allocation Decisions
Strech, Daniel; Hurst, Samia; Danis, Marion
2013-01-01
Background Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. Objectives and Methods This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Results Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. Conclusion This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindvidual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures. PMID:20706163
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Mobile technology supporting trainee doctors' workplace learning and patient care: an evaluation.
Hardyman, Wendy; Bullock, Alison; Brown, Alice; Carter-Ingram, Sophie; Stacey, Mark
2013-01-21
The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded "iDoc", a project offering trainee doctors a Smartphone library of medical textbooks. Data on trainee doctors' (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience.Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors' discussions with seniors; independent practice; patient care; and this 'just-in-time' access to reliable information supported confident and efficient decision-making. A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge.By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires dialogue: what Smartphone technology can do is augment, not replace, discussion with their colleagues in the community of practice.
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Larkin, Paul; Mesagno, Christopher; Berry, Jason; Spittle, Michael; Harvey, Jack
2018-02-01
Decision-making is a central component of the in-game performance of Australian football umpires; however, current umpire training focuses largely on physiological development with decision-making skills development conducted via explicit lecture-style meetings with limited practice devoted to making actual decisions. Therefore, this study investigated the efficacy of a video-based training programme, aimed to provide a greater amount of contextualised visual experiences without explicit instruction, to improve decision-making skills of umpires. Australian football umpires (n = 52) were recruited from metropolitan and regional Division 1 competitions. Participants were randomly assigned to an intervention or control group and classified according to previous umpire game experience (i.e., experienced; less experienced). The intervention group completed a 12-week video-based decision-making training programme, with decision-making performance assessed at pre-training, and 1-week retention and 3-week retention periods. The control group did not complete any video-based training. Results indicated a significant Group (intervention; Control) × Test interaction (F(1, 100) = 3.98; P = 0.02, partial ῆ 2 = 0.074), with follow-up pairwise comparisons indicating significant within-group differences over time for the intervention group. In addition, decision-making performance of the less experienced umpires in the intervention group significantly improved (F(2, 40) = 5.03, P = 0.01, partial ῆ 2 = 0.201). Thus, video-based training programmes may be a viable adjunct to current training programmes to hasten decision-making development, especially for less experienced umpires.
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Health and wellbeing boards: public health decision making bodies or political pawns?
Greaves, Z; McCafferty, S
2017-02-01
Health and Wellbeing boards in England are uniquely constituted; embedded in the local authorities with membership drawn from a range of stakeholders and partner organizations. This raises the question of how decision making functions of the boards reflects wider public health decision making, if criteria are applied to decision making, and what prioritization processes, if any, are used. Qualitative research methods were employed and five local boards were approached, interview dyads were conducted with the boards Chair and Director of Public Health across four of these (n = 4). Three questions were addressed: how are decisions made? What are the criteria applied to decision making? And how are criteria then prioritized? A thematic approach was used to analyse data identifying codes and extracting key themes. Equity, effectiveness and consistency with strategies of board and partners were most consistently identified by participants as criteria influencing decisions. Prioritization was described as an engaged and collaborative process, but criteria were not explicitly referenced in the decision making of the boards which instead made unstructured prioritization of population sub-groups or interventions agreed by consensus. Criteria identified are broadly consistent with those used in wider public health practice but additionally incorporated criteria which recognizes the political siting of the boards. The study explored the variety in different board's approaches to prioritization and identified a lack of clarity and rigour in the identification and use of criteria in prioritization processes. Decision making may benefit from the explicit inclusion of criteria in the prioritization process. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Rahman, M Azizur; Rusteberg, Bernd; Gogu, R C; Lobo Ferreira, J P; Sauter, Martin
2012-05-30
This study reports the development of a new spatial multi-criteria decision analysis (SMCDA) software tool for selecting suitable sites for Managed Aquifer Recharge (MAR) systems. The new SMCDA software tool functions based on the combination of existing multi-criteria evaluation methods with modern decision analysis techniques. More specifically, non-compensatory screening, criteria standardization and weighting, and Analytical Hierarchy Process (AHP) have been combined with Weighted Linear Combination (WLC) and Ordered Weighted Averaging (OWA). This SMCDA tool may be implemented with a wide range of decision maker's preferences. The tool's user-friendly interface helps guide the decision maker through the sequential steps for site selection, those steps namely being constraint mapping, criteria hierarchy, criteria standardization and weighting, and criteria overlay. The tool offers some predetermined default criteria and standard methods to increase the trade-off between ease-of-use and efficiency. Integrated into ArcGIS, the tool has the advantage of using GIS tools for spatial analysis, and herein data may be processed and displayed. The tool is non-site specific, adaptive, and comprehensive, and may be applied to any type of site-selection problem. For demonstrating the robustness of the new tool, a case study was planned and executed at Algarve Region, Portugal. The efficiency of the SMCDA tool in the decision making process for selecting suitable sites for MAR was also demonstrated. Specific aspects of the tool such as built-in default criteria, explicit decision steps, and flexibility in choosing different options were key features, which benefited the study. The new SMCDA tool can be augmented by groundwater flow and transport modeling so as to achieve a more comprehensive approach to the selection process for the best locations of the MAR infiltration basins, as well as the locations of recovery wells and areas of groundwater protection. The new spatial multicriteria analysis tool has already been implemented within the GIS based Gabardine decision support system as an innovative MAR planning tool. Copyright © 2012 Elsevier Ltd. All rights reserved.
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López Martínez, Jorge S; Martín López, María Jesús; Scandroglio, Barbara; Martínez García, José Manuel
2008-05-01
Family perception of organ donation has been explored by numerous authors using statements by the people who decided whether or not to donate the organs of a relative in a situation of brain death. Within this tradition, in this work, we analyze the discourse of six families who granted permission for organ donation and three who refused. We describe the process-based interpretation of this experience and identify psychosocial variables and processes that further our understanding of the decision finally adopted. We have identified two heuristics that guide family decision when organ donation is requested: the explicit or inferred will of the deceased and family attitudes to organ donation and transplant. It is postulated that the interaction of these two factors explains a large amount of the decisions made. We also hypothesize that a marked discrepancy between these two factors increases the importance of other aspects, especially the role of the transplant coordinator and of other healthcare personnel. These results support, at a social level, the implementation of transplant promotion programs; and at a healthcare level, the combined use of techniques of crisis intervention and attitude change.
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Just healthcare and human flourishing: Why resource allocation is not just enough.
Hewitt, Jayne
2017-01-01
Over many years, different theories have been developed to guide the social practices and policies of institutions so that they demonstrate equal concern and respect for all, and satisfy the requirements of justice. Although the normative principles described in a theory may support just institutions, whether this results in just outcomes will depend on how the decisions that implement the principles are made and actioned. As a societal institution charged with caring for people, ensuring just outcomes is a distinct concern in healthcare. Relationships within this institution are constitutive of human flourishing and are also important to justice. Yet, it is not possible to create, maintain or evaluate interpersonal relationships in the same manner as institutions because rather than being universal and impartial, they are particular and partial. Consequently, the link between theories of justice that guide decision-making in relation to structures or institutions, and the relationships that influence those with a proximate effect on individuals, is not explicit. To address this gap, this article argues that a focus on human flourishing provides a nexus between the decision-making for just institutions and just outcomes for individuals.
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Effects of dividing attention during encoding on perceptual priming of unfamiliar visual objects.
Soldan, Anja; Mangels, Jennifer A; Cooper, Lynn A
2008-11-01
According to the distractor-selection hypothesis (Mulligan, 2003), dividing attention during encoding reduces perceptual priming when responses to non-critical (i.e., distractor) stimuli are selected frequently and simultaneously with critical stimulus encoding. Because direct support for this hypothesis comes exclusively from studies using familiar word stimuli, the present study tested whether the predictions of the distractor-selection hypothesis extend to perceptual priming of unfamiliar visual objects using the possible/impossible object decision test. Consistent with the distractor-selection hypothesis, Experiments 1 and 2 found no reduction in priming when the non-critical stimuli were presented infrequently and non-synchronously with the critical target stimuli, even though explicit recognition memory was reduced. In Experiment 3, non-critical stimuli were presented frequently and simultaneously during encoding of critical stimuli; however, no decrement in priming was detected, even when encoding time was reduced. These results suggest that priming in the possible/impossible object decision test is relatively immune to reductions in central attention and that not all aspects of the distractor-selection hypothesis generalise to priming of unfamiliar visual objects. Implications for theoretical models of object decision priming are discussed.
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Chapter 15: Using System Dynamics to Model Industry's Developmental Response to Energy Policy
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bush, Brian; Inman, Daniel; Newes, Emily
In this chapter we explore the potential development of the biofuels industry using the Biomass Scenario Model (BSM), a system dynamics model developed at the National Renewable Energy Laboratory through the support of the U.S. Department of Energy. The BSM is designed to analyze the implications of policy on the development of the supply chain for biofuels in the United States. It explicitly represents the behavior of decision makers such as farmers, investors, fueling station owners, and consumers. We analyze several illustrative case studies that explore a range of policies and discuss how incentives interact with individual parts of themore » supply chain as well as the industry as a whole. The BSM represents specific incentives that are intended to approximate policy in the form of selected laws and regulations. Through characterizing the decision making behaviors of economic actors within the supply chain that critically influence the adoption rate of new biofuels production technologies and demonstrating synergies among policies, we find that incentives with coordinated impacts on each major element of the supply chain catalyze net effects of decision maker behavior such that the combined incentives are greater than the summed effects of individual incentives in isolation.« less
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Effects of dividing attention during encoding on perceptual priming of unfamiliar visual objects
Soldan, Anja; Mangels, Jennifer A.; Cooper, Lynn A.
2008-01-01
According to the distractor-selection hypothesis (Mulligan, 2003), dividing attention during encoding reduces perceptual priming when responses to non-critical (i.e., distractor) stimuli are selected frequently and simultaneously with critical stimulus encoding. Because direct support for this hypothesis comes exclusively from studies using familiar word stimuli, the present study tested whether the predictions of the distractor-selection hypothesis extend to perceptual priming of unfamiliar visual objects using the possible/impossible object-decision test. Consistent with the distractor-selection hypothesis, Experiments 1 and 2 found no reduction in priming when the non-critical stimuli were presented infrequently and non-synchronously with the critical target stimuli, even though explicit recognition memory was reduced. In Experiment 3, non-critical stimuli were presented frequently and simultaneously during encoding of critical stimuli; however, no decrement in priming was detected, even when encoding time was reduced. These results suggest that priming in the possible/impossible object-decision test is relatively immune to reductions in central attention and that not all aspects of the distractor-selection hypothesis generalize to priming of unfamiliar visual objects. Implications for theoretical models of object-decision priming are discussed. PMID:18821167
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ERIC Educational Resources Information Center
Raab, Markus
2007-01-01
Background: Recent developments of theories for teaching decision making in sport offer a large variety of applications for the context of physical education. Purpose: This review of current models of teaching tactical skills concludes that most models incorporate different cognitive learning mechanisms, such as implicit and explicit learning, and…
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Managing in a Culture of Debate: Enhancing Administrative Effectiveness through Procedural Fairness
ERIC Educational Resources Information Center
Moshavi, Dan; Standifird, Stephen
2017-01-01
The contestability of ideas is at the heart of a healthy academic institution. As a result, administrators face the challenge of making and implementing difficult decisions in an environment that is designed to explicitly create thoughtful discord. We argue that procedural fairness--explaining how and why important decisions are made--is an…
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D'Ambruoso, Sarah F; Coscarelli, Anne; Hurvitz, Sara; Wenger, Neil; Coniglio, David; Donaldson, Dusty; Pietras, Christopher; Walling, Anne M
2016-11-01
Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.
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NASA Astrophysics Data System (ADS)
Obropta, Christopher C.; Niazi, Mehran; Kardos, Josef S.
2008-12-01
Environmental decision support systems (EDSSs) are an emerging tool used to integrate the evaluation of highly complex and interrelated physicochemical, biological, hydrological, social, and economic aspects of environmental problems. An EDSS approach is developed to address hot-spot concerns for a water quality trading program intended to implement the total maximum daily load (TMDL) for phosphorus in the Non-Tidal Passaic River Basin of New Jersey. Twenty-two wastewater treatment plants (WWTPs) spread throughout the watershed are considered the major sources of phosphorus loading to the river system. Periodic surface water diversions to a major reservoir from the confluence of two key tributaries alter the natural hydrology of the watershed and must be considered in the development of a trading framework that ensures protection of water quality. An EDSS is applied that enables the selection of a water quality trading framework that protects the watershed from phosphorus-induced hot spots. The EDSS employs Simon’s (1960) three stages of the decision-making process: intelligence, design, and choice. The identification of two potential hot spots and three diversion scenarios enables the delineation of three management areas for buying and selling of phosphorus credits among WWTPs. The result shows that the most conservative option entails consideration of two possible diversion scenarios, and trading between management areas is restricted accordingly. The method described here is believed to be the first application of an EDSS to a water quality trading program that explicitly accounts for surface water diversions.
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Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth
2004-01-01
A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.
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A new paradigm for clinical communication: critical review of literature in cancer care.
Salmon, Peter; Young, Bridget
2017-03-01
To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients. © 2016 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.
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Campbell, Jonathan D; Zerzan, Judy; Garrison, Louis P; Libby, Anne M
2013-04-01
Comparative-effectiveness research (CER) at the population level is missing standardized approaches to quantify and weigh interventions in terms of their clinical risks, benefits, and uncertainty. We proposed an adapted CER framework for population decision making, provided example displays of the outputs, and discussed the implications for population decision makers. Building on decision-analytical modeling but excluding cost, we proposed a 2-step approach to CER that explicitly compared interventions in terms of clinical risks and benefits and linked this evidence to the quality-adjusted life year (QALY). The first step was a traditional intervention-specific evidence synthesis of risks and benefits. The second step was a decision-analytical model to simulate intervention-specific progression of disease over an appropriate time. The output was the ability to compare and quantitatively link clinical outcomes with QALYs. The outputs from these CER models include clinical risks, benefits, and QALYs over flexible and relevant time horizons. This approach yields an explicit, structured, and consistent quantitative framework to weigh all relevant clinical measures. Population decision makers can use this modeling framework and QALYs to aid in their judgment of the individual and collective risks and benefits of the alternatives over time. Future research should study effective communication of these domains for stakeholders. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.
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NASA Astrophysics Data System (ADS)
Pierce, S. A.; Wagner, K.; Schwartz, S.; Gentle, J. N., Jr.
2016-12-01
Critical water resources face the effects of historic drought, increased demand, and potential contamination, the need has never been greater to develop resources to effectively communicate conservation and protection across a broad audience and geographical area. The Watermark application and macro-analysis methodology merges topical analysis of context rich corpus from policy texts with multi-attributed solution sets from integrated models of water resource and other subsystems, such as mineral, food, energy, or environmental systems to construct a scalable, robust, and reproducible approach for identifying links between policy and science knowledge bases. The Watermark application is an open-source, interactive workspace to support science-based visualization and decision making. Designed with generalization in mind, Watermark is a flexible platform that allows for data analysis and inclusion of large datasets with an interactive front-end capable of connecting with other applications as well as advanced computing resources. In addition, the Watermark analysis methodology offers functionality that streamlines communication with non-technical users for policy, education, or engagement with groups around scientific topics of societal relevance. The technology stack for Watermark was selected with the goal of creating a robust and dynamic modular codebase that can be adjusted to fit many use cases and scale to support usage loads that range between simple data display to complex scientific simulation-based modelling and analytics. The methodology uses to topical analysis and simulation-optimization to systematically analyze the policy and management realities of resource systems and explicitly connect the social and problem contexts with science-based and engineering knowledge from models. A case example demonstrates use in a complex groundwater resources management study highlighting multi-criteria spatial decision making and uncertainty comparisons.
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Schwartz, Jennifer A T; Pearson, Steven D
2013-06-24
Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Qualitative document review. Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.
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Lorenz, Marco; Fürst, Christine; Thiel, Enrico
2013-09-01
Regarding increasing pressures by global societal and climate change, the assessment of the impact of land use and land management practices on land degradation and the related decrease in sustainable provision of ecosystem services gains increasing interest. Existing approaches to assess agricultural practices focus on the assessment of single crops or statistical data because spatially explicit information on practically applied crop rotations is mostly not available. This provokes considerable uncertainties in crop production models as regional specifics have to be neglected or cannot be considered in an appropriate way. In a case study in Saxony, we developed an approach to (i) derive representative regional crop rotations by combining different data sources and expert knowledge. This includes the integration of innovative crop sequences related to bio-energy production or organic farming and different soil tillage, soil management and soil protection techniques. Furthermore, (ii) we developed a regionalization approach for transferring crop rotations and related soil management strategies on the basis of statistical data and spatially explicit data taken from so called field blocks. These field blocks are the smallest spatial entity for which agricultural practices must be reported to apply for agricultural funding within the frame of the European Agricultural Fund for Rural Development (EAFRD) program. The information was finally integrated into the spatial decision support tool GISCAME to assess and visualize in spatially explicit manner the impact of alternative agricultural land use strategies on soil erosion risk and ecosystem services provision. Objective of this paper is to present the approach how to create spatially explicit information on agricultural management practices for a study area around Dresden, the capital of the German Federal State Saxony. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Mason, Anne; Drummond, Michael; Ramsey, Scott; Campbell, Jonathan; Raisch, Dennis
2010-07-10
In contrast to the United States, several European countries have health technology assessment programs for drugs, many of which assess cost effectiveness. Coverage decisions that consider cost effectiveness may lead to restrictions in access. For a purposive sample of five decision-making bodies, we analyzed US and United Kingdom coverage decisions on all anticancer drugs approved by the US Food and Drug Administration (FDA) from 2004 to 2008. Data sources for the timing and outcome of licensing and coverage decisions included published and unpublished documentation, Web sites, and personal communication. The FDA approved 59 anticancer drugs over the study period, of which 46 were also approved by the European Medicines Agency. In the United States, 100% of drugs were covered, mostly without restriction. However, the United Kingdom bodies made positive coverage decisions for less than half of licensed drugs (National Institute for Health and Clinical Excellence [NICE]: 39%; Scottish Medicines Consortium [SMC]: 43%). Whereas the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) covered all 59 drugs from the FDA license date, delays were evident for some Regence Group decisions that were informed by cost effectiveness (median, 0 days; semi-interquartile range [SIQR], 122 days; n = 22). Relative to the European Medicines Agency license date, median time to coverage was 783 days (SIQR, 170 days) for NICE and 231 days (SIQR, 129 days) for the SMC. Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.
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Groundwater Remediation using Bayesian Information-Gap Decision Theory
NASA Astrophysics Data System (ADS)
O'Malley, D.; Vesselinov, V. V.
2016-12-01
Probabilistic analyses of groundwater remediation scenarios frequently fail because the probability of an adverse, unanticipated event occurring is often high. In general, models of flow and transport in contaminated aquifers are always simpler than reality. Further, when a probabilistic analysis is performed, probability distributions are usually chosen more for convenience than correctness. The Bayesian Information-Gap Decision Theory (BIGDT) was designed to mitigate the shortcomings of the models and probabilistic decision analyses by leveraging a non-probabilistic decision theory - information-gap decision theory. BIGDT considers possible models that have not been explicitly enumerated and does not require us to commit to a particular probability distribution for model and remediation-design parameters. Both the set of possible models and the set of possible probability distributions grow as the degree of uncertainty increases. The fundamental question that BIGDT asks is "How large can these sets be before a particular decision results in an undesirable outcome?". The decision that allows these sets to be the largest is considered to be the best option. In this way, BIGDT enables robust decision-support for groundwater remediation problems. Here we apply BIGDT to in a representative groundwater remediation scenario where different options for hydraulic containment and pump & treat are being considered. BIGDT requires many model runs and for complex models high-performance computing resources are needed. These analyses are carried out on synthetic problems, but are applicable to real-world problems such as LANL site contaminations. BIGDT is implemented in Julia (a high-level, high-performance dynamic programming language for technical computing) and is part of the MADS framework (http://mads.lanl.gov/ and https://github.com/madsjulia/Mads.jl).
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Executive functions and risky decision-making in patients with opiate dependence.
Brand, Matthias; Roth-Bauer, Martina; Driessen, Martin; Markowitsch, Hans J
2008-09-01
Recent evidence suggests that individuals with opiate dependence may have cognitive dysfunctions particularly within the spectrum of executive functioning and emotional processing. Such dysfunctions can also compromise daily decisions associated with risk-taking behaviors. However, it remains unclear whether patients addicted to opiates show impaired decision-making on gambling tasks that specify explicit rules for rewards and punishments and provide information about probabilities associated with different long-term outcomes. In this study, we examined 18 individuals with opiate dependence and 18 healthy comparison subjects, matched for age, gender, and education with the Game of Dice Task (GDT). The GDT is a gambling task with explicit rules for gains and losses and fix winning probabilities. In addition, all subjects completed a neuropsychological test battery that primarily focused on executive functions and a personality questionnaire. On the GDT, patients chose the risky alternatives more frequently than the control group. Patients' GDT performance was related to executive functioning but not to other neuropsychological constructs, personality or dependence specific variables with one exception that is the number of days of abstinence. Thus, patients with opiate dependence demonstrate abnormalities in decision-making that might be neuropsychologically associated with dysfunctional behavior in patients' daily lives. Decision-making and other neuropsychological functioning should be considered in the treatment of opiate dependence.
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Difficult end-of-life treatment decisions: do other factors trump advance directives?
Hardin, Steven B; Yusufaly, Yasmin A
2004-07-26
Advance directives are widely promoted as a means to plan for patients' decisional incapacity, yet there is little evidence of their effectiveness. We devised a study to assess physicians' compliance with hypothetical advance directives and further examine their clinical reasoning. The study consisted of an analysis of a mailed written survey containing 6 hypothetical cases of seriously ill patients. Each case contained an explicit advance directive with potential conflict between the directive and (1) prognosis, (2) wishes of family or friends, or (3) quality of life. Data were collected on the clinical treatment decisions made by physicians and the reasons for those decisions. Study participants were all internal medicine faculty and resident physicians from a single academic institution. A total of 47% analyzable surveys (117/250) were returned. Decisions by faculty and residents were not consistent with the advance directive in 65% of cases. This inconsistency was similar for faculty and residents (68% and 61%, respectively; P>.05). When physicians made decisions inconsistent with the advance directive, they were more likely to list reasons other than the directive for their decisions (89%; P<.001). Internists frequently made treatment decisions that were not consistent with an explicit advance directive. In difficult clinical situations, internists appear to consider other factors such as prognosis, perceived quality of life, and the wishes of family or friends as more determinative than the directive. Future work needs to explore the generalizability of these findings and examine how strictly patients desire their advance directives to be followed.
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ERIC Educational Resources Information Center
Fang, Su-Chi; Hsu, Ying-Shao; Hsu, Wei Hsiu
2016-01-01
The study explored how to best use scaffolds for supporting students' inquiry practices in computer-supported learning environments. We designed a series of inquiry units assisted with three versions of written inquiry prompts (generic and context-specific); that is, three scaffold-fading conditions: implicit, explicit, and fading. We then…
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Batterink, Laura; Neville, Helen
2011-01-01
The vast majority of word meanings are learned simply by extracting them from context, rather than by rote memorization or explicit instruction. Although this skill is remarkable, little is known about the brain mechanisms involved. In the present study, ERPs were recorded as participants read stories in which pseudowords were presented multiple times, embedded in consistent, meaningful contexts (referred to as meaning condition, M+) or inconsistent, meaningless contexts (M−). Word learning was then assessed implicitly using a lexical decision task and explicitly through recall and recognition tasks. Overall, during story reading, M− words elicited a larger N400 than M+ words, suggesting that participants were better able to semantically integrate M+ words than M− words throughout the story. In addition, M+ words whose meanings were subsequently correctly recognized and recalled elicited a more positive ERP in a later time-window compared to M+ words whose meanings were incorrectly remembered, consistent with the idea that the late positive component (LPC) is an index of encoding processes. In the lexical decision task, no behavioral or electrophysiological evidence for implicit priming was found for M+ words. In contrast, during the explicit recognition task, M+ words showed a robust N400 effect. The N400 effect was dependent upon recognition performance, such that only correctly recognized M+ words elicited an N400. This pattern of results provides evidence that the explicit representations of word meanings can develop rapidly, while implicit representations may require more extensive exposure or more time to emerge. PMID:21452941
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Supporting dynamic change detection: using the right tool for the task.
Vallières, Benoît R; Hodgetts, Helen M; Vachon, François; Tremblay, Sébastien
2016-01-01
Detecting task-relevant changes in a visual scene is necessary for successfully monitoring and managing dynamic command and control situations. Change blindness-the failure to notice visual changes-is an important source of human error. Change History EXplicit (CHEX) is a tool developed to aid change detection and maintain situation awareness; and in the current study we test the generality of its ability to facilitate the detection of changes when this subtask is embedded within a broader dynamic decision-making task. A multitasking air-warfare simulation required participants to perform radar-based subtasks, for which change detection was a necessary aspect of the higher-order goal of protecting one's own ship. In this task, however, CHEX rendered the operator even more vulnerable to attentional failures in change detection and increased perceived workload. Such support was only effective when participants performed a change detection task without concurrent subtasks. Results are interpreted in terms of the NSEEV model of attention behavior (Steelman, McCarley, & Wickens, Hum. Factors 53:142-153, 2011; J. Exp. Psychol. Appl. 19:403-419, 2013), and suggest that decision aids for use in multitasking contexts must be designed to fit within the available workload capacity of the user so that they may truly augment cognition.
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A Spatially-Explicit Technique for Evaluation of Alternative ...
Ecosystems contribute to maintaining human well-being directly through provision of goods and indirectly through provision of services that support clean water, clean air, flood protection and atmospheric stability. Transparently accounting for biophysical attributes from which humans derive benefit is essential to support dialog among the public, resource managers, decision makers, and scientists. We analyzed the potential ecosystem goods and services production from alternative future land use scenarios in the US Tampa Bay region. Ecosystem goods and service metrics included carbon sequestration, nitrogen removal, air pollutant removal, and stormwater retention. Each scenario was compared to a 2006 baseline land use. Estimated production of denitrification services changed by 28% and carbon sequestration by 20% between 2006 and the “business as usual” scenario. An alternative scenario focused on “natural resource protection” resulted in an estimated 9% loss in air pollution removal. Stormwater retention was estimated to change 18% from 2006 to 2060 projections. Cost effective areas for conservation, almost 1588 ha, beyond current conservation lands, were identified by comparing ecosystem goods and services production to assessed land values. Our ecosystem goods and services approach provides a simple and quantitative way to examine a more complete set of potential outcomes from land use decisions. This study demonstrates an approach for spatially expli
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Martin, Eileen; Gonzalez, Raul; Vassileva, Jasmin; Maki, Pauline M; Bechara, Antoine; Brand, Matthias
2016-01-01
HIV+ individuals with and without substance use disorders make significantly poorer decisions when information about the probability and magnitude of wins and losses is not available. We administered the Game of Dice Task, a measure of decision making under risk that provides this information explicitly, to 92 HIV+ and 134 HIV- substance-dependent men and women. HIV+ participants made significantly poorer decisions than HIV- participants, but this deficit appeared more prominent among HIV+ women. These data indicate that decision making under risk is impaired among HIV+ substance-dependent individuals (SDIs). Potential factors for the HIV+ women's relatively greater impairment are discussed.
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Neural responses to ambiguity involve domain-general and domain-specific emotion processing systems.
Neta, Maital; Kelley, William M; Whalen, Paul J
2013-04-01
Extant research has examined the process of decision making under uncertainty, specifically in situations of ambiguity. However, much of this work has been conducted in the context of semantic and low-level visual processing. An open question is whether ambiguity in social signals (e.g., emotional facial expressions) is processed similarly or whether a unique set of processors come on-line to resolve ambiguity in a social context. Our work has examined ambiguity using surprised facial expressions, as they have predicted both positive and negative outcomes in the past. Specifically, whereas some people tended to interpret surprise as negatively valenced, others tended toward a more positive interpretation. Here, we examined neural responses to social ambiguity using faces (surprise) and nonface emotional scenes (International Affective Picture System). Moreover, we examined whether these effects are specific to ambiguity resolution (i.e., judgments about the ambiguity) or whether similar effects would be demonstrated for incidental judgments (e.g., nonvalence judgments about ambiguously valenced stimuli). We found that a distinct task control (i.e., cingulo-opercular) network was more active when resolving ambiguity. We also found that activity in the ventral amygdala was greater to faces and scenes that were rated explicitly along the dimension of valence, consistent with findings that the ventral amygdala tracks valence. Taken together, there is a complex neural architecture that supports decision making in the presence of ambiguity: (a) a core set of cortical structures engaged for explicit ambiguity processing across stimulus boundaries and (b) other dedicated circuits for biologically relevant learning situations involving faces.
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Does long-term object priming depend on the explicit detection of object identity at encoding?
Gomes, Carlos A.; Mayes, Andrew
2015-01-01
It is currently unclear whether objects have to be explicitly identified at encoding for reliable behavioral long-term object priming to occur. We conducted two experiments that investigated long-term object and non-object priming using a selective-attention encoding manipulation that reduces explicit object identification. In Experiment 1, participants either counted dots flashed within an object picture (shallow encoding) or engaged in an animacy task (deep encoding) at study, whereas, at test, they performed an object-decision task. Priming, as measured by reaction times (RTs), was observed for both types of encoding, and was of equivalent magnitude. In Experiment 2, non-object priming (faster RTs for studied relative to unstudied non-objects) was also obtained under the same selective-attention encoding manipulation as in Experiment 1, and the magnitude of the priming effect was equivalent between experiments. In contrast, we observed a linear decrement in recognition memory accuracy across conditions (deep encoding of Experiment 1 > shallow encoding Experiment 1 > shallow encoding of Experiment 2), suggesting that priming was not contaminated by explicit memory strategies. We argue that our results are more consistent with the identification/production framework than the perceptual/conceptual distinction, and we conclude that priming of pictures largely ignored at encoding can be subserved by the automatic retrieval of two types of instances: one at the motor level and another at an object-decision level. PMID:25852594
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Gathmann, Bettina; Schiebener, Johannes; Wolf, Oliver T.; Brand, Matthias
2015-01-01
Performing two cognitively demanding tasks at the same time is known to decrease performance. The current study investigates the underlying executive functions of a dual-tasking situation involving the simultaneous performance of decision making under explicit risk and a working memory task. It is suggested that making a decision and performing a working memory task at the same time should particularly require monitoring—an executive control process supervising behavior and the state of processing on two tasks. To test the role of a supervisory/monitoring function in such a dual-tasking situation we investigated 122 participants with the Game of Dice Task plus 2-back task (GDT plus 2-back task). This dual task requires participants to make decisions under risk and to perform a 2-back working memory task at the same time. Furthermore, a task measuring a set of several executive functions gathered in the term concept formation (Modified Card Sorting Test, MCST) and the newly developed Balanced Switching Task (BST), measuring monitoring in particular, were used. The results demonstrate that concept formation and monitoring are involved in the simultaneous performance of decision making under risk and a working memory task. In particular, the mediation analysis revealed that BST performance partially mediates the influence of MCST performance on the GDT plus 2-back task. These findings suggest that monitoring is one important subfunction for superior performance in a dual-tasking situation including decision making under risk and a working memory task. PMID:25741308
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Dudaniec, Rachael Y; Worthington Wilmer, Jessica; Hanson, Jeffrey O; Warren, Matthew; Bell, Sarah; Rhodes, Jonathan R
2016-01-01
Landscape genetics lacks explicit methods for dealing with the uncertainty in landscape resistance estimation, which is particularly problematic when sample sizes of individuals are small. Unless uncertainty can be quantified, valuable but small data sets may be rendered unusable for conservation purposes. We offer a method to quantify uncertainty in landscape resistance estimates using multimodel inference as an improvement over single model-based inference. We illustrate the approach empirically using co-occurring, woodland-preferring Australian marsupials within a common study area: two arboreal gliders (Petaurus breviceps, and Petaurus norfolcensis) and one ground-dwelling antechinus (Antechinus flavipes). First, we use maximum-likelihood and a bootstrap procedure to identify the best-supported isolation-by-resistance model out of 56 models defined by linear and non-linear resistance functions. We then quantify uncertainty in resistance estimates by examining parameter selection probabilities from the bootstrapped data. The selection probabilities provide estimates of uncertainty in the parameters that drive the relationships between landscape features and resistance. We then validate our method for quantifying uncertainty using simulated genetic and landscape data showing that for most parameter combinations it provides sensible estimates of uncertainty. We conclude that small data sets can be informative in landscape genetic analyses provided uncertainty can be explicitly quantified. Being explicit about uncertainty in landscape genetic models will make results more interpretable and useful for conservation decision-making, where dealing with uncertainty is critical. © 2015 John Wiley & Sons Ltd.
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Improving our legacy: Incorporation of adaptive management into state wildlife action plans
Fontaine, J.J.
2011-01-01
The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ???25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. ?? 2010 .
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Improving our legacy: incorporation of adaptive management into state wildlife action plans.
Fontaine, Joseph J
2011-05-01
The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ~25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. Published by Elsevier Ltd.
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van der Weijden, Trudy; Post, Heleen; Brand, Paul L P; van Veenendaal, Haske; Drenthen, Ton; van Mierlo, Linda Aj; Stalmeier, Peep; Damman, Olga C; Stiggelbout, Anne
2017-06-01
Currently, shared decision making (SDM) is on the agenda among target patient representative groups, policy makers and professional bodies. Although the International Conference for Shared Decision Making (ISDM) 2011 generated a positive boost, hesitation was also felt among Dutch clinicians, who are challenged by many new tasks. No hesitation is seen among the majority of patients, opting mostly for the SDM model. We haven't reached these patients' needs fully yet, given disappointing research data on patients' experiences and professional behaviour. There is plenty of room for improvement in daily practice, for which many best practices are being designed and increasingly implemented, such as national campaigns to empower patients, central governance of patient decision aids that are developed along clinical practice guidelines, postgraduate training, collaborative learning and system changes, and merging goal setting and SDM in complex care. This is explicitly supported by the Dutch government, the Ministry of Health, patient groups, professional bodies and health insurers. The culture shift in the minds and hearts of patients and clinicians has started but is still ongoing. Enthusiasm for this way of working could be undermined if SDM is defined and implemented in a simplistic, dogmatic manner leading to irresponsible transferring of the professionals' uncertainty, responsibility, and decisional stress to patients. Copyright © 2017. Published by Elsevier GmbH.
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Are baboons learning "orthographic" representations? Probably not
Bröker, Franziska; Ramscar, Michael; Baayen, Harald
2017-01-01
The ability of Baboons (papio papio) to distinguish between English words and nonwords has been modeled using a deep learning convolutional network model that simulates a ventral pathway in which lexical representations of different granularity develop. However, given that pigeons (columba livia), whose brain morphology is drastically different, can also be trained to distinguish between English words and nonwords, it appears that a less species-specific learning algorithm may be required to explain this behavior. Accordingly, we examined whether the learning model of Rescorla and Wagner, which has proved to be amazingly fruitful in understanding animal and human learning could account for these data. We show that a discrimination learning network using gradient orientation features as input units and word and nonword units as outputs succeeds in predicting baboon lexical decision behavior—including key lexical similarity effects and the ups and downs in accuracy as learning unfolds—with surprising precision. The models performance, in which words are not explicitly represented, is remarkable because it is usually assumed that lexicality decisions, including the decisions made by baboons and pigeons, are mediated by explicit lexical representations. By contrast, our results suggest that in learning to perform lexical decision tasks, baboons and pigeons do not construct a hierarchy of lexical units. Rather, they make optimal use of low-level information obtained through the massively parallel processing of gradient orientation features. Accordingly, we suggest that reading in humans first involves initially learning a high-level system building on letter representations acquired from explicit instruction in literacy, which is then integrated into a conventionalized oral communication system, and that like the latter, fluent reading involves the massively parallel processing of the low-level features encoding semantic contrasts. PMID:28859134
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Are baboons learning "orthographic" representations? Probably not.
Linke, Maja; Bröker, Franziska; Ramscar, Michael; Baayen, Harald
2017-01-01
The ability of Baboons (papio papio) to distinguish between English words and nonwords has been modeled using a deep learning convolutional network model that simulates a ventral pathway in which lexical representations of different granularity develop. However, given that pigeons (columba livia), whose brain morphology is drastically different, can also be trained to distinguish between English words and nonwords, it appears that a less species-specific learning algorithm may be required to explain this behavior. Accordingly, we examined whether the learning model of Rescorla and Wagner, which has proved to be amazingly fruitful in understanding animal and human learning could account for these data. We show that a discrimination learning network using gradient orientation features as input units and word and nonword units as outputs succeeds in predicting baboon lexical decision behavior-including key lexical similarity effects and the ups and downs in accuracy as learning unfolds-with surprising precision. The models performance, in which words are not explicitly represented, is remarkable because it is usually assumed that lexicality decisions, including the decisions made by baboons and pigeons, are mediated by explicit lexical representations. By contrast, our results suggest that in learning to perform lexical decision tasks, baboons and pigeons do not construct a hierarchy of lexical units. Rather, they make optimal use of low-level information obtained through the massively parallel processing of gradient orientation features. Accordingly, we suggest that reading in humans first involves initially learning a high-level system building on letter representations acquired from explicit instruction in literacy, which is then integrated into a conventionalized oral communication system, and that like the latter, fluent reading involves the massively parallel processing of the low-level features encoding semantic contrasts.
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Analysing and exemplifying forensic conclusion criteria in terms of Bayesian decision theory.
Biedermann, A; Bozza, S; Taroni, F
2018-03-01
There is ongoing discussion in forensic science and the law about the nature of the conclusions reached based on scientific evidence, and on how such conclusions - and conclusion criteria - may be justified by rational argument. Examples, among others, are encountered in fields such as fingermarks (e.g., 'this fingermark comes from Mr. A's left thumb'), handwriting examinations (e.g., 'the questioned signature is that of Mr. A'), kinship analyses (e.g., 'Mr. A is the father of child C') or anthropology (e.g., 'these are human remains'). Considerable developments using formal methods of reasoning based on, for example (Bayesian) decision theory, are available in literature, but currently such reference principles are not explicitly used in operational forensic reporting and ensuing decision-making. Moreover, applied examples, illustrating the principles, are scarce. A potential consequence of this in practical proceedings, and hence a cause of concern, is that underlying ingredients of decision criteria (such as losses quantifying the undesirability of adverse decision consequences), are not properly dealt with. There is merit, thus, in pursuing the study and discussion of practical examples, demonstrating that formal decision-theoretic principles are not merely conceptual considerations. Actually, these principles can be shown to underpin practical decision-making procedures and existing legal decision criteria, though often not explicitly apparent as such. In this paper, we will present such examples and discuss their properties from a Bayesian decision-theoretic perspective. We will argue that these are essential concepts for an informed discourse on decision-making across forensic disciplines and the development of a coherent view on this topic. We will also emphasize that these principles are of normative nature in the sense that they provide standards against which actual judgment and decision-making may be compared. Most importantly, these standards are justified independently of peoples' observable decision behaviour, and of whether or not one endorses these formal methods of reasoning. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
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Integrating the social sciences to understand human-water dynamics
NASA Astrophysics Data System (ADS)
Carr, G.; Kuil, L., Jr.
2017-12-01
Many interesting and exciting socio-hydrological models have been developed in recent years. Such models often aim to capture the dynamic interplay between people and water for a variety of hydrological settings. As such, peoples' behaviours and decisions are brought into the models as drivers of and/or respondents to the hydrological system. To develop and run such models over a sufficiently long time duration to observe how the water-human system evolves the human component is often simplified according to one or two key behaviours, characteristics or decisions (e.g. a decision to move away from a drought or flood area; a decision to pump groundwater, or a decision to plant a less water demanding crop). To simplify the social component, socio-hydrological modellers often pull knowledge and understanding from existing social science theories. This requires them to negotiate complex territory, where social theories may be underdeveloped, contested, dynamically evolving, or case specific and difficult to generalise or upscale. A key question is therefore, how can this process be supported so that the resulting socio-hydrological models adequately describe the system and lead to meaningful understanding of how and why it behaves as it does? Collaborative interdisciplinary research teams that bring together social and natural scientists are likely to be critical. Joint development of the model framework requires specific attention to clarification to expose all underlying assumptions, constructive discussion and negotiation to reach agreement on the modelled system and its boundaries. Mutual benefits to social scientists can be highlighted, i.e. socio-hydrological work can provide insights for further exploring and testing social theories. Collaborative work will also help ensure underlying social theory is made explicit, and may identify ways to include and compare multiple theories. As socio-hydrology progresses towards supporting policy development, approaches that brings in stakeholders and non-scientist participants to develop the conceptual modelling framework will become essential. They are also critical for fully understanding human-water dynamics.
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Computational neuroanatomy: ontology-based representation of neural components and connectivity
Rubin, Daniel L; Talos, Ion-Florin; Halle, Michael; Musen, Mark A; Kikinis, Ron
2009-01-01
Background A critical challenge in neuroscience is organizing, managing, and accessing the explosion in neuroscientific knowledge, particularly anatomic knowledge. We believe that explicit knowledge-based approaches to make neuroscientific knowledge computationally accessible will be helpful in tackling this challenge and will enable a variety of applications exploiting this knowledge, such as surgical planning. Results We developed ontology-based models of neuroanatomy to enable symbolic lookup, logical inference and mathematical modeling of neural systems. We built a prototype model of the motor system that integrates descriptive anatomic and qualitative functional neuroanatomical knowledge. In addition to modeling normal neuroanatomy, our approach provides an explicit representation of abnormal neural connectivity in disease states, such as common movement disorders. The ontology-based representation encodes both structural and functional aspects of neuroanatomy. The ontology-based models can be evaluated computationally, enabling development of automated computer reasoning applications. Conclusion Neuroanatomical knowledge can be represented in machine-accessible format using ontologies. Computational neuroanatomical approaches such as described in this work could become a key tool in translational informatics, leading to decision support applications that inform and guide surgical planning and personalized care for neurological disease in the future. PMID:19208191
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Rikard-Bell, G; Waters, E; Ward, J
2006-07-01
We report within a case study a reproducible process to facilitate the explicit incorporation of evidence by a multidisciplinary group into clinical policy development. To support the decision-making of a multidisciplinary Intersectoral Advisory Group (IAG) convened by the Royal Australasian College of Physicians Health Policy Unit, a systematic review of randomized controlled trials about environmental tobacco smoke and smoking cessation interventions in paediatric settings was first undertaken. As reported in detail here, IAG members were then formally engaged in a transparent and replicable process to understand and interpret the synthesized evidence and to proffer their independent reactions regarding policy, practice and research. Our intention was to ensure that all IAG members were democratically engaged and made aware of the available evidence. As clinical policy must engage stakeholder representatives from diverse backgrounds, a process to equalize understanding of the evidence and 'democratize' judgment about its implications is needed. Future research must then examine the benefits of such explicit steps when guidelines, in turn, are implemented. We hypothesize that changes to future practice will be more likely if processes undertaken to develop guidelines are transparent to clinicians and other target groups.
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A communication model of shared decision making: accounting for cancer treatment decisions.
Siminoff, Laura A; Step, Mary M
2005-07-01
The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient.
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Forney, William M.; Oldham, I. Benson; Crescenti, Neil
2013-01-01
This report describes and applies the Land Use Simulation Model (LUSM), the final modeling product for the long-term decision support project funded by the Southern Nevada Public Land Management Act and developed by the U.S. Geological Survey’s Western Geographic Science Center for the Lake Tahoe Basin. Within the context of the natural-resource management and anthropogenic issues of the basin and in an effort to advance land-use and land-cover change science, this report addresses the problem of developing the LUSM as a decision support system. It includes consideration of land-use modeling theory, fire modeling and disturbance in the wildland-urban interface, historical land-use change and its relation to active land management, hydrologic modeling and the impact of urbanization as related to the Lahontan Regional Water Quality Control Board’s recently developed Total Maximum Daily Load report for the basin, and biodiversity in urbanizing areas. The LUSM strives to inform land-management decisions in a complex regulatory environment by simulating parcel-based, land-use transitions with a stochastic, spatially constrained, agent-based model. The tool is intended to be useful for multiple purposes, including the multiagency Pathway 2007 regional planning effort, the Tahoe Regional Planning Agency (TRPA) Regional Plan Update, and complementary research endeavors and natural-resource-management efforts. The LUSM is an Internet-based, scenario-generation decision support tool for allocating retired and developed parcels over the next 20 years. Because USGS staff worked closely with TRPA staff and their “Code of Ordinances” and analyzed datasets of historical management and land-use practices, this report accomplishes the task of providing reasonable default values for a baseline scenario that can be used in the LUSM. One result from the baseline scenario for the model suggests that all vacant parcels could be allocated within 12 years. Results also include: assessment of model functionality, brief descriptions of the 7 basic output tables, assessment of the rate of change in land-use allocation pools over time, locations and amounts of the spatially explicit probabilities of land-use transitions by real estate commodity, and analysis of the state change from today’s existing land cover to potential land uses in the future. Assumptions and limitations of the model are presented. This report concludes with suggested next steps to support the continued utility of the LUSM and additional research avenues.
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Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria
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
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Model Development for EHR Interdisciplinary Information Exchange of ICU Common Goals
Collins, Sarah A.; Bakken, Suzanne; Vawdrey, David K.; Coiera, Enrico; Currie, Leanne
2010-01-01
Purpose Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient–centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals. Methods The theoretical frameworks of distributed cognition and the clinical communication space were integrated and a previously published categorization of verbal information exchange was used. 59.5 hours of interdisciplinary rounds in a Neurovascular ICU were observed and five interviews and one focus group with ICU nurses and physicians were conducted. Results Current documentation tools in the ICU were not sufficient to capture the nurses' and physicians' collaborative decision-making and verbal communication of goal-directed actions and interactions. Clinicians perceived the EHR to be inefficient for information retrieval, leading to a further reliance on verbal information exchange. Conclusion The model suggests that EHRs should support: 1) Information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and 2) Messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support. PMID:20974549
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2012-01-01
Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors. PMID:22333210
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EEG Classification with a Sequential Decision-Making Method in Motor Imagery BCI.
Liu, Rong; Wang, Yongxuan; Newman, Geoffrey I; Thakor, Nitish V; Ying, Sarah
2017-12-01
To develop subject-specific classifier to recognize mental states fast and reliably is an important issue in brain-computer interfaces (BCI), particularly in practical real-time applications such as wheelchair or neuroprosthetic control. In this paper, a sequential decision-making strategy is explored in conjunction with an optimal wavelet analysis for EEG classification. The subject-specific wavelet parameters based on a grid-search method were first developed to determine evidence accumulative curve for the sequential classifier. Then we proposed a new method to set the two constrained thresholds in the sequential probability ratio test (SPRT) based on the cumulative curve and a desired expected stopping time. As a result, it balanced the decision time of each class, and we term it balanced threshold SPRT (BTSPRT). The properties of the method were illustrated on 14 subjects' recordings from offline and online tests. Results showed the average maximum accuracy of the proposed method to be 83.4% and the average decision time of 2.77[Formula: see text]s, when compared with 79.2% accuracy and a decision time of 3.01[Formula: see text]s for the sequential Bayesian (SB) method. The BTSPRT method not only improves the classification accuracy and decision speed comparing with the other nonsequential or SB methods, but also provides an explicit relationship between stopping time, thresholds and error, which is important for balancing the speed-accuracy tradeoff. These results suggest that BTSPRT would be useful in explicitly adjusting the tradeoff between rapid decision-making and error-free device control.
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The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions.
Hirsh, Adam T; Hollingshead, Nicole A; Ashburn-Nardo, Leslie; Kroenke, Kurt
2015-06-01
Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty-nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and nonopioid analgesics) decisions for 12 virtual patients with acute pain. Race (black/white) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers' decisions, such that decisions varied as a function of ambiguity for white but not for black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however, providers' implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between white and black patients are, in part, attributable to the nature (ie, ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors. This study examined the unique and collective influence of patient race, provider racial bias, and clinical ambiguity on providers' pain management decisions. These results could inform the development of interventions aimed at reducing disparities and improving pain care. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
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NASA Astrophysics Data System (ADS)
Necefer, Len Edward
Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided through the developed decision aid on beliefs and preferences related to the type and scale of energy development, trust of decision makers, and larger concern for environmental protection. Finally, chapter 5 presents concluding thoughts future research and on how technical-social decision tools can provide a means ensuring effective decision making on the Navajo Nation and other American Indian communities.
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Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke
2014-01-01
Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208
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Herrera, José M; Alagador, Diogo; Salgueiro, Pedro; Mira, António
2018-01-01
Managing landscape connectivity is a widely recognized overarching strategy for conserving biodiversity in human-impacted landscapes. However, planning the conservation and management of landscape connectivity of multiple and ecologically distinct species is still challenging. Here we provide a spatially-explicit framework which identifies and prioritizes connectivity conservation and restoration actions for species with distinct habitat affinities. Specifically, our study system comprised three groups of common bird species, forest-specialists, farmland-specialists, and generalists, populating a highly heterogeneous agricultural countryside in the southwestern Iberian Peninsula. We first performed a comprehensive analysis of the environmental variables underlying the distributional patterns of each bird species to reveal generalities in their guild-specific responses to landscape structure. Then, we identified sites which could be considered pivotal in maintaining current levels of landscape connectivity for the three bird guilds simultaneously, as well as the number and location of sites that need to be restored to maximize connectivity levels. Interestingly, we found that a small number of sites defined the shortest connectivity paths for the three bird guilds simultaneously, and were therefore considered key for conservation. Moreover, an even smaller number of sites were identified as critical to expand the landscape connectivity at maximum for the regional bird assemblage as a whole. Our spatially-explicit framework can provide valuable decision-making support to conservation practitioners aiming to identify key connectivity and restoration sites, a particularly urgent task in rapidly changing landscapes such as agroecosystems.
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Salgueiro, Pedro; Mira, António
2018-01-01
Managing landscape connectivity is a widely recognized overarching strategy for conserving biodiversity in human-impacted landscapes. However, planning the conservation and management of landscape connectivity of multiple and ecologically distinct species is still challenging. Here we provide a spatially-explicit framework which identifies and prioritizes connectivity conservation and restoration actions for species with distinct habitat affinities. Specifically, our study system comprised three groups of common bird species, forest-specialists, farmland-specialists, and generalists, populating a highly heterogeneous agricultural countryside in the southwestern Iberian Peninsula. We first performed a comprehensive analysis of the environmental variables underlying the distributional patterns of each bird species to reveal generalities in their guild-specific responses to landscape structure. Then, we identified sites which could be considered pivotal in maintaining current levels of landscape connectivity for the three bird guilds simultaneously, as well as the number and location of sites that need to be restored to maximize connectivity levels. Interestingly, we found that a small number of sites defined the shortest connectivity paths for the three bird guilds simultaneously, and were therefore considered key for conservation. Moreover, an even smaller number of sites were identified as critical to expand the landscape connectivity at maximum for the regional bird assemblage as a whole. Our spatially-explicit framework can provide valuable decision-making support to conservation practitioners aiming to identify key connectivity and restoration sites, a particularly urgent task in rapidly changing landscapes such as agroecosystems. PMID:29641610
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Salomon-Ferrer, Romelia; Götz, Andreas W; Poole, Duncan; Le Grand, Scott; Walker, Ross C
2013-09-10
We present an implementation of explicit solvent all atom classical molecular dynamics (MD) within the AMBER program package that runs entirely on CUDA-enabled GPUs. First released publicly in April 2010 as part of version 11 of the AMBER MD package and further improved and optimized over the last two years, this implementation supports the three most widely used statistical mechanical ensembles (NVE, NVT, and NPT), uses particle mesh Ewald (PME) for the long-range electrostatics, and runs entirely on CUDA-enabled NVIDIA graphics processing units (GPUs), providing results that are statistically indistinguishable from the traditional CPU version of the software and with performance that exceeds that achievable by the CPU version of AMBER software running on all conventional CPU-based clusters and supercomputers. We briefly discuss three different precision models developed specifically for this work (SPDP, SPFP, and DPDP) and highlight the technical details of the approach as it extends beyond previously reported work [Götz et al., J. Chem. Theory Comput. 2012, DOI: 10.1021/ct200909j; Le Grand et al., Comp. Phys. Comm. 2013, DOI: 10.1016/j.cpc.2012.09.022].We highlight the substantial improvements in performance that are seen over traditional CPU-only machines and provide validation of our implementation and precision models. We also provide evidence supporting our decision to deprecate the previously described fully single precision (SPSP) model from the latest release of the AMBER software package.
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Explicit Pre-Training Instruction Does Not Improve Implicit Perceptual-Motor Sequence Learning
ERIC Educational Resources Information Center
Sanchez, Daniel J.; Reber, Paul J.
2013-01-01
Memory systems theory argues for separate neural systems supporting implicit and explicit memory in the human brain. Neuropsychological studies support this dissociation, but empirical studies of cognitively healthy participants generally observe that both kinds of memory are acquired to at least some extent, even in implicit learning tasks. A key…
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Risky decision-making under risk in schizophrenia: A deliberate choice?
Pedersen, Anya; Göder, Robert; Tomczyk, Samuel; Ohrmann, Patricia
2017-09-01
Patients with schizophrenia reveal impaired decision-making strategies causing social, financial and health care problems. The extent to which deficits in decision-making reflect intentional risky choices in schizophrenia is still under debate. Based on previous studies we expected patients with schizophrenia to reveal a riskier performance on the GDT and to make more disadvantageous decisions on the IGT. In the present study, we investigated 38 patients with schizophrenia and 38 matched healthy control subjects with two competing paradigms regarding feedback: (1) The Game of Dice Task (GDT), in which the probabilities of winning or losing are stable and explicitly disclosed to the subject, to assess decision-making under risk and (2) the Iowa Gambling Task (IGT), which requires subjects to infer the probabilities of winning or losing from feedback, to investigate decision-making under ambiguity. Patients with schizophrenia revealed an overall riskier performance on the GDT; although they adjusted their strategy over the course of the GDT, they still made significantly more disadvantageous choices than controls. More positive symptoms in patients with schizophrenia indicated by higher PANSS positive scores were associated with riskier choices and less use of negative feedback. Compared to healthy controls, they were not impaired in net score but chose more disadvantageous cards than controls on the first block of the IGT. Effects of medication at the time of testing cannot be ruled out. Our findings suggest that patients with schizophrenia make riskier decisions and are less able to regulate their decision-making to implement advantageous strategies, even when the probabilities of winning or losing are explicitly disclosed. The dissociation between performance on the GDT and IGT suggests a pronounced impairment of executive functions related to the dorsolateral prefrontal cortex. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth
2004-01-01
Objective: A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. Design: This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. Results: The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Conclusion: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge. PMID:15187061
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Murray, Jennifer; Williams, Brian; Hoskins, Gaylor; Skar, Silje; McGhee, John; Treweek, Shaun; Sniehotta, Falko F; Sheikh, Aziz; Brown, Gordon; Hagen, Suzanne; Cameron, Linda; Jones, Claire; Gauld, Dylan
2016-01-01
Visualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing. Our final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions. We have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.
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Methods for handling uncertainty within pharmaceutical funding decisions
NASA Astrophysics Data System (ADS)
Stevenson, Matt; Tappenden, Paul; Squires, Hazel
2014-01-01
This article provides a position statement regarding decision making under uncertainty within the economic evaluation of pharmaceuticals, with a particular focus upon the National Institute for Health and Clinical Excellence context within England and Wales. This area is of importance as funding agencies have a finite budget from which to purchase a selection of competing health care interventions. The objective function generally used is that of maximising societal health with an explicit acknowledgement that there will be opportunity costs associated with purchasing a particular intervention. Three components of uncertainty are discussed within a pharmaceutical funding perspective: methodological uncertainty, parameter uncertainty and structural uncertainty, alongside a discussion of challenges that are particularly pertinent to health economic evaluation. The discipline has focused primarily on handling methodological and parameter uncertainty and a clear reference case has been developed for consistency across evaluations. However, uncertainties still remain. Less attention has been given to methods for handling structural uncertainty. The lack of adequate methods to explicitly incorporate this aspect of model development may result in the true uncertainty surrounding health care investment decisions being underestimated. Research in this area is ongoing as we review.
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Taylor, Shelley E; Welch, William T; Kim, Heejung S; Sherman, David K
2007-09-01
Social support is believed to be a universally valuable resource for combating stress, yet Asians and Asian Americans report that social support is not helpful to them, resist seeking it, and are underrepresented among recipients of supportive services. We distinguish between explicit social support (seeking and using advice and emotional solace) and implicit social support (focusing on valued social groups) and show that Asians and Asian Americans are psychologically and biologically benefited more by implicit social support than by explicit social support; the reverse is true for European Americans. Our discussion focuses on cultural differences in the construal of relationships and their implications for social support and delivery of support services.
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Estimating carnivore community structures
Jiménez, José; Nuñez-Arjona, Juan Carlos; Rueda, Carmen; González, Luis Mariano; García-Domínguez, Francisco; Muñoz-Igualada, Jaime; López-Bao, José Vicente
2017-01-01
Obtaining reliable estimates of the structure of carnivore communities is of paramount importance because of their ecological roles, ecosystem services and impact on biodiversity conservation, but they are still scarce. This information is key for carnivore management: to build support for and acceptance of management decisions and policies it is crucial that those decisions are based on robust and high quality information. Here, we combined camera and live-trapping surveys, as well as telemetry data, with spatially-explicit Bayesian models to show the usefulness of an integrated multi-method and multi-model approach to monitor carnivore community structures. Our methods account for imperfect detection and effectively deal with species with non-recognizable individuals. In our Mediterranean study system, the terrestrial carnivore community was dominated by red foxes (0.410 individuals/km2); Egyptian mongooses, feral cats and stone martens were similarly abundant (0.252, 0.249 and 0.240 individuals/km2, respectively), whereas badgers and common genets were the least common (0.130 and 0.087 individuals/km2, respectively). The precision of density estimates improved by incorporating multiple covariates, device operation, and accounting for the removal of individuals. The approach presented here has substantial implications for decision-making since it allows, for instance, the evaluation, in a standard and comparable way, of community responses to interventions. PMID:28120871
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Yang, Joyce P; Leu, Janxin; Simoni, Jane M; Chen, Wei Ti; Shiu, Cheng-Shi; Zhao, Hongxin
2015-08-01
China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.
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NASA Astrophysics Data System (ADS)
Firdausi, N.; Prabawa, H. W.; Sutarno, H.
2017-02-01
In an effort to maximize a student’s academic growth, one of the tools available to educators is the explicit instruction. Explicit instruction is marked by a series of support or scaffold, where the students will be guided through the learning process with a clear statement of purpose and a reason for learning new skills, a clear explanation and demonstration of learning targets, supported and practiced with independent feedback until mastery has been achieved. The technology development trend of todays, requires an adjustment in the development of learning object that supports the achievement of explicit instruction targets. This is where the gamification position is. In the role as a pedagogical strategy, the use of gamification preformance study class is still relatively new. Gamification not only use the game elements and game design techniques in non-game contexts, but also to empower and engage learners with the ability of motivation on learning approach and maintains a relaxed atmosphere. With using Reseach and Development methods, this paper presents the integration of technology (which in this case using the concept of gamification) in explicit instruction settings and the impact on the improvement of students’ understanding.
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A multi-objective decision-making approach to the journal submission problem.
Wong, Tony E; Srikrishnan, Vivek; Hadka, David; Keller, Klaus
2017-01-01
When researchers complete a manuscript, they need to choose a journal to which they will submit the study. This decision requires to navigate trade-offs between multiple objectives. One objective is to share the new knowledge as widely as possible. Citation counts can serve as a proxy to quantify this objective. A second objective is to minimize the time commitment put into sharing the research, which may be estimated by the total time from initial submission to final decision. A third objective is to minimize the number of rejections and resubmissions. Thus, researchers often consider the trade-offs between the objectives of (i) maximizing citations, (ii) minimizing time-to-decision, and (iii) minimizing the number of resubmissions. To complicate matters further, this is a decision with multiple, potentially conflicting, decision-maker rationalities. Co-authors might have different preferences, for example about publishing fast versus maximizing citations. These diverging preferences can lead to conflicting trade-offs between objectives. Here, we apply a multi-objective decision analytical framework to identify the Pareto-front between these objectives and determine the set of journal submission pathways that balance these objectives for three stages of a researcher's career. We find multiple strategies that researchers might pursue, depending on how they value minimizing risk and effort relative to maximizing citations. The sequences that maximize expected citations within each strategy are generally similar, regardless of time horizon. We find that the "conditional impact factor"-impact factor times acceptance rate-is a suitable heuristic method for ranking journals, to strike a balance between minimizing effort objectives and maximizing citation count. Finally, we examine potential co-author tension resulting from differing rationalities by mapping out each researcher's preferred Pareto front and identifying compromise submission strategies. The explicit representation of trade-offs, especially when multiple decision-makers (co-authors) have different preferences, facilitates negotiations and can support the decision process.
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A multi-objective decision-making approach to the journal submission problem
Hadka, David; Keller, Klaus
2017-01-01
When researchers complete a manuscript, they need to choose a journal to which they will submit the study. This decision requires to navigate trade-offs between multiple objectives. One objective is to share the new knowledge as widely as possible. Citation counts can serve as a proxy to quantify this objective. A second objective is to minimize the time commitment put into sharing the research, which may be estimated by the total time from initial submission to final decision. A third objective is to minimize the number of rejections and resubmissions. Thus, researchers often consider the trade-offs between the objectives of (i) maximizing citations, (ii) minimizing time-to-decision, and (iii) minimizing the number of resubmissions. To complicate matters further, this is a decision with multiple, potentially conflicting, decision-maker rationalities. Co-authors might have different preferences, for example about publishing fast versus maximizing citations. These diverging preferences can lead to conflicting trade-offs between objectives. Here, we apply a multi-objective decision analytical framework to identify the Pareto-front between these objectives and determine the set of journal submission pathways that balance these objectives for three stages of a researcher’s career. We find multiple strategies that researchers might pursue, depending on how they value minimizing risk and effort relative to maximizing citations. The sequences that maximize expected citations within each strategy are generally similar, regardless of time horizon. We find that the “conditional impact factor”—impact factor times acceptance rate—is a suitable heuristic method for ranking journals, to strike a balance between minimizing effort objectives and maximizing citation count. Finally, we examine potential co-author tension resulting from differing rationalities by mapping out each researcher’s preferred Pareto front and identifying compromise submission strategies. The explicit representation of trade-offs, especially when multiple decision-makers (co-authors) have different preferences, facilitates negotiations and can support the decision process. PMID:28582430
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MacCluskie, Margaret C.; Romito, Angela; Peterson, James T.; Lawler, James P.
2015-01-01
A fundamental goal of the National Park Service (NPS) is the long-term protection and management of resources in the National Park System. Reaching this goal requires multiple approaches, including the conservation of essential habitats and the identification and elimination of potential threats to biota and habitats. To accomplish these goals, the NPS has implemented the Alaska Region Vital Signs Inventory and Monitoring (I&M) Program to monitor key biological, chemical, and physical components of ecosystems at more than 270 national parks. The Alaska Region has four networks—Arctic, Central, Southeast, and Southwest. By monitoring vital signs over large spatial and temporal scales, park managers are provided with information on the status and trajectory of park resources as well as a greater understanding and insight into the ecosystem dynamics. While detecting and quantifying change is important to conservation efforts, to be useful for formulating remedial actions, monitoring data must explicitly relate to management objectives and be collected in such a manner as to resolve key uncertainties about the dynamics of the system (Nichols and Williams 2006). Formal decision making frameworks (versus more traditional processes described below) allow for the explicit integration of monitoring data into decision making processes to improve the understanding of system dynamics, thereby improving future decisions (Williams 2011).
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Semenic, Sonia; Edwards, Nancy; Premji, Shahirose; Olson, Joanne; Williams, Beverly; Montgomery, Phyllis
2015-03-31
Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada. Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2. Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications. Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.
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Enhancing L2 Vocabulary Acquisition through Implicit Reading Support Cues in E-books
ERIC Educational Resources Information Center
Liu, Yeu-Ting; Leveridge, Aubrey Neil
2017-01-01
Various explicit reading support cues, such as gloss, QR codes and hypertext annotation, have been embedded in e-books designed specifically for fostering various aspects of language development. However, explicit visual cues are not always reliably perceived as salient or effective by language learners. The current study explored the efficacy of…
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Stelzenmüller, V; Lee, J; Garnacho, E; Rogers, S I
2010-10-01
For the UK continental shelf we developed a Bayesian Belief Network-GIS framework to visualise relationships between cumulative human pressures, sensitive marine landscapes and landscape vulnerability, to assess the consequences of potential marine planning objectives, and to map uncertainty-related changes in management measures. Results revealed that the spatial assessment of footprints and intensities of human activities had more influence on landscape vulnerabilities than the type of landscape sensitivity measure used. We addressed questions regarding consequences of potential planning targets, and necessary management measures with spatially-explicit assessment of their consequences. We conclude that the BN-GIS framework is a practical tool allowing for the visualisation of relationships, the spatial assessment of uncertainty related to spatial management scenarios, the engagement of different stakeholder views, and enables a quick update of new spatial data and relationships. Ultimately, such BN-GIS based tools can support the decision-making process used in adaptive marine management. Copyright © 2010 Elsevier Ltd. All rights reserved.
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STOPP/START version 2-development of software applications: easier said than done?
Anrys, Pauline; Boland, Benoît; Degryse, Jean-Marie; De Lepeleire, Jan; Petrovic, Mirko; Marien, Sophie; Dalleur, Olivia; Strauven, Goedele; Foulon, Veerle; Spinewine, Anne
2016-09-01
Explicit criteria, such as the STOPP/START criteria, are increasingly used both in clinical practice and in research to identify potentially inappropriate prescribing in older people. In an article on the STOPP/START criteria version 2, O'Mahony et al have pointed out the advantages of developing computerised criteria. Both clinical decision support systems to support healthcare professionals and software applications to automatically detect inappropriate prescribing in research studies can be developed. In the process of developing such tools, difficulties may occur. In the context of a research study, we have developed an algorithm to automatically apply STOPP/START criteria version 2 to our research database. We comment in this paper on different kinds of difficulties encountered and make suggestions that could be taken into account when developing the next version of the criteria. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Davis, Esther L; McCaffery, Kirsten; Mullan, Barbara; Juraskova, Ilona
2015-12-01
Decision aids (DAs) are non-directive communication tools that help patients make value-consistent health-care decisions. However, most DAs have been developed without an explicit theoretical framework, resulting in a lack of understanding of how DAs achieve outcomes. To investigate the effect of promoting affective vs. deliberative processing on DA effectiveness based on dual-process theory. One hundred and forty-eight female university students participated in a randomized controlled experiment with three conditions: emotion-focused, information-focused and control. Preference-value consistency, knowledge, decisional conflict and satisfaction were compared across the conditions using planned contrast analyses. The intervention comprised two different DAs and instructional manipulations. The emotion-focused condition received a modified DA with affective content and instructions to induce an affective reaction. The information-focused and control conditions received the same DA without the affective content. The information-focused condition received additional instructions to induce deliberative processing. Controlling for the experiment-wise error rate at P < 0.017, the emotion-focused and information-focused conditions had significantly higher decisional satisfaction than the control condition (P < 0.001). The emotion-focused condition did not demonstrate preference-value consistency. There were no significant differences for decisional conflict and knowledge. Results suggest that the promotion of affective processing may hinder value-consistent decision making, while deliberative processing may enhance decisional satisfaction. This investigation of the effect of affective and deliberative processes in DA-supported decision making has implications for the design and use of DAs. DA effectiveness may be enhanced by incorporating a simple instruction to focus on the details of the information. © 2014 John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Sakschewski, Mark; Eggert, Sabina; Schneider, Susanne; Bögeholz, Susanne
2014-09-01
The concept of energy is one key component of science education curricula worldwide. While it is still being taught in many science classrooms from a mainly conceptual knowledge perspective, the need to frame the concept of energy as a socioscientific issue and implement it in the context of citizenship education and education for sustainable development, is getting more and more explicit. As we will be faced with limited fossil fuels and the consequences of global climate change in the future, students have to be supported in becoming literate citizens who are able to reach informed energy-related decisions. In this article, we focus on students' reasoning and decision-making processes about socioscientific energy-related issues. In more detail, we developed a paper-and-pencil measurement instrument to assess secondary school students' competencies in this domain. The functioning of the measurement instrument was analysed with a sample of 850 students from grades 6, 8, 10 and 12 using item response theory. Findings show that the measurement instrument functions in terms of reliability and validity. Concerning student ability, elaborate reasoning and decision-making was characterised by the use of trade-offs and the ability to weigh arguments and to reflect on the structure of reasoning and decision-making processes. The developed measurement instrument provides a complement for existing test instruments on conceptual knowledge about the concept of energy. It aims to contribute to a change in teaching about energy, especially in physics education in the sense of education for sustainable development.
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Explicit pre-training instruction does not improve implicit perceptual-motor sequence learning
Sanchez, Daniel J.; Reber, Paul J.
2012-01-01
Memory systems theory argues for separate neural systems supporting implicit and explicit memory in the human brain. Neuropsychological studies support this dissociation, but empirical studies of cognitively healthy participants generally observe that both kinds of memory are acquired to at least some extent, even in implicit learning tasks. A key question is whether this observation reflects parallel intact memory systems or an integrated representation of memory in healthy participants. Learning of complex tasks in which both explicit instruction and practice is used depends on both kinds of memory, and how these systems interact will be an important component of the learning process. Theories that posit an integrated, or single, memory system for both types of memory predict that explicit instruction should contribute directly to strengthening task knowledge. In contrast, if the two types of memory are independent and acquired in parallel, explicit knowledge should have no direct impact and may serve in a “scaffolding” role in complex learning. Using an implicit perceptual-motor sequence learning task, the effect of explicit pre-training instruction on skill learning and performance was assessed. Explicit pre-training instruction led to robust explicit knowledge, but sequence learning did not benefit from the contribution of pre-training sequence memorization. The lack of an instruction benefit suggests that during skill learning, implicit and explicit memory operate independently. While healthy participants will generally accrue parallel implicit and explicit knowledge in complex tasks, these types of information appear to be separately represented in the human brain consistent with multiple memory systems theory. PMID:23280147
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Attitudinal effects of degrading themes and sexual explicitness in video materials.
Golde, J A; Strassberg, D S; Turner, C M; Lowe, K
2000-07-01
This study examined the independent and interactive effects of sexual explicitness and degrading themes toward women on mens' attitudes following exposure to video presentations of male-female interactions. Subjects were 83 male college students who viewed video vignettes under one of four stimulus conditions: (a) sexually explicit/degrading, (b) sexually explicit/nondegrading, (c) nonexplicit/degrading, and (d) nonexplicit/nondegrading. Results revealed that men exposed to degrading material, regardless of explicitness, were significantly more likely to express attitudes supportive of rape, while explicitness had no significant main or interactive effect on these attitudes. Further, the interaction of explicitness with degradation was found to impact scores on a measure of sexual callousness. Theoretical and clinical implications of these findings are discussed.
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Mobile technology supporting trainee doctors’ workplace learning and patient care: an evaluation
2013-01-01
Background The amount of information needed by doctors has exploded. The nature of knowledge (explicit and tacit) and processes of knowledge acquisition and participation are complex. Aiming to assist workplace learning, Wales Deanery funded “iDoc”, a project offering trainee doctors a Smartphone library of medical textbooks. Methods Data on trainee doctors’ (Foundation Year 2) workplace information seeking practice was collected by questionnaire in 2011 (n = 260). iDoc baseline questionnaires (n = 193) collected data on Smartphone usage alongside other workplace information sources. Case reports (n = 117) detail specific instances of Smartphone use. Results Most frequently (daily) used information sources in the workplace: senior medical staff (80% F2 survey; 79% iDoc baseline); peers (70%; 58%); and other medical/nursing team staff (53% both datasets). Smartphones were used more frequently by males (p < 0.01). Foundation Year 1 (newly qualified) was judged the most useful time to have a Smartphone library because of increased responsibility and lack of knowledge/experience. Preferred information source varied by question type: hard copy texts for information-based questions; varied resources for skills queries; and seniors for more complex problems. Case reports showed mobile technology used for simple (information-based), complex (problem-based) clinical questions and clinical procedures (skills-based scenarios). From thematic analysis, the Smartphone library assisted: teaching and learning from observation; transition from medical student to new doctor; trainee doctors’ discussions with seniors; independent practice; patient care; and this ‘just-in-time’ access to reliable information supported confident and efficient decision-making. Conclusion A variety of information sources are used regularly in the workplace. Colleagues are used daily but seniors are not always available. During transitions, constant access to the electronic library was valued. It helped prepare trainee doctors for discussions with their seniors, assisting the interchange between explicit and tacit knowledge. By supporting accurate prescribing and treatment planning, the electronic library contributed to enhanced patient care. Trainees were more rapidly able to medicate patients to reduce pain and more quickly call for specific assessments. However, clinical decision-making often requires dialogue: what Smartphone technology can do is augment, not replace, discussion with their colleagues in the community of practice. PMID:23336964
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UML Profiles for Design Decisions and Non-Functional Requirements
DOE Office of Scientific and Technical Information (OSTI.GOV)
Zhu, Liming; Gorton, Ian
2007-06-30
A software architecture is composed of a collection of design decisions. Each design decision helps or hinders certain Non-Functional Requirements (NFR). Current software architecture views focus on expressing components and connectors in the system. Design decisions and their relationships with non-functional requirements are often captured in separate design documentation, not explicitly expressed in any views. This disassociation makes architecture comprehension and architecture evolution harder. In this paper, we propose a UML profile for modeling design decisions and an associated UML profile for modeling non-functional requirements in a generic way. The two UML profiles treat design decisions and nonfunctional requirements asmore » first-class elements. Modeled design decisions always refer to existing architectural elements and thus maintain traceability between the two. We provide a mechanism for checking consistency over this traceability. An exemplar is given as« less
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Probabilistic Risk Assessment for Decision Making During Spacecraft Operations
NASA Technical Reports Server (NTRS)
Meshkat, Leila
2009-01-01
Decisions made during the operational phase of a space mission often have significant and immediate consequences. Without the explicit consideration of the risks involved and their representation in a solid model, it is very likely that these risks are not considered systematically in trade studies. Wrong decisions during the operational phase of a space mission can lead to immediate system failure whereas correct decisions can help recover the system even from faulty conditions. A problem of special interest is the determination of the system fault protection strategies upon the occurrence of faults within the system. Decisions regarding the fault protection strategy also heavily rely on a correct understanding of the state of the system and an integrated risk model that represents the various possible scenarios and their respective likelihoods. Probabilistic Risk Assessment (PRA) modeling is applicable to the full lifecycle of a space mission project, from concept development to preliminary design, detailed design, development and operations. The benefits and utilities of the model, however, depend on the phase of the mission for which it is used. This is because of the difference in the key strategic decisions that support each mission phase. The focus of this paper is on describing the particular methods used for PRA modeling during the operational phase of a spacecraft by gleaning insight from recently conducted case studies on two operational Mars orbiters. During operations, the key decisions relate to the commands sent to the spacecraft for any kind of diagnostics, anomaly resolution, trajectory changes, or planning. Often, faults and failures occur in the parts of the spacecraft but are contained or mitigated before they can cause serious damage. The failure behavior of the system during operations provides valuable data for updating and adjusting the related PRA models that are built primarily based on historical failure data. The PRA models, in turn, provide insight into the effect of various faults or failures on the risk and failure drivers of the system and the likelihood of possible end case scenarios, thereby facilitating the decision making process during operations. This paper describes the process of adjusting PRA models based on observed spacecraft data, on one hand, and utilizing the models for insight into the future system behavior on the other hand. While PRA models are typically used as a decision aid during the design phase of a space mission, we advocate adjusting them based on the observed behavior of the spacecraft and utilizing them for decision support during the operations phase.
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Armitage, James M; Cousins, Ian T; Hauck, Mara; Harbers, Jasper V; Huijbregts, Mark A J
2007-06-01
Multimedia environmental fate models are commonly-applied tools for assessing the fate and distribution of contaminants in the environment. Owing to the large number of chemicals in use and the paucity of monitoring data, such models are often adopted as part of decision-support systems for chemical risk assessment. The purpose of this study was to evaluate the performance of three multimedia environmental fate models (spatially- and non-spatially-explicit) at a European scale. The assessment was conducted for four polycyclic aromatic hydrocarbons (PAHs) and hexachlorobenzene (HCB) and compared predicted and median observed concentrations using monitoring data collected for air, water, sediments and soils. Model performance in the air compartment was reasonable for all models included in the evaluation exercise as predicted concentrations were typically within a factor of 3 of the median observed concentrations. Furthermore, there was good correspondence between predictions and observations in regions that had elevated median observed concentrations for both spatially-explicit models. On the other hand, all three models consistently underestimated median observed concentrations in sediment and soil by 1-3 orders of magnitude. Although regions with elevated median observed concentrations in these environmental media were broadly identified by the spatially-explicit models, the magnitude of the discrepancy between predicted and median observed concentrations is of concern in the context of chemical risk assessment. These results were discussed in terms of factors influencing model performance such as the steady-state assumption, inaccuracies in emission estimates and the representativeness of monitoring data.
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The hippocampus supports both recollection and familiarity when memories are strong
Smith, Christine N.; Wixted, John T.; Squire, Larry R.
2011-01-01
Recognition memory is thought to consist of two component processes – recollection and familiarity. It has been suggested that the hippocampus supports recollection, while adjacent cortex supports familiarity. However, the qualitative experiences of recollection and familiarity are typically confounded with a quantitative difference in memory strength (recollection > familiarity). Thus, the question remains whether the hippocampus might in fact support familiarity-based memories whenever they are as strong as recollection-based memories. We addressed this problem in a novel way using the Remember/Know procedure where we could explicitly match the confidence and accuracy of Remember and Know decisions. As in earlier studies, recollected items had higher accuracy and confidence than familiar items, and hippocampal activity was higher for recollected items than for familiar items. Furthermore hippocampal activity was similar for familiar items, misses, and correct rejections. When the accuracy and confidence of recollected and familiar items were matched, the findings were dramatically different. Hippocampal activity was now similar for recollected and familiar items. Importantly, hippocampal activity was also greater for familiar items than for misses or correct rejections (as well as for recollected items vs. misses or correct rejections). Our findings suggest that the hippocampus supports both recollection and familiarity when memories are strong. PMID:22049412
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Averaging business cycles vs. myopia: Do we need a long term vision when developing IRP?
DOE Office of Scientific and Technical Information (OSTI.GOV)
McDonald, C.; Gupta, P.C.
1995-05-01
Utility demand forecasting is inherently imprecise due to the number of uncertainties resulting from business cycles, policy making, technology breakthroughs, national and international political upheavals and the limitations of the forecasting tools. This implies that revisions based primarily on recent experience could lead to unstable forecasts. Moreover, new planning tools are required that provide an explicit consideration of uncertainty and lead to flexible and robust planning tools are required that provide an explicit consideration of uncertainty and lead to flexible and robust planning decisions.
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Coordinated Development and Deployment of Scenarios for Sustained Assessment
NASA Astrophysics Data System (ADS)
Lipschultz, F.; Weaver, C. P.; Leidner, A. K.; Delgado, A.; Grambsch, A.
2017-12-01
There has been a clear need for a more coordinated Federal government approach for authoritative, climate-relevant scenarios to support growing demands by decision-makers, to meet stakeholder needs for consistent approaches and guidance, and to better address the needs of the impacts, adaptation and vulnerability community. To begin to satisfy these decision-support needs, in early 2015 the U.S. Global Change Research Program (USGCRP) began coordinated production of scenario information for use across a suite of USGCRP activities. These have been implemented in the 4th National Climate Assessment (NCA4), the Climate Science Special Report and the Climate Resilience Toolkit (CRT), all of which are intended to help better organize, summarize, and communicate science to decision-makers as they think about our future. First, USGCRP introduced and implemented an explicit risk-framing approach across the entire scenario enterprise to encourage exploration of tail risks. A suite of scenario products was developed framed around three simplified storylines: `Lower', `Higher', and `Upper Bound' departures from current baselines. Second, USGCRP developed future climate information for the U.S. using Representative Concentration Pathway (RCP) 8.5 and RCP 4.5, including a weighted mean of Global Climate Models and adoption of an improved statistical downscaling approach across USGCRP products. Additional variables were derived from the downscaled parameters for use across USGCRP reports and in the CRT's Climate Explorer tool. Third, and given the need to address other tightly-coupled global changes in a more integrated way, a set of population, housing density, and impervious surface projections were developed based on global scenarios. In addition, USGCRP and the National Ocean Council developed scenarios of future sea-level rise and coastal-flood hazard for the U.S. and integrated them into existing Federal capabilities to support preparedness planning. To better convey these scenario components, next steps include capability for dynamic interaction between NCA4 products and CRT to permit users to explore and customize relevant information for their decision at spatial scales that matter to them, as well as links to more in-depth CRT content.
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NASA Astrophysics Data System (ADS)
Liu, Y.; Zhang, W.; Yan, C.
2012-07-01
Presently, planning and assessment in maintenance, renewal and decision-making for watershed hydrology, water resource management and water quality assessment are evolving toward complex, spatially explicit regional environmental assessments. These problems have to be addressed with object-oriented spatio-temporal data models that can restore, manage, query and visualize various historic and updated basic information concerning with watershed hydrology, water resource management and water quality as well as compute and evaluate the watershed environmental conditions so as to provide online forecasting to police-makers and relevant authorities for supporting decision-making. The extensive data requirements and the difficult task of building input parameter files, however, has long been an obstacle to use of such complex models timely and effectively by resource managers. Success depends on an integrated approach that brings together scientific, education and training advances made across many individual disciplines and modified to fit the needs of the individuals and groups who must write, implement, evaluate, and adjust their watershed management plans. The centre for Hydro-science Research, Nanjing University, in cooperation with the relevant watershed management authorities, has developed a WebGIS management platform to facilitate this complex process. Improve the management of watersheds over the Huaihe basin through the development, promotion and use of a web-based, user-friendly, geospatial watershed management data and decision support system (WMDDSS) involved many difficulties for the development of this complicated System. In terms of the spatial and temporal characteristics of historic and currently available information on meteorological, hydrological, geographical, environmental and other relevant disciplines, we designed an object-oriented spatiotemporal data model that combines spatial, attribute and temporal information to implement the management system. Using this system, we can update, query and analyze environmental information as well as manage historical data, and a visualization tool was provided to help the user interpret results so as to provide scientific support for decision-making. The utility of the system has been demonstrated its values by being used in watershed management and environmental assessments.
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Human Factors of CC-130 Operations. Volume 5: Human Factors in Decision Making
1998-02-01
known about human information processing and decision making. Topics for HFDM training come directly from this theoretical framework . The proposed...The proposed training can be distinguished from other approaches with similar goals (either explicit or implicit) by its base within a theoretical ... framework of human information processing. The differences lie less in the content than in the way the material is organized and shaped by theory. The
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Diagnostic decision-making and strategies to improve diagnosis.
Thammasitboon, Satid; Cutrer, William B
2013-10-01
A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable. © 2013 Mosby, Inc. All rights reserved.
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Multi-Criteria Decision Analysis for Assessment and Appraisal of Orphan Drugs.
Iskrov, Georgi; Miteva-Katrandzhieva, Tsonka; Stefanov, Rumen
2016-01-01
Limited resources and expanding expectations push all countries and types of health systems to adopt new approaches in priority setting and resources allocation. Despite best efforts, it is difficult to reconcile all competing interests, and trade-offs are inevitable. This is why multi-criteria decision analysis (MCDA) has played a major role in recent uptake of value-based reimbursement. MCDA framework enables exploration of stakeholders' preferences, as well as explicit organization of broad range of criteria on which real-world decisions are made. Assessment and appraisal of orphan drugs tend to be one of the most complicated health technology assessment (HTA) tasks. Access to market approved orphan therapies remains an issue. Early constructive dialog among rare disease stakeholders and elaboration of orphan drug-tailored decision support tools could set the scene for ongoing accumulation of evidence, as well as for proper reimbursement decision-making. The objective of this study was to create an MCDA value measurement model to assess and appraise orphan drugs. This was achieved by exploring the preferences on decision criteria's weights and performance scores through a stakeholder-representative survey and a focus group discussion that were both organized in Bulgaria. Decision criteria that describe the health technology's characteristics were unanimously agreed as the most important group of reimbursement considerations. This outcome, combined with the high individual weight of disease severity and disease burden criteria, underlined some of the fundamental principles of health care - equity and fairness. Our study proved that strength of evidence may be a key criterion in orphan drug assessment and appraisal. Evidence is used not only to shape reimbursement decision-making but also to lend legitimacy to policies pursued. The need for real-world data on orphan drugs was largely stressed. Improved knowledge on MCDA feasibility and integration to HTA is of paramount importance, as progress in medicine and innovative health technologies should correspond to patient, health-care system, and societal values.
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Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey.
Simianu, Vlad V; Grounds, Margaret A; Joslyn, Susan L; LeClerc, Jared E; Ehlers, Anne P; Agrawal, Nidhi; Alfonso-Cristancho, Rafael; Flaxman, Abraham D; Flum, David R
2016-12-01
Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty. Four hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse ("defensive medicine") decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost. In the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(-$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions. All participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.
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Hybrid modeling of nitrate fate in large catchments using fuzzy-rules
NASA Astrophysics Data System (ADS)
van der Heijden, Sven; Haberlandt, Uwe
2010-05-01
Especially for nutrient balance simulations, physically based ecohydrological modeling needs an abundance of measured data and model parameters, which for large catchments all too often are not available in sufficient spatial or temporal resolution or are simply unknown. For efficient large-scale studies it is thus beneficial to have methods at one's disposal which are parsimonious concerning the number of model parameters and the necessary input data. One such method is fuzzy-rule based modeling, which compared to other machine-learning techniques has the advantages to produce models (the fuzzy-rules) which are physically interpretable to a certain extent, and to allow the explicit introduction of expert knowledge through pre-defined rules. The study focuses on the application of fuzzy-rule based modeling for nitrate simulation in large catchments, in particular concerning decision support. Fuzzy-rule based modeling enables the generation of simple, efficient, easily understandable models with nevertheless satisfactory accuracy for problems of decision support. The chosen approach encompasses a hybrid metamodeling, which includes the generation of fuzzy-rules with data originating from physically based models as well as a coupling with a physically based water balance model. For the generation of the needed training data and also as coupled water balance model the ecohydrological model SWAT is employed. The conceptual model divides the nitrate pathway into three parts. The first fuzzy-module calculates nitrate leaching with the percolating water from soil surface to groundwater, the second module simulates groundwater passage, and the final module replaces the in-stream processes. The aim of this modularization is to create flexibility for using each of the modules on its own, for changing or completely replacing it. For fuzzy-rule based modeling this can explicitly mean that the re-training of one of the modules with newly available data will be possible without problem, while the module assembly does not have to be modified. Apart from the concept of hybrid metamodeling first results are presented for the fuzzy-module for nitrate passage through the unsaturated zone.
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Validity for an integrated laboratory analogue of sexual aggression and bystander intervention.
Parrott, Dominic J; Tharp, Andra Teten; Swartout, Kevin M; Miller, Cameron A; Hall, Gordon C Nagayama; George, William H
2012-01-01
This study sought to develop and validate an integrated laboratory paradigm of sexual aggression and bystander intervention. Participants were a diverse community sample (54% African American) of heterosexual males (N = 156) between 21 and 35 years of age who were recruited to complete the study with a male friend and an ostensibly single, heterosexual female who reported a strong dislike of sexual content in the media. Participants viewed a sexually explicit or nonsexually explicit film clip as part of contrived media rating task and made individual choices of which film clip to show the female confederate. Immediately thereafter, participants were required to reach consensus on a group decision of which film clip to show the female confederate. Subjecting a target to an unwanted experience with a sexual connotation was operationalized as selection of the sexually explicit video, whereas successful bystander intervention was operationalized as the event of one partner individually selecting the sexually explicit video but then selecting the nonsexually explicit video for the group choice. Results demonstrated that a 1-year history of sexual aggression and endorsement of pertinent misogynistic attitudes significantly predicted selection of the sexually-explicit video. In addition, bystander efficacy significantly predicted men's successful prevention of their male peer's intent to show the female confederate a sexually explicit video. Discussion focused on how these data inform future research and bystander intervention programming for sexual aggression. © 2012 Wiley Periodicals, Inc.
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Poolton, J M; Masters, R S W; Maxwell, J P
2007-06-01
Heuristics of evolutionary biology (e.g., survival of the fittest) dictate that phylogenetically older processes are inherently more stable and resilient to disruption than younger processes. On the grounds that non-declarative behaviour emerged long before declarative behaviour, Reber (1992) argues that implicit (non-declarative) learning is supported by neural processes that are evolutionarily older than those supporting explicit learning. Reber suggested that implicit learning thus leads to performance that is more robust than explicit learning. Applying this evolutionary framework to motor performance, we examined whether implicit motor learning, relative to explicit motor learning, conferred motor output that was resilient to physiological fatigue and durable over time. In Part One of the study a fatigued state was induced by a double Wingate Anaerobic test protocol. Fatigue had no affect on performance of participants in the implicit condition; whereas, performance of participants in the explicit condition deteriorated significantly. In Part Two of the study a convenience sample of participants was recalled following a one-year hiatus. In both the implicit and the explicit condition retention of performance was seen and, contrary to the findings in Part One, so was resilience to fatigue. The resilient performance in the explicit condition after one year may have resulted from forgetting (the decay of declarative knowledge) or from consolidation of declarative knowledge as implicit memories. In either case, implicit processes were left to more effectively support motor performance.
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Mapping malaria risk and vulnerability in the United Republic of Tanzania: a spatial explicit model.
Hagenlocher, Michael; Castro, Marcia C
2015-01-01
Outbreaks of vector-borne diseases (VBDs) impose a heavy burden on vulnerable populations. Despite recent progress in eradication and control, malaria remains the most prevalent VBD. Integrative approaches that take into account environmental, socioeconomic, demographic, biological, cultural, and political factors contributing to malaria risk and vulnerability are needed to effectively reduce malaria burden. Although the focus on malaria risk has increasingly gained ground, little emphasis has been given to develop quantitative methods for assessing malaria risk including malaria vulnerability in a spatial explicit manner. Building on a conceptual risk and vulnerability framework, we propose a spatial explicit approach for modeling relative levels of malaria risk - as a function of hazard, exposure, and vulnerability - in the United Republic of Tanzania. A logistic regression model was employed to identify a final set of risk factors and their contribution to malaria endemicity based on multidisciplinary geospatial information. We utilized a Geographic Information System for the construction and visualization of a malaria vulnerability index and its integration into a spatially explicit malaria risk map. The spatial pattern of malaria risk was very heterogeneous across the country. Malaria risk was higher in Mainland areas than in Zanzibar, which is a result of differences in both malaria entomological inoculation rate and prevailing vulnerabilities. Areas of high malaria risk were identified in the southeastern part of the country, as well as in two distinct "hotspots" in the northwestern part of the country bordering Lake Victoria, while concentrations of high malaria vulnerability seem to occur in the northwestern, western, and southeastern parts of the mainland. Results were visualized using both 10×10 km(2) grids and subnational administrative units. The presented approach makes an important contribution toward a decision support tool. By decomposing malaria risk into its components, the approach offers evidence on which factors could be targeted for reducing malaria risk and vulnerability to the disease. Ultimately, results offer relevant information for place-based intervention planning and more effective spatial allocation of resources.
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Yao, Mike Z; Mahood, Chad; Linz, Daniel
2010-01-01
The present study examines the short-term cognitive effects of playing a sexually explicit video game with female "objectification" content on male players. Seventy-four male students from a university in California, U.S. participated in a laboratory experiment. They were randomly assigned to play either a sexually-explicit game or one of two control games. Participants' cognitive accessibility to sexual and sexually objectifying thoughts was measured in a lexical decision task. A likelihood-to-sexually-harass scale was also administered. Results show that playing a video game with the theme of female "objectification" may prime thoughts related to sex, encourage men to view women as sex objects, and lead to self-reported tendencies to behave inappropriately towards women in social situations.
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Structured decision making: Chapter 5
Runge, Michael C.; Grand, James B.; Mitchell, Michael S.; Krausman, Paul R.; Cain, James W. III
2013-01-01
Wildlife management is a decision-focused discipline. It needs to integrate traditional wildlife science and social science to identify actions that are most likely to achieve the array of desires society has surrounding wildlife populations. Decision science, a vast field with roots in economics, operations research, and psychology, offers a rich set of tools to help wildlife managers frame, decompose, analyze, and synthesize their decisions. The nature of wildlife management as a decision science has been recognized since the inception of the field, but formal methods of decision analysis have been underused. There is tremendous potential for wildlife management to grow further through the use of formal decision analysis. First, the wildlife science and human dimensions of wildlife disciplines can be readily integrated. Second, decisions can become more efficient. Third, decisions makers can communicate more clearly with stakeholders and the public. Fourth, good, intuitive wildlife managers, by explicitly examining how they make decisions, can translate their art into a science that is readily used by the next generation.
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Hwang, David Y; Yagoda, Daniel; Perrey, Hilary M; Tehan, Tara M; Guanci, Mary; Ananian, Lillian; Currier, Paul F; Cobb, J Perren; Rosand, Jonathan
2014-04-01
Many prior nursing studies regarding family members specifically of neuroscience intensive care unit (neuro-ICU) patients have focused on identifying their primary needs. A concept related to identifying these needs and assessing whether they have been met is determining whether families explicitly report satisfaction with the care that both they and their loved ones have received. The objective of this study was to explore family satisfaction with care in an academic neuro-ICU and compare results with concurrent data from the same hospital's medical ICU (MICU). Over 38 days, we administered the Family Satisfaction-ICU instrument to neuro-ICU and MICU patients' families at the time of ICU discharge. Those whose loved ones passed away during ICU admission were excluded. When asked about the respect and compassion that they received from staff, 76.3% (95% CI [66.5, 86.1]) of neuro-ICU families were completely satisfied, as opposed to 92.7% in the MICU (95% CI [84.4, 101.0], p = .04). Respondents were less likely to be completely satisfied with the courtesy of staff if they reported participation in zero formal family meeting. Less than 60% of neuro-ICU families were completely satisfied by (1) frequency of physician communication, (2) inclusion and (3) support during decision making, and (4) control over the care of their loved ones. Parents of patients were more likely than other relatives to feel very included and supported in the decision-making process. Future studies may focus on evaluating strategies for neuro-ICU nurses and physicians to provide better decision-making support and to implement more frequent family meetings even for those patients who may not seem medically or socially complicated to the team. Determining satisfaction with care for those families whose loved ones passed away during their neuro-ICU admission is another potential avenue for future investigation.
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Battling Arrow's Paradox to Discover Robust Water Management Alternatives
NASA Astrophysics Data System (ADS)
Kasprzyk, J. R.; Reed, P. M.; Hadka, D.
2013-12-01
This study explores whether or not Arrow's Impossibility Theorem, a theory of social choice, affects the formulation of water resources systems planning problems. The theorem discusses creating an aggregation function for voters choosing from more than three alternatives for society. The Impossibility Theorem is also called Arrow's Paradox, because when trying to add more voters, a single individual's preference will dictate the optimal group decision. In the context of water resources planning, our study is motivated by recent theoretical work that has generalized the insights for Arrow's Paradox to the design of complex engineered systems. In this framing of the paradox, states of society are equivalent to water planning or design alternatives, and the voters are equivalent to multiple planning objectives (e.g. minimizing cost or maximizing performance). Seen from this point of view, multi-objective water planning problems are functionally equivalent to the social choice problem described above. Traditional solutions to such multi-objective problems aggregate multiple performance measures into a single mathematical objective. The Theorem implies that a subset of performance concerns will inadvertently dictate the overall design evaluations in unpredictable ways using such an aggregation. We suggest that instead of aggregation, an explicit many-objective approach to water planning can help overcome the challenges posed by Arrow's Paradox. Many-objective planning explicitly disaggregates measures of performance while supporting the discovery of the planning tradeoffs, employing multiobjective evolutionary algorithms (MOEAs) to find solutions. Using MOEA-based search to address Arrow's Paradox requires that the MOEAs perform robustly with increasing problem complexity, such as adding additional objectives and/or decisions. This study uses comprehensive diagnostic evaluation of MOEA search performance across multiple problem formulations (both aggregated and many-objective) to show whether or not aggregating performance measures biases decision making. In this study, we explore this hypothesis using an urban water portfolio management case study in the Lower Rio Grande Valley. The diagnostic analysis shows that modern self-adaptive MOEA search is efficient, effective, and reliable for the more complex many-objective LRGV planning formulations. Results indicate that although many classical water systems planning frameworks seek to account for multiple objectives, the common practice of reducing the problem into one or more highly aggregated performance measures can severely and negatively bias planning decisions.
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DoD Product Line Practice Workshop Report
1998-05-01
capability. The essential enterprise management practices include ensuring sound business goals providing an appropriate funding model performing...business. This way requires vision and explicit support at the organizational level. There must be an explicit funding model to support the development...the same group seems to work best in smaller organizations. A funding model for core asset development also needs to be developed because the core
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[Priority setting and bedside rationing: a discussion of empirical findings].
Strech, Daniel
2011-01-01
In addition to empirical forecasts on the extent of the current and future limitations on health care resources, empirical data on the status quo of bedside rationing play a significant role in developing suitable alternatives in dealing with limited financial resources. This article presents and discusses selected results of the international and German survey research on bedside rationing. Survey studies among physicians could prove world-wide that rationing decisions are made already today by individual physicians in the in- and out-patient services. In German hospitals, rationing is also a wide-spread though non-transparent and not (yet) very common phenomenon for an individual physician. Varying criteria for bedside rationing contribute to the fact that the current approach to bedside rationing leads to dissatisfaction on the part of physicians and to a potential disadvantage of certain patient groups. Explicit, i.e. transparent and systematic, ways of rationing could remedy these deficiencies and are therefore clearly preferable in this context. However, further specification of the methods of explicit rationing and a critical evaluation of their application in practice are needed. Moreover, it is mainly the quality of the underlying evidence that determines whether or not the actual decisions become more reasonable and fair by means of more explicit rationing approaches. Copyright © 2011 S. Karger AG, Basel.
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Toward a formalization of the process to select IMIA Yearbook best papers.
Lamy, J-B; Séroussi, B; Griffon, N; Kerdelhué, G; Jaulent, M-C; Bouaud, J
2015-01-01
Each year, the International Medical Informatics Association Yearbook recognizes significant scientific papers, labelled as "best papers", published the previous year in the subfields of biomedical informatics that correspond to the different section topics of the journal. For each section, about fifteen pre-selected "candidate" best papers are externally peer-reviewed to select the actual best papers. Although based on the available literature, little is known about the pre-selection process. To move toward an explicit formalization of the candidate best papers selection process to reduce variability in the literature search across sections and over years. A methodological framework is proposed to build for each section topic specific queries tailored to PubMed and Web of Science citation databases. The two sets of returned papers are merged and reviewed by two independent section editors and citations are tagged as "discarded", "pending", and "kept". A protocolized consolidation step is then jointly conducted to resolve conflicts. A bibliographic software tool, BibReview, was developed to support the whole process. The proposed search strategy was fully applied to the Decision Support section of the 2013 edition of the Yearbook. For this section, 1124 references were returned (689 PubMed-specific, 254 WoS-specific, 181 common to both databases) among which the 15 candidate best papers were selected. The search strategy for determining candidate best papers for an IMIA Yearbook's section is now explicitly specified and allows for reproducibility. However, some aspects of the whole process remain reviewer-dependent, mostly because there is no characterization of a "best paper".
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Recollective performance advantages for implicit memory tasks.
Sheldon, Signy A M; Moscovitch, Morris
2010-10-01
A commonly held assumption is that processes underlying explicit and implicit memory are distinct. Recent evidence, however, suggests that they may interact more than previously believed. Using the remember-know procedure the current study examines the relation between recollection, a process thought to be exclusive to explicit memory, and performance on two implicit memory tasks, lexical decision and word stem completion. We found that, for both implicit tasks, words that were recollected were associated with greater priming effects than were words given a subsequent familiarity rating or words that had been studied but were not recognised (misses). Broadly, our results suggest that non-voluntary processes underlying explicit memory also benefit priming, a measure of implicit memory. More specifically, given that this benefit was due to a particular aspect of explicit memory (recollection), these results are consistent with some strength models of memory and with Moscovitch's (2008) proposal that recollection is a two-stage process, one rapid and unconscious and the other more effortful and conscious.
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Design of a cooperative problem-solving system for en-route flight planning: An empirical evaluation
NASA Technical Reports Server (NTRS)
Layton, Charles; Smith, Philip J.; Mc Coy, C. Elaine
1994-01-01
Both optimization techniques and expert systems technologies are popular approaches for developing tools to assist in complex problem-solving tasks. Because of the underlying complexity of many such tasks, however, the models of the world implicitly or explicitly embedded in such tools are often incomplete and the problem-solving methods fallible. The result can be 'brittleness' in situations that were not anticipated by the system designers. To deal with this weakness, it has been suggested that 'cooperative' rather than 'automated' problem-solving systems be designed. Such cooperative systems are proposed to explicitly enhance the collaboration of the person (or a group of people) and the computer system. This study evaluates the impact of alternative design concepts on the performance of 30 airline pilots interacting with such a cooperative system designed to support en-route flight planning. The results clearly demonstrate that different system design concepts can strongly influence the cognitive processes and resultant performances of users. Based on think-aloud protocols, cognitive models are proposed to account for how features of the computer system interacted with specific types of scenarios to influence exploration and decision making by the pilots. The results are then used to develop recommendations for guiding the design of cooperative systems.
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Design of a cooperative problem-solving system for en-route flight planning: An empirical evaluation
NASA Technical Reports Server (NTRS)
Layton, Charles; Smith, Philip J.; McCoy, C. Elaine
1994-01-01
Both optimization techniques and expert systems technologies are popular approaches for developing tools to assist in complex problem-solving tasks. Because of the underlying complexity of many such tasks, however, the models of the world implicitly or explicitly embedded in such tools are often incomplete and the problem-solving methods fallible. The result can be 'brittleness' in situations that were not anticipated by the system designers. To deal with this weakness, it has been suggested that 'cooperative' rather than 'automated' problem-solving systems be designed. Such cooperative systems are proposed to explicitly enhance the collaboration of the person (or a group of people) and the computer system. This study evaluates the impact of alternative design concepts on the performance of 30 airline pilots interacting with such a cooperative system designed to support enroute flight planning. The results clearly demonstrate that different system design concepts can strongly influence the cognitive processes and resultant performances of users. Based on think-aloud protocols, cognitive models are proposed to account for how features of the computer system interacted with specific types of scenarios to influence exploration and decision making by the pilots. The results are then used to develop recommendations for guiding the design of cooperative systems.
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Holmquist-Johnson, Christopher; Hanson, Leanne; Daniels, Joan; Talbert, Colin; Haegele, Jeanette
2016-05-23
Topock Marsh is a large wetland adjacent to the Colorado River and the main feature of Havasu National Wildlife Refuge (Havasu NWR) in southern Arizona. In 2010, the U.S. Fish and Wildlife Service (FWS) and Bureau of Reclamation began a project to improve water management capabilities at Topock Marsh and protect habitats and species. Initial construction required a drawdown, which caused below-average inflows and water depths in 2010–11. U.S. Geological Survey Fort Collins Science Center (FORT) scientists collected an assemblage of biotic, abiotic, and hydrologic data from Topock Marsh during the drawdown and immediately after, thus obtaining valuable information needed by FWS.Building upon that work, FORT developed a decision support system (DSS) to better understand ecosystem health and function of Topock Marsh under various hydrologic conditions. The DSS was developed using a spatially explicit geographic information system package of historical data, habitat indices, and analytical tools to synthesize outputs for hydrologic time periods. Deliverables include high-resolution orthorectified imagery of Topock Marsh; a DSS tool that can be used by Havasu NWR to compare habitat availability associated with three hydrologic scenarios (dry, average, wet years); and this final report which details study results. This project, therefore, has addressed critical FWS management questions by integrating ecologic and hydrologic information into a DSS framework. This DSS will assist refuge management to make better informed decisions about refuge operations and better understand the ecological results of those decisions by providing tools to identify the effects of water operations on species-specific habitat and ecological processes. While this approach was developed to help FWS use the best available science to determine more effective water management strategies at Havasu NWR, technologies used in this study could be applied elsewhere within the region.
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NASA Astrophysics Data System (ADS)
Rosenberg, D. E.
2008-12-01
Designing and implementing a hydro-economic computer model to support or facilitate collaborative decision making among multiple stakeholders or users can be challenging and daunting. Collaborative modeling is distinguished and more difficult than non-collaborative efforts because of a large number of users with different backgrounds, disagreement or conflict among stakeholders regarding problem definitions, modeling roles, and analysis methods, plus evolving ideas of model scope and scale and needs for information and analysis as stakeholders interact, use the model, and learn about the underlying water system. This presentation reviews the lifecycle for collaborative model making and identifies some key design decisions that stakeholders and model developers must make to develop robust and trusted, verifiable and transparent, integrated and flexible, and ultimately useful models. It advances some best practices to implement and program these decisions. Among these best practices are 1) modular development of data- aware input, storage, manipulation, results recording and presentation components plus ways to couple and link to other models and tools, 2) explicitly structure both input data and the meta data that describes data sources, who acquired it, gaps, and modifications or translations made to put the data in a form usable by the model, 3) provide in-line documentation on model inputs, assumptions, calculations, and results plus ways for stakeholders to document their own model use and share results with others, and 4) flexibly program with graphical object-oriented properties and elements that allow users or the model maintainers to easily see and modify the spatial, temporal, or analysis scope as the collaborative process moves forward. We draw on examples of these best practices from the existing literature, the author's prior work, and some new applications just underway. The presentation concludes by identifying some future directions for collaborative modeling including geo-spatial display and analysis, real-time operations, and internet-based tools plus the design and programming needed to implement these capabilities.
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Implicit and explicit ethnocentrism: revisiting the ideologies of prejudice.
Cunningham, William A; Nezlek, John B; Banaji, Mahzarin R
2004-10-01
Two studies investigated relationships among individual differences in implicit and explicit prejudice, right-wing ideology, and rigidity in thinking. The first study examined these relationships focusing on White Americans' prejudice toward Black Americans. The second study provided the first test of implicit ethnocentrism and its relationship to explicit ethnocentrism by studying the relationship between attitudes toward five social groups. Factor analyses found support for both implicit and explicit ethnocentrism. In both studies, mean explicit attitudes toward out groups were positive, whereas implicit attitudes were negative, suggesting that implicit and explicit prejudices are distinct; however, in both studies, implicit and explicit attitudes were related (r = .37, .47). Latent variable modeling indicates a simple structure within this ethnocentric system, with variables organized in order of specificity. These results lead to the conclusion that (a) implicit ethnocentrism exists and (b) it is related to and distinct from explicit ethnocentrism.
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Parameter and uncertainty estimation for mechanistic, spatially explicit epidemiological models
NASA Astrophysics Data System (ADS)
Finger, Flavio; Schaefli, Bettina; Bertuzzo, Enrico; Mari, Lorenzo; Rinaldo, Andrea
2014-05-01
Epidemiological models can be a crucially important tool for decision-making during disease outbreaks. The range of possible applications spans from real-time forecasting and allocation of health-care resources to testing alternative intervention mechanisms such as vaccines, antibiotics or the improvement of sanitary conditions. Our spatially explicit, mechanistic models for cholera epidemics have been successfully applied to several epidemics including, the one that struck Haiti in late 2010 and is still ongoing. Calibration and parameter estimation of such models represents a major challenge because of properties unusual in traditional geoscientific domains such as hydrology. Firstly, the epidemiological data available might be subject to high uncertainties due to error-prone diagnosis as well as manual (and possibly incomplete) data collection. Secondly, long-term time-series of epidemiological data are often unavailable. Finally, the spatially explicit character of the models requires the comparison of several time-series of model outputs with their real-world counterparts, which calls for an appropriate weighting scheme. It follows that the usual assumption of a homoscedastic Gaussian error distribution, used in combination with classical calibration techniques based on Markov chain Monte Carlo algorithms, is likely to be violated, whereas the construction of an appropriate formal likelihood function seems close to impossible. Alternative calibration methods, which allow for accurate estimation of total model uncertainty, particularly regarding the envisaged use of the models for decision-making, are thus needed. Here we present the most recent developments regarding methods for parameter and uncertainty estimation to be used with our mechanistic, spatially explicit models for cholera epidemics, based on informal measures of goodness of fit.
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EPA's Policy on Evaluating Risk to Children
It is the policy of EPA to consider the risks to infants and children consistently and explicitly as a part of risk assessments generated during its decision making process, including the setting of standards to protect public health and the environment.
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Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis.
Hernández-Marrero, Pablo; Fradique, Emília; Pereira, Sandra Martins
2018-01-01
Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices. Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients' preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses' involvement and practices in end-of-life decision-making.
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[Decision Making and Electrodermal Activity].
Kobayakawa, Mutsutaka
2016-08-01
Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.
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Asking better questions: How presentation formats influence information search.
Wu, Charley M; Meder, Björn; Filimon, Flavia; Nelson, Jonathan D
2017-08-01
While the influence of presentation formats have been widely studied in Bayesian reasoning tasks, we present the first systematic investigation of how presentation formats influence information search decisions. Four experiments were conducted across different probabilistic environments, where subjects (N = 2,858) chose between 2 possible search queries, each with binary probabilistic outcomes, with the goal of maximizing classification accuracy. We studied 14 different numerical and visual formats for presenting information about the search environment, constructed across 6 design features that have been prominently related to improvements in Bayesian reasoning accuracy (natural frequencies, posteriors, complement, spatial extent, countability, and part-to-whole information). The posterior variants of the icon array and bar graph formats led to the highest proportion of correct responses, and were substantially better than the standard probability format. Results suggest that presenting information in terms of posterior probabilities and visualizing natural frequencies using spatial extent (a perceptual feature) were especially helpful in guiding search decisions, although environments with a mixture of probabilistic and certain outcomes were challenging across all formats. Subjects who made more accurate probability judgments did not perform better on the search task, suggesting that simple decision heuristics may be used to make search decisions without explicitly applying Bayesian inference to compute probabilities. We propose a new take-the-difference (TTD) heuristic that identifies the accuracy-maximizing query without explicit computation of posterior probabilities. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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A Framework for Integrating Environmental Justice in Regulatory Analysis
Nweke, Onyemaechi C.
2011-01-01
With increased interest in integrating environmental justice into the process for developing environmental regulations in the United States, analysts and decision makers are confronted with the question of what methods and data can be used to assess disproportionate environmental health impacts. However, as a first step to identifying data and methods, it is important that analysts understand what information on equity impacts is needed for decision making. Such knowledge originates from clearly stated equity objectives and the reflection of those objectives throughout the analytical activities that characterize Regulatory Impact Analysis (RIA), a process that is traditionally used to inform decision making. The framework proposed in this paper advocates structuring analyses to explicitly provide pre-defined output on equity impacts. Specifically, the proposed framework emphasizes: (a) defining equity objectives for the proposed regulatory action at the onset of the regulatory process, (b) identifying specific and related sub-objectives for key analytical steps in the RIA process, and (c) developing explicit analytical/research questions to assure that stated sub-objectives and objectives are met. In proposing this framework, it is envisioned that information on equity impacts informs decision-making in regulatory development, and that this is achieved through a systematic and consistent approach that assures linkages between stated equity objectives, regulatory analyses, selection of policy options, and the design of compliance and enforcement activities. PMID:21776235
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The value of thinly spread QALYs.
Mortimer, Duncan
2006-01-01
A number of recent findings from the literature imply that the value of a QALY varies depending on the concentration or dispersion of that QALY over treated individuals. Given that funding decisions are currently made under either the assumption of distributive-neutrality or some combination of explicit decision criteria and implicit adjustment for distributional concerns, it is likely that substantial social welfare gains are available if distributional objectives could be more accurately reflected in funding decisions. This paper considers three alternative approaches to explicitly adjust for distributional concerns with regard to the concentration or dispersion of individual health gains. Including non-health arguments in the objective function by 'weighting' QALYs for distributional effects or imposing differential funding thresholds for interventions with different distributional effects might be considered first- and second-best solutions, and would likely deliver the greatest social welfare gains. However, there is some doubt that first- or second-best solutions would be: (i) feasible given current data gaps; and (ii) politically acceptable. Rather, a simple and transparent approach is suggested wherein the sponsors of interventions that deliver health gains that are of questionable 'welfare-significance' for the treated individual would be required to provide decision-makers with an estimate of willingness to pay for the QALYs in question and would only be eligible for funding in the event that the positive net present value criterion is met.
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Orsini, Caitlin A; Trotta, Rose T; Bizon, Jennifer L; Setlow, Barry
2015-01-28
Several neuropsychiatric disorders are associated with abnormal decision-making involving risk of punishment, but the neural basis of this association remains poorly understood. Altered activity in brain systems including the basolateral amygdala (BLA) and orbitofrontal cortex (OFC) can accompany these same disorders, and these structures are implicated in some forms of decision-making. The current study investigated the role of the BLA and OFC in decision-making under risk of explicit punishment. Rats were trained in the risky decision-making task (RDT), in which they chose between two levers, one that delivered a small safe reward, and the other that delivered a large reward accompanied by varying risks of footshock punishment. Following training, they received sham or neurotoxic lesions of BLA or OFC, followed by RDT retesting. BLA lesions increased choice of the large risky reward (greater risk-taking) compared to both prelesion performance and sham controls. When reward magnitudes were equated, both BLA lesion and control groups shifted their choice to the safe (no shock) reward lever, indicating that the lesions did not impair punishment sensitivity. In contrast to BLA lesions, OFC lesions significantly decreased risk-taking compared with sham controls, but did not impair discrimination between different reward magnitudes or alter baseline levels of anxiety. Finally, neither lesion significantly affected food-motivated lever pressing under various fixed ratio schedules, indicating that lesion-induced alterations in risk-taking were not secondary to changes in appetitive motivation. Together, these findings indicate distinct roles for the BLA and OFC in decision-making under risk of explicit punishment. Copyright © 2015 the authors 0270-6474/15/351368-12$15.00/0.
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ERIC Educational Resources Information Center
Ramponi, Cristina; Barnard, Philip J.; Kherif, Ferath; Henson, Richard N.
2011-01-01
Although functional neuroimaging studies have supported the distinction between explicit and implicit forms of memory, few have matched explicit and implicit tests closely, and most of these tested perceptual rather than conceptual implicit memory. We compared event-related fMRI responses during an intentional test, in which a group of…
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Persons With Disabilities as an Unrecognized Health Disparity Population
Walker, Deborah Klein; Correa-De-Araujo, Rosaly
2015-01-01
Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness. PMID:25689212
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Ravesteijn, Wim; Liu, Yi; Yan, Ping
2015-01-01
The paper outlines and specifies 'responsible port innovation', introducing the development of a methodological and procedural step-by-step plan for the implementation and evaluation of (responsible) innovations. Subsequently, it uses this as a guideline for the analysis and evaluation of two case-studies. The construction of the Rotterdam Maasvlakte 2 Port meets most of the formulated requirements, though making values more explicit and treating it as a process right from the start could have benefitted the project. The Dalian Dayao Port could improve its decision-making procedures in several respects, including the introduction of new methods to handle value tensions. Both projects show that public support is crucial in responsible port innovation and that it should be not only a multi-faceted but also a multi-level strategy.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Coram, Jamie L.; Morrow, James D.; Perkins, David Nikolaus
2015-09-01
This document describes the PANTHER R&D Application, a proof-of-concept user interface application developed under the PANTHER Grand Challenge LDRD. The purpose of the application is to explore interaction models for graph analytics, drive algorithmic improvements from an end-user point of view, and support demonstration of PANTHER technologies to potential customers. The R&D Application implements a graph-centric interaction model that exposes analysts to the algorithms contained within the GeoGraphy graph analytics library. Users define geospatial-temporal semantic graph queries by constructing search templates based on nodes, edges, and the constraints among them. Users then analyze the results of the queries using bothmore » geo-spatial and temporal visualizations. Development of this application has made user experience an explicit driver for project and algorithmic level decisions that will affect how analysts one day make use of PANTHER technologies.« less
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Kawamura, Yuta; Kusumi, Takashi
2015-04-01
Advertisements for charity generally employ one of two advertising strategies. The first appeals to the efficacy of support, while the second appeals to the necessity of support. Two experiments investigated the effect of each type of charity advertising on donations and on donors' explicit and implicit evaluations of the recipients. The results indicated that although participants' explicit evaluations of charity recipients were not changed by efficacy-based advertising, they were negatively influenced by necessity-based advertising. Furthermore, Experiment 1 detected moderating effects of empathic concern. The explicit evaluations of participants in the necessity-based advertising group were negatively correlated with their empathic concern. Implicit evaluations were consistently negative in both groups. Both advertising strategies were more effective at securing donations than the control group, which did not use any strategies. These findings suggest practical implications for charity advertising.
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A Bayesian Attractor Model for Perceptual Decision Making
Bitzer, Sebastian; Bruineberg, Jelle; Kiebel, Stefan J.
2015-01-01
Even for simple perceptual decisions, the mechanisms that the brain employs are still under debate. Although current consensus states that the brain accumulates evidence extracted from noisy sensory information, open questions remain about how this simple model relates to other perceptual phenomena such as flexibility in decisions, decision-dependent modulation of sensory gain, or confidence about a decision. We propose a novel approach of how perceptual decisions are made by combining two influential formalisms into a new model. Specifically, we embed an attractor model of decision making into a probabilistic framework that models decision making as Bayesian inference. We show that the new model can explain decision making behaviour by fitting it to experimental data. In addition, the new model combines for the first time three important features: First, the model can update decisions in response to switches in the underlying stimulus. Second, the probabilistic formulation accounts for top-down effects that may explain recent experimental findings of decision-related gain modulation of sensory neurons. Finally, the model computes an explicit measure of confidence which we relate to recent experimental evidence for confidence computations in perceptual decision tasks. PMID:26267143
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Bedia, Manuel G; Di Paolo, Ezequiel
2012-01-01
Dual-process approaches of decision-making examine the interaction between affective/intuitive and deliberative processes underlying value judgment. From this perspective, decisions are supported by a combination of relatively explicit capabilities for abstract reasoning and relatively implicit evolved domain-general as well as learned domain-specific affective responses. One such approach, the somatic markers hypothesis (SMH), expresses these implicit processes as a system of evolved primary emotions supplemented by associations between affect and experience that accrue over lifetime, or somatic markers. In this view, somatic markers are useful only if their local capability to predict the value of an action is above a baseline equal to the predictive capability of the combined rational and primary emotional subsystems. We argue that decision-making has often been conceived of as a linear process: the effect of decision sequences is additive, local utility is cumulative, and there is no strong environmental feedback. This widespread assumption can have consequences for answering questions regarding the relative weight between the systems and their interaction within a cognitive architecture. We introduce a mathematical formalization of the SMH and study it in situations of dynamic, non-linear decision chains using a discrete-time stochastic model. We find, contrary to expectations, that decision-making events can interact non-additively with the environment in apparently paradoxical ways. We find that in non-lethal situations, primary emotions are represented globally over and above their local weight, showing a tendency for overcautiousness in situated decision chains. We also show that because they tend to counteract this trend, poorly attuned somatic markers that by themselves do not locally enhance decision-making, can still produce an overall positive effect. This result has developmental and evolutionary implications since, by promoting exploratory behavior, somatic markers would seem to be beneficial even at early stages when experiential attunement is poor. Although the model is formulated in terms of the SMH, the implications apply to dual systems theories in general since it makes minimal assumptions about the nature of the processes involved.
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Benjamin, Joseph R.; McDonnell, Kevin; Dunham, Jason B.; Brignon, William R.; Peterson, James T.
2017-06-21
With the decline of bull trout (Salvelinus confluentus), managers face multiple, and sometimes contradictory, management alternatives for species recovery. Moreover, effective decision-making involves all stakeholders influenced by the decisions (such as Tribal, State, Federal, private, and non-governmental organizations) because they represent diverse objectives, jurisdictions, policy mandates, and opinions of the best management strategy. The process of structured decision making is explicitly designed to address these elements of the decision making process. Here we report on an application of structured decision making to a population of bull trout believed threatened by high densities of nonnative brook trout (S. fontinalis) and habitat fragmentation in Long Creek, a tributary to the Sycan River in the Klamath River Basin, south-central Oregon. This involved engaging stakeholders to identify (1) their fundamental objectives for the conservation of bull trout, (2) feasible management alternatives to achieve their objectives, and (3) biological information and assumptions to incorporate in a decision model. Model simulations suggested an overarching theme among the top decision alternatives, which was a need to simultaneously control brook trout and ensure that the migratory tactic of bull trout can be expressed. More specifically, the optimal management decision, based on the estimated adult abundance at year 10, was to combine the eradication of brook trout from Long Creek with improvement of downstream conditions (for example, connectivity or habitat conditions). Other top decisions included these actions independently, as well as electrofishing removal of brook trout. In contrast, translocating bull trout to a different stream or installing a barrier to prevent upstream spread of brook trout had minimal or negative effects on the bull trout population. Moreover, sensitivity analyses suggested that these actions were consistently identified as optimal across a large range of parameter values. Taken together, these results support the conclusion that management actions focused on controlling brook trout and enhancing migrant bull trout are more likely to yield more adult bull trout within the 10-year time frame specified by stakeholders.
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Bedia, Manuel G.; Di Paolo, Ezequiel
2012-01-01
Dual-process approaches of decision-making examine the interaction between affective/intuitive and deliberative processes underlying value judgment. From this perspective, decisions are supported by a combination of relatively explicit capabilities for abstract reasoning and relatively implicit evolved domain-general as well as learned domain-specific affective responses. One such approach, the somatic markers hypothesis (SMH), expresses these implicit processes as a system of evolved primary emotions supplemented by associations between affect and experience that accrue over lifetime, or somatic markers. In this view, somatic markers are useful only if their local capability to predict the value of an action is above a baseline equal to the predictive capability of the combined rational and primary emotional subsystems. We argue that decision-making has often been conceived of as a linear process: the effect of decision sequences is additive, local utility is cumulative, and there is no strong environmental feedback. This widespread assumption can have consequences for answering questions regarding the relative weight between the systems and their interaction within a cognitive architecture. We introduce a mathematical formalization of the SMH and study it in situations of dynamic, non-linear decision chains using a discrete-time stochastic model. We find, contrary to expectations, that decision-making events can interact non-additively with the environment in apparently paradoxical ways. We find that in non-lethal situations, primary emotions are represented globally over and above their local weight, showing a tendency for overcautiousness in situated decision chains. We also show that because they tend to counteract this trend, poorly attuned somatic markers that by themselves do not locally enhance decision-making, can still produce an overall positive effect. This result has developmental and evolutionary implications since, by promoting exploratory behavior, somatic markers would seem to be beneficial even at early stages when experiential attunement is poor. Although the model is formulated in terms of the SMH, the implications apply to dual systems theories in general since it makes minimal assumptions about the nature of the processes involved. PMID:23087655
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Velázquez, A; Bocco, G; Torres, A
2001-05-01
Optimum natural resource management and biodiversity conservation are desirable goals. These, however, often exclude each other, since maximum economic benefits have promoted drastic reductions in biodiversity throughout the world. This dilemma confronts local stakeholders, who usually go for maximizing economic inputs, whereas other social (e.g., academic) sectors are favor conservation practices. In this paper we describe the way two scientific approaches--landscape and participatory research--were used to develop sound and durable land use scenarios. These two approaches included expert knowledge of both social and environmental conditions in indigenous communities. Our major emphasis was given to detect spatially explicit land use scenarios and capacity building in order to construct a decision support system operated by stakeholders of the Comunidad Indigena de Nuevo San Juan Parangaricutiro in Mexico. The system for decision-making was fed with data from inventories of both abiotic and biotic biodiversity components. All research, implementation, and monitoring activities were conducted in close collaboration with members of the indigenous community. As a major result we obtained a number of forest alternative uses that favor emerging markets and make this indigenous community less dependent on a single market. Furthermore, skilled members of the community are now running the automated system for decision-making. In conclusion, our results were better expressed as products with direct benefits in local livelihoods rather than pure academic outputs.
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Accounting for no net loss: A critical assessment of biodiversity offsetting metrics and methods.
Carreras Gamarra, Maria Jose; Lassoie, James Philip; Milder, Jeffrey
2018-08-15
Biodiversity offset strategies are based on the explicit calculation of both losses and gains necessary to establish ecological equivalence between impact and offset areas. Given the importance of quantifying biodiversity values, various accounting methods and metrics are continuously being developed and tested for this purpose. Considering the wide array of alternatives, selecting an appropriate one for a specific project can be not only challenging, but also crucial; accounting methods can strongly influence the biodiversity outcomes of an offsetting strategy, and if not well-suited to the context and values being offset, a no net loss outcome might not be delivered. To date there has been no systematic review or comparative classification of the available biodiversity accounting alternatives that aim at facilitating metric selection, and no tools that guide decision-makers throughout such a complex process. We fill this gap by developing a set of analyses to support (i) identifying the spectrum of available alternatives, (ii) understanding the characteristics of each and, ultimately (iii) making the most sensible and sound decision about which one to implement. The metric menu, scoring matrix, and decision tree developed can be used by biodiversity offsetting practitioners to help select an existing metric, and thus achieve successful outcomes that advance the goal of no net loss of biodiversity. Copyright © 2018 Elsevier Ltd. All rights reserved.
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A new spatial multiple discrete-continuous modeling approach to land use change analysis.
DOT National Transportation Integrated Search
2013-09-01
This report formulates a multiple discrete-continuous probit (MDCP) land-use model within a : spatially explicit economic structural framework for land-use change decisions. The spatial : MDCP model is capable of predicting both the type and intensit...
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A CONCEPT MAP FOR INTEGRATED ENVIRONMENTAL ASSESSMENT AND FUTURES MODELING
Integrated assessment models are differentiated from other models by their explicit concern for results that are useful to decision makers. While the details will differ greatly for each particular integrated assessments project, there are certain concepts that will be present f...
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Problem formulation, metrics, open government, and on-line collaboration
NASA Astrophysics Data System (ADS)
Ziegler, C. R.; Schofield, K.; Young, S.; Shaw, D.
2010-12-01
Problem formulation leading to effective environmental management, including synthesis and application of science by government agencies, may benefit from collaborative on-line environments. This is illustrated by two interconnected projects: 1) literature-based evidence tools that support causal assessment and problem formulation, and 2) development of output, outcome, and sustainability metrics for tracking environmental conditions. Specifically, peer-production mechanisms allow for global contribution to science-based causal evidence databases, and subsequent crowd-sourced development of causal networks supported by that evidence. In turn, science-based causal networks may inform problem formulation and selection of metrics or indicators to track environmental condition (or problem status). Selecting and developing metrics in a collaborative on-line environment may improve stakeholder buy-in, the explicit relevance of metrics to planning, and the ability to approach problem apportionment or accountability, and to define success or sustainability. Challenges include contribution governance, data-sharing incentives, linking on-line interfaces to data service providers, and the intersection of environmental science and social science. Degree of framework access and confidentiality may vary by group and/or individual, but may ultimately be geared at demonstrating connections between science and decision making and supporting a culture of open government, by fostering transparency, public engagement, and collaboration.
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George, Nathalie; Jemel, Boutheina; Fiori, Nicole; Chaby, Laurence; Renault, Bernard
2005-08-01
We investigated the ERP correlates of the subjective perception of upright and upside-down ambiguous pictures as faces using two-tone Mooney stimuli in an explicit facial decision task (deciding whether a face is perceived or not in the display). The difficulty in perceiving upside-down Mooneys as faces was reflected by both lower rates of "Face" responses and delayed "Face" reaction times for upside-down relative to upright stimuli. The N170 was larger for the stimuli reported as "faces". It was also larger for the upright than the upside-down stimuli only when they were reported as faces. Furthermore, facial decision as well as stimulus orientation effects spread from 140-190 ms to 390-440 ms. The behavioural delay in 'Face' responses to upside-down stimuli was reflected in ERPs by later effect of facial decision for upside-down relative to upright Mooneys over occipito-temporal electrodes. Moreover, an orientation effect was observed only for the stimuli reported as faces; it yielded a marked hemispheric asymmetry, lasting from 140-190 ms to 390-440 ms post-stimulus onset in the left hemisphere and from 340-390 to 390-440 ms only in the right hemisphere. Taken together, the results supported a preferential involvement of the right hemisphere in the detection of faces, whatever their orientation. By contrast, the early orientation effect in the left hemisphere suggested that upside-down Mooney stimuli were processed as non face objects until facial decision was reached in this hemisphere. The present data show that face perception involves not only spatially but also temporally distributed activities in occipito-temporal regions.
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Efficace, Fabio; Jacobs, Marc; Pusic, Andrea; Greimel, Elfriede; Piciocchi, Alfonso; Kieffer, Jacobien M; Gilbert, Alexandra; Fayers, Peter; Blazeby, Jane
2014-07-01
The aim for this study is to investigate the methodological quality and potential impact on clinical decision making of patient reported outcome (PRO) assessment in randomised controlled trials (RCTs) in the gynaecological cancer sites. A systematic review identified RCTs published between January 2004 and June 2012. Relevant studies were evaluated using a pre-determined extraction form which included: (1) Trial demographics and clinical and PRO characteristics; (2) level of PRO reporting and (3) bias, assessed using the Cochrane Risk of Bias tool. All studies were additionally analysed in relation to their relevance in supporting clinical decision making. Fifty RCTs enrolling 24,991 patients were identified. In eight RCTs (16%) a PRO was the primary end-point. Twenty-one studies (42%) were carried out in a multi-national context. Where statistically significant PRO differences between treatments were found, it related in most cases to both symptoms and domains other than symptoms (n=17, 57%). The majority of studies (n=42, 84%) did not mention the mode of administration nor the methods of collecting PRO data. Statistical approaches for dealing with missing data were only explicitly mentioned in nine RCTs (18%). Sixteen RCTs (32%) were considered to be of high-quality and thus able to inform clinical decision making. Higher-quality PRO studies were generally associated with RCTs that were at a low risk of bias. This study showed that RCTs with PROs were generally well designed and conducted. In a third the information was very informative to fully understand the pros and cons of PROs treatment decision-making. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Downing, N Lance; Adler-Milstein, Julia; Palma, Jonathan P; Lane, Steven; Eisenberg, Matthew; Sharp, Christopher; Longhurst, Christopher A
2017-01-01
Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied. Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent. We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors. Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent. Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.
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Kuziemsky, Craig E; Varpio, Lara
2011-08-01
As more healthcare delivery is provided by collaborative teams there is a need for enhanced design of health information systems (HISs) to support collaborative care delivery. The purpose of this study was to develop a model of the different types of awareness that exist in interprofessional collaborative care (ICC) delivery to inform HIS design to support ICC. Qualitative data collection and analysis was done. The data sources consisted of 90 h of non-participant observations and 30 interviews with nurses, physicians, medical residents, volunteers, and personal support workers. Many of the macro-level ICC activities (e.g. morning rounds, shift change) were constituted by micro-level activities that involved different types of awareness. We identified four primary types of ICC awareness: patient, team member, decision making, and environment. Each type of awareness is discussed and supported by study data. We also discuss implication of our findings for enhanced design of existing HISs as well as providing insight on how HISs could be better designed to support ICC awareness. Awareness is a complex yet crucial piece of successful ICC. The information sources that provided and supported ICC awareness were varied. The different types of awareness from the model can help us understand the explicit details of how care providers communicate and exchange information with one another. Increased understanding of ICC awareness can assist with the design and evaluation of HISs to support collaborative activities. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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Hassin, Ran R; Bargh, John A; Engell, Andrew D; McCulloch, Kathleen C
2009-09-01
Working Memory (WM) plays a crucial role in many high-level cognitive processes (e.g., reasoning, decision making, goal pursuit and cognitive control). The prevalent view holds that active components of WM are predominantly intentional and conscious. This conception is oftentimes expressed explicitly, but it is best reflected in the nature of major WM tasks: All of them are blatantly explicit. We developed two new WM paradigms that allow for an examination of the role of conscious awareness in WM. Results from five studies show that WM can operate unintentionally and outside of conscious awareness, thus suggesting that the current view should be expanded to include implicit WM.
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Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey.
Chambaere, Kenneth; Bilsen, Johan; Cohen, Joachim; Onwuteaka-Philipsen, Bregje D; Mortier, Freddy; Deliens, Luc
2010-06-15
Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects.
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Haider, Adil H; Schneider, Eric B; Sriram, N; Scott, Valerie K; Swoboda, Sandra M; Zogg, Cheryl K; Dhiman, Nitasha; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Freischlag, Julie A; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A
2015-06-01
Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered. Registered nurses were administered implicit association tests (IATs) for social class and race. Ordered logistic regression was then used to examine associations among treatment differences, race, or social class, and RN's IAT scores. Spearman's rank coefficients comparing RN's implicit (IAT) and explicit (stated) preferences were also investigated. Two hundred and forty-five RNs participated. The majority were female (n=217 [88.5%]) and white (n=203 [82.9%]). Most reported that they had no explicit race or class preferences (n=174 [71.0%] and n=108 [44.1%], respectively). However, only 36 nurses (14.7%) demonstrated no implicit race preference as measured by race IAT, and only 16 nurses (6.53%) displayed no implicit class preference on the class IAT. Implicit association tests scores did not statistically correlate with vignette-based clinical decision making. Spearman's rank coefficients comparing implicit (IAT) and explicit preferences also demonstrated no statistically significant correlation (r=-0.06; p=0.340 and r=-0.06; p=0.342, respectively). The majority of RNs displayed implicit preferences toward white race and upper social class patients on IAT assessment. However, unlike published data on physicians, implicit biases among RNs did not correlate with clinical decision making. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
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Campolina, Alessandro Gonçalves; Soárez, Patrícia Coelho De; Amaral, Fábio Vieira do; Abe, Jair Minoro
2017-10-26
Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts' values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision's outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.
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Welch, Vivian A; Akl, Elie A; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed T; de Beer, Hans; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg; Morton, Rachael; Mosdol, Annhild; Petkovic, Jennifer; Schünemann, Holger J; Sharaf, Ravi N; Singh, Jasvinder A; Stanev, Roger; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter
2017-10-01
This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
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Mazur, D J
1990-01-01
Appellate courts, state legislatures, and ethicists have recently (post-1972) been interested-through the evolving court doctrine of informed consent-in patient-physician joint decision making. Yet these professional groups' approaches differ markedly from that of decision analysis, failing to include an explicit role for patients' rational processing of information in informed consent. In addition, these groups charge that decision analysts are misestimating patient dysutilities. This paper examines three issues: 1) in what sense(s), if any, is decision-analytic work in individualized medical decision making misestimating patient dysutilities, 2) if this misestimation is real, whether it is an example of the normative-descriptive tensions that exist in medical decision making, and 3) in what ways do the relationships between decision-analytic and judicial decision making change when informed consent is viewed in terms of contract law as opposed to tort law. This paper argues that a key link dividing these professional groups is the differing weights given to the "value of information" by decision-analytic vs. non-decision-analytic frameworks.
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Stacey, Dawn; Chambers, Suzanne K; Jacobsen, Mary Jane; Dunn, Jeff
2008-11-01
To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions. A pre- and post-test study guided by the Ottawa Model of Research Use. Australian statewide cancer call center that provides public access to information and supportive cancer services. 34 nurses, psychologists, and other allied healthcare professionals at the cancer call center. Participants completed baseline measures and, subsequently, were exposed to an intervention that included a decision support tutorial, coaching protocol, and skill-building workshop. Strategies were implemented to address organizational barriers. Perceived barriers and facilitators influencing provision of decision support, decision support knowledge, quality of decision support provided to standardized callers, and call length. Postintervention participants felt more prepared, confident in providing decision support, and aware of decision support resources. They had a stronger belief that providing decision support was within their role. Participants significantly improved their knowledge and provided higher-quality decision support to standardized callers without changing call length. The implementation intervention overcame several identified barriers that influenced call center professionals when providing decision support. Nurses and other helpline professionals have the potential to provide decision support designed to help callers understand cancer information, clarify their values associated with their options, and reduce decisional conflict. However, they require targeted education and organizational interventions to reduce their perceived barriers to providing decision support.
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Two-stage fuzzy-stochastic robust programming: a hybrid model for regional air quality management.
Li, Yongping; Huang, Guo H; Veawab, Amornvadee; Nie, Xianghui; Liu, Lei
2006-08-01
In this study, a hybrid two-stage fuzzy-stochastic robust programming (TFSRP) model is developed and applied to the planning of an air-quality management system. As an extension of existing fuzzy-robust programming and two-stage stochastic programming methods, the TFSRP can explicitly address complexities and uncertainties of the study system without unrealistic simplifications. Uncertain parameters can be expressed as probability density and/or fuzzy membership functions, such that robustness of the optimization efforts can be enhanced. Moreover, economic penalties as corrective measures against any infeasibilities arising from the uncertainties are taken into account. This method can, thus, provide a linkage to predefined policies determined by authorities that have to be respected when a modeling effort is undertaken. In its solution algorithm, the fuzzy decision space can be delimited through specification of the uncertainties using dimensional enlargement of the original fuzzy constraints. The developed model is applied to a case study of regional air quality management. The results indicate that reasonable solutions have been obtained. The solutions can be used for further generating pollution-mitigation alternatives with minimized system costs and for providing a more solid support for sound environmental decisions.
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NASA Astrophysics Data System (ADS)
Rosenzweig, B.; Vorosmarty, C. J.; Miara, A.; Stewart, R.; Wollheim, W. M.; Lu, X.; Kicklighter, D. W.; Ehsani, N.; Shikhmacheva, K.; Yang, P.
2013-12-01
The Northeastern United States is one of the most urbanized regions of the world and its 70 million residents will be challenged by climate change as well as competing demands for land and water through the remainder of the 21st Century. The strategic management decisions made in the next few years will have major impacts on the region's future water resources, but planners have had limited quantitative information to support their decision-making. We have developed a Northeast Regional Earth System Model (NE-RESM), which allows for the testing of future scenarios of climate change, land use change and infrastructure management to better understand their implications for the region's water resources and ecosystem services. Human features of the water cycle - including thermoelectric power plants, wastewater treatment plants interbasin transfers and changes in impervious cover with different patterns of urban development - are explicitly represented in our modeling. We are currently engaged in a novel, participatory scenario design process with regional stakeholders to ensure the policy relevancy of our modeling experiments. The NE-RESM hydrologic modeling domain. Figure by Stanley Glidden and Rob Stewart
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The Evolution of System Safety at NASA
NASA Technical Reports Server (NTRS)
Dezfuli, Homayoon; Everett, Chris; Groen, Frank
2014-01-01
The NASA system safety framework is in the process of change, motivated by the desire to promote an objectives-driven approach to system safety that explicitly focuses system safety efforts on system-level safety performance, and serves to unify, in a purposeful manner, safety-related activities that otherwise might be done in a way that results in gaps, redundancies, or unnecessary work. An objectives-driven approach to system safety affords more flexibility to determine, on a system-specific basis, the means by which adequate safety is achieved and verified. Such flexibility and efficiency is becoming increasingly important in the face of evolving engineering modalities and acquisition models, where, for example, NASA will increasingly rely on commercial providers for transportation services to low-earth orbit. A key element of this objectives-driven approach is the use of the risk-informed safety case (RISC): a structured argument, supported by a body of evidence, that provides a compelling, comprehensible and valid case that a system is or will be adequately safe for a given application in a given environment. The RISC addresses each of the objectives defined for the system, providing a rational basis for making informed risk acceptance decisions at relevant decision points in the system life cycle.
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Information gathering, management and transfering for geospacial intelligence
NASA Astrophysics Data System (ADS)
Nunes, Paulo; Correia, Anacleto; Teodoro, M. Filomena
2017-07-01
Information is a key subject in modern organization operations. The success of joint and combined operations with organizations partners depends on the accurate information and knowledge flow concerning the operations theatre: provision of resources, environment evolution, markets location, where and when an event occurred. As in the past and nowadays we cannot conceive modern operations without maps and geo-spatial information (GI). Information and knowledge management is fundamental to the success of organizational decisions in an uncertainty environment. The georeferenced information management is a process of knowledge management, it begins in the raw data and ends on generating knowledge. GI and intelligence systems allow us to integrate all other forms of intelligence and can be a main platform to process and display geo-spatial-time referenced events. Combining explicit knowledge with peoples know-how to generate a continuous learning cycle that supports real time decisions mitigates the influences of fog of everyday competition and provides the knowledge supremacy. Extending the preliminary analysis done in [1], this work applies the exploratory factor analysis to a questionnaire about the GI and intelligence management in an organization company allowing to identify future lines of action to improve information process sharing and exploration of all the potential of this important resource.
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EXPECT: Explicit Representations for Flexible Acquisition
NASA Technical Reports Server (NTRS)
Swartout, BIll; Gil, Yolanda
1995-01-01
To create more powerful knowledge acquisition systems, we not only need better acquisition tools, but we need to change the architecture of the knowledge based systems we create so that their structure will provide better support for acquisition. Current acquisition tools permit users to modify factual knowledge but they provide limited support for modifying problem solving knowledge. In this paper, the authors argue that this limitation (and others) stem from the use of incomplete models of problem-solving knowledge and inflexible specification of the interdependencies between problem-solving and factual knowledge. We describe the EXPECT architecture which addresses these problems by providing an explicit representation for problem-solving knowledge and intent. Using this more explicit representation, EXPECT can automatically derive the interdependencies between problem-solving and factual knowledge. By deriving these interdependencies from the structure of the knowledge-based system itself EXPECT supports more flexible and powerful knowledge acquisition.
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Text Detection and Translation from Natural Scenes
2001-06-01
is no explicit tags around Chinese words. A module for Chinese word segmentation is included in the system. This segmentor uses a word- frequency ... list to make segmentation decisions. We tested the EBMT based method using randomly selected 50 signs from our database, assuming perfect sign
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Hudjetz, Silvana; Lennartz, Gottfried; Krämer, Klara; Roß-Nickoll, Martina; Gergs, André; Preuss, Thomas G.
2014-01-01
The degradation of natural and semi-natural landscapes has become a matter of global concern. In Germany, semi-natural grasslands belong to the most species-rich habitat types but have suffered heavily from changes in land use. After abandonment, the course of succession at a specific site is often difficult to predict because many processes interact. In order to support decision making when managing semi-natural grasslands in the Eifel National Park, we built the WoodS-Model (Woodland Succession Model). A multimodeling approach was used to integrate vegetation dynamics in both the herbaceous and shrub/tree layer. The cover of grasses and herbs was simulated in a compartment model, whereas bushes and trees were modelled in an individual-based manner. Both models worked and interacted in a spatially explicit, raster-based landscape. We present here the model description, parameterization and testing. We show highly detailed projections of the succession of a semi-natural grassland including the influence of initial vegetation composition, neighborhood interactions and ungulate browsing. We carefully weighted the single processes against each other and their relevance for landscape development under different scenarios, while explicitly considering specific site conditions. Model evaluation revealed that the model is able to emulate successional patterns as observed in the field as well as plausible results for different population densities of red deer. Important neighborhood interactions such as seed dispersal, the protection of seedlings from browsing ungulates by thorny bushes, and the inhibition of wood encroachment by the herbaceous layer, have been successfully reproduced. Therefore, not only a detailed model but also detailed initialization turned out to be important for spatially explicit projections of a given site. The advantage of the WoodS-Model is that it integrates these many mutually interacting processes of succession. PMID:25494057
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NASA Astrophysics Data System (ADS)
Russo, Giovanni; Shorten, Robert
2018-04-01
This paper is concerned with the study of common noise-induced synchronization phenomena in complex networks of diffusively coupled nonlinear systems. We consider the case where common noise propagation depends on the network state and, as a result, the noise diffusion process at the nodes depends on the state of the network. For such networks, we present an algebraic sufficient condition for the onset of synchronization, which depends on the network topology, the dynamics at the nodes, the coupling strength and the noise diffusion. Our result explicitly shows that certain noise diffusion processes can drive an unsynchronized network towards synchronization. In order to illustrate the effectiveness of our result, we consider two applications: collective decision processes and synchronization of chaotic systems. We explicitly show that, in the former application, a sufficiently large noise can drive a population towards a common decision, while, in the latter, we show how common noise can synchronize a network of Lorentz chaotic systems.
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Schultz, Douglas H.; Balderston, Nicholas L.; Geiger, Jennifer A.; Helmstetter, Fred J.
2014-01-01
The nature of the relationship between explicit and implicit learning is a topic of considerable debate. In order to investigate this relationship we conducted two experiments on postconditioning revaluation of the unconditional stimulus (UCS) in human fear conditioning. In Experiment 1, the intensity of the UCS was decreased following acquisition for one group (devaluation) and held constant for another group (control). A subsequent test revealed that even though both groups exhibited similar levels of UCS expectancy, the devaluation group had significantly smaller conditional skin conductance responses. The devaluation effect was not explained by differences in the explicit estimates of UCS probability or explicit knowledge that the UCS intensity had changed. In Experiment 2, the value of the UCS was increased following acquisition for one group (inflation) and held constant for another group (control). Test performance revealed that UCS inflation did not alter expectancy ratings, but the inflation group exhibited larger learned skin conductance responses than the control group. The inflation effect was not explained by differences in the explicit estimates of UCS probability or explicit knowledge that the UCS intensity had changed. The SCR revaluation effect was not dependent on explicit memory processes in either experiment. In both experiments we found differences on an implicit measure of learning in the absence of changes in explicit measures. Together, the differences observed between expectancy measures and skin conductance support the idea that these responses might reflect different types of memory formed during the same training procedure and be supported by separate neural systems. PMID:23731073
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Implicit and explicit social mentalizing: dual processes driven by a shared neural network
Van Overwalle, Frank; Vandekerckhove, Marie
2013-01-01
Recent social neuroscientific evidence indicates that implicit and explicit inferences on the mind of another person (i.e., intentions, attributions or traits), are subserved by a shared mentalizing network. Under both implicit and explicit instructions, ERP studies reveal that early inferences occur at about the same time, and fMRI studies demonstrate an overlap in core mentalizing areas, including the temporo-parietal junction (TPJ) and the medial prefrontal cortex (mPFC). These results suggest a rapid shared implicit intuition followed by a slower explicit verification processes (as revealed by additional brain activation during explicit vs. implicit inferences). These data provide support for a default-adjustment dual-process framework of social mentalizing. PMID:24062663
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Evaluation of the quality of patient information to support informed shared decision-making.
Godolphin, W; Towle, A; McKendry, R
2001-12-01
(a) To find out how much patient information material on display in family physicians' offices refers to management choices, and hence may be useful to support informed and shared decision-making (ISDM) by patients and (b) to evaluate the quality of print information materials exchanged during the consultation, i.e. brought in by patients or given out by family physicians. All print information available for patients and exchanged between physicians and patients was collected in a single complete day of the office practices of 21 family physicians. A published and validated instrument (DISCERN) was used to assess quality. Community office practices in the greater Vancouver area, British Columbia, Canada. The physicians were purposefully recruited by their association with the medical school Department of Family Practice, their interest in providing patients with print information and their representation of a range of practice types and location. The source of the pamphlets and these categories: available in the physicians' offices; exchanged between physician and patient; and produced with the explicit or apparent intent to support evidence-based patient choice. The quality of the print information to support ISDM, as measured by DISCERN and the ease of use and reliability of the DISCERN tool. Fewer than 50% of pamphlets available in these offices fulfilled our minimum criteria for ISDM (mentioned more than one management option). Offices varied widely in the proportion of pamphlets on display that supported ISDM and how particular the physician was in selecting materials. The DISCERN tool is quick, valid and reliable for the evaluation of patient information. The quality of patient information materials used in the consultation and available in these offices was below midpoint on the DISCERN score. Major deficiencies were with respect to the mention of choices, risks, effect of no treatment or uncertainty and reliability (source, evidence-base). Good quality information can be produced; some is available locally.
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Collective Intelligence and Three Aspects of Planning in Organizations: A NASA Example
NASA Technical Reports Server (NTRS)
Billman, Dorrit; Feary, Michael
2010-01-01
For many complex sociotechnical systems, planning seems to require explicit coordination; certainly, in executing a plan the activities of different actors must be tightly coupled. However, distributing the needed planning information can be very burdensome and error prone, because different groups need different collections of information, updated or kept current on different time cycles. Further, the information needed to form successful plans is often highly distributed, and while feedback about the success of prior plans may exist, it may not be available to those in a position of using this to improve plans or to detect and resolve other problems in the system (Weick, 1995). Tools to support various aspects of planning have been developed, and can provide a huge benefit to the individuals working on that aspect. To be tractable, most solutions address a quite bounded slice of work, isolating it from the larger context. Prospective planning takes place over multiple, nested cycles of decision making. This builds a plan that specifies activities of different granularity. "Subplans" may specify multiple parallel activities by different groups and individuals, as well as sequential, nested actions by a single actor. Planning produces valuable, sharable, external, representations: in addition to prospective use, plans support retrospective assessment and also action in the present. Viewing planning in a larger context - both temporal and organizational -- enables noticing what one does not know and generating more systemic and effective solutions. Viewing a problem as one of collective intelligence invites thinking about the larger organizational context. Many approaches to supporting collective intelligence do not support execution of highly contingent actions, distributed across many players, and hence provide incomplete support for planning. However, CI technology maybe helpful in managing the processes of gathering information for decision making in planning and of distributing plan information to various actors, needed on various time cycles.
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Systems thinking, complexity and managerial decision-making: an analytical review.
Cramp, D G; Carson, E R
2009-05-01
One feature that characterizes the organization and delivery of health care is its inherent complexity. All too often, with so much information and so many activities involved, it is difficult for decision-makers to determine in an objective fashion an appropriate course of action. It would appear that a holistic rather than a reductionist approach would be advantageous. The aim of this paper is to review how formal systems thinking can aid decision-making in complex situations. Consideration is given as to how the use of a number of systems modelling methodologies can help in gaining an understanding of a complex decision situation. This in turn can enhance the possibility of a decision being made in a more rational, explicit and transparent fashion. The arguments and approaches are illustrated using examples taken from the public health arena.
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Toward interactive scheduling systems for managing medical resources.
Oddi, A; Cesta, A
2000-10-01
Managers of medico-hospital facilities are facing two general problems when allocating resources to activities: (1) to find an agreement between several and contrasting requirements; (2) to manage dynamic and uncertain situations when constraints suddenly change over time due to medical needs. This paper describes the results of a research aimed at applying constraint-based scheduling techniques to the management of medical resources. A mixed-initiative problem solving approach is adopted in which a user and a decision support system interact to incrementally achieve a satisfactory solution to the problem. A running prototype is described called Interactive Scheduler which offers a set of functionalities for a mixed-initiative interaction to cope with the medical resource management. Interactive Scheduler is endowed with a representation schema used for describing the medical environment, a set of algorithms that address the specific problems of the domain, and an innovative interaction module that offers functionalities for the dialogue between the support system and its user. A particular contribution of this work is the explicit representation of constraint violations, and the definition of scheduling algorithms that aim at minimizing the amount of constraint violations in a solution.
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Pleger, Lyn; Sager, Fritz
2016-09-18
Evaluations can only serve as a neutral evidence base for policy decision-making as long as they have not been altered along non-scientific criteria. Studies show that evaluators are repeatedly put under pressure to deliver results in line with given expectations. The study of pressure and influence to misrepresent findings is hence an important research strand for the development of evaluation praxis. A conceptual challenge in the area of evaluation ethics research is the fact that pressure can be not only negative, but also positive. We develop a heuristic model of influence on evaluations that does justice to this ambivalence of influence: the BUSD-model (betterment, undermining, support, distortion). The model is based on the distinction of two dimensions, namely 'explicitness of pressure' and 'direction of influence'. We demonstrate how the model can be applied to understand pressure and offer a practical tool to distinguish positive from negative influence in the form of three so-called differentiators (awareness, accordance, intention). The differentiators comprise a practical component by assisting evaluators who are confronted with influence. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Neumann, Peter J; Drummond, Michael F; Jönsson, Bengt; Luce, Bryan R; Schwartz, J Sanford; Siebert, Uwe; Sullivan, Sean D
2010-01-01
Previously, our group-the International Working Group for HTA Advancement-proposed a set of fifteen Key Principles that could be applied to health technology assessment (HTA) programs in different jurisdictions and across a range of organizations and perspectives. In this commentary, we investigate the extent to which these principles are supported and used by fourteen selected HTA organizations worldwide. We find that some principles are broadly supported: examples include being explicit about HTA goals and scope; considering a wide range of evidence and outcomes; and being unbiased and transparent. Other principles receive less widespread support: examples are addressing issues of generalizability and transferability; being transparent on the link between HTA findings and decision-making processes; considering a full societal perspective; and monitoring the implementation of HTA findings. The analysis also suggests a lack of consensus in the field about some principles--for example, considering a societal perspective. Our study highlights differences in the uptake of key principles for HTA and indicates considerable room for improvement for HTA organizations to adopt principles identified to reflect good HTA practices. Most HTA organizations espouse certain general concepts of good practice--for example, assessments should be unbiased and transparent. However, principles that require more intensive follow-up--for example, monitoring the implementation of HTA findings--have received little support and execution.
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Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight
2007-01-01
Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.
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Sexual Health Curricula in U.S. Medical Schools: Current Educational Objectives
ERIC Educational Resources Information Center
Galletly, Carol; Lechuga, Julia; Layde, Joseph B.; Pinkerton, Steven
2010-01-01
Objective: The authors identify the explicit and implicit objectives that shape decisions about what medical schools teach regarding human sexuality. Methods: The authors reviewed relevant articles in journals, physician licensing examinations, and publications by professional organizations to identify learning objectives for human sexuality in…
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On the Teaching of Portfolio Theory.
ERIC Educational Resources Information Center
Biederman, Daniel K.
1992-01-01
Demonstrates how a simple portfolio problem expressed explicitly as an expected utility maximization problem can be used to instruct students in portfolio theory. Discusses risk aversion, decision making under uncertainty, and the limitations of the traditional mean variance approach. Suggests students may develop a greater appreciation of general…
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78 FR 58897 - Pipeline Safety: Administrative Procedures; Updates and Technical Corrections
Federal Register 2010, 2011, 2012, 2013, 2014
2013-09-25
... incorporate increased transparency into the decision making process, the regulations must explicitly recognize... certainty, and due process. II. Discussion of Comments The comments received from the trade organizations... assistance through these processes by assisting OPS in the development of written responses to requests for...
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The National Atlas of Ecosystem Services: Spatially Explicit Characterization of Ecosystem Services
The US EPA’s Ecosystem Services Research Program (ESRP) is conducting transdisciplinary research to develop tools to enable decision-makers at all levels of governance to proactively conserve ecosystem services. One of these tools is a National Atlas of Ecosystem Services which ...
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Creating a systems engineering approach for the manual on uniform traffic control devices.
DOT National Transportation Integrated Search
2011-03-01
The Manual on Uniform Traffic Control Devices (MUTCD) provides basic principles for use of traffic : control devices (TCD). However, most TCDs are not explicitly required, and the decision to use a given : TCD in a given situation is typically made b...
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How Decision Support Systems Can Benefit from a Theory of Change Approach.
Allen, Will; Cruz, Jennyffer; Warburton, Bruce
2017-06-01
Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.
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How Decision Support Systems Can Benefit from a Theory of Change Approach
NASA Astrophysics Data System (ADS)
Allen, Will; Cruz, Jennyffer; Warburton, Bruce
2017-06-01
Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.
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Lebrun, Victoria; Muessig, Kathryn E
2016-01-01
Background Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. PMID:26787311
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Mangone, Emily Rose; Lebrun, Victoria; Muessig, Kathryn E
2016-01-19
Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted.
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Uncertainty of Monetary Valued Ecosystem Services – Value Transfer Functions for Global Mapping
Schmidt, Stefan; Manceur, Ameur M.; Seppelt, Ralf
2016-01-01
Growing demand of resources increases pressure on ecosystem services (ES) and biodiversity. Monetary valuation of ES is frequently seen as a decision-support tool by providing explicit values for unconsidered, non-market goods and services. Here we present global value transfer functions by using a meta-analytic framework for the synthesis of 194 case studies capturing 839 monetary values of ES. For 12 ES the variance of monetary values could be explained with a subset of 93 study- and site-specific variables by utilizing boosted regression trees. This provides the first global quantification of uncertainties and transferability of monetary valuations. Models explain from 18% (water provision) to 44% (food provision) of variance and provide statistically reliable extrapolations for 70% (water provision) to 91% (food provision) of the terrestrial earth surface. Although the application of different valuation methods is a source of uncertainty, we found evidence that assuming homogeneity of ecosystems is a major error in value transfer function models. Food provision is positively correlated with better life domains and variables indicating positive conditions for human well-being. Water provision and recreation service show that weak ownerships affect valuation of other common goods negatively (e.g. non-privately owned forests). Furthermore, we found support for the shifting baseline hypothesis in valuing climate regulation. Ecological conditions and societal vulnerability determine valuation of extreme event prevention. Valuation of habitat services is negatively correlated with indicators characterizing less favorable areas. Our analysis represents a stepping stone to establish a standardized integration of and reporting on uncertainties for reliable and valid benefit transfer as an important component for decision support. PMID:26938447
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Kantak, Shailesh S; Mummidisetty, Chaithanya K; Stinear, James W
2012-09-01
Implicit and explicit memory systems for motor skills compete with each other during and after motor practice. Primary motor cortex (M1) is known to be engaged during implicit motor learning, while dorsal premotor cortex (PMd) is critical for explicit learning. To elucidate the neural substrates underlying the interaction between implicit and explicit memory systems, adults underwent a randomized crossover experiment of anodal transcranial direct current stimulation (AtDCS) applied over M1, PMd or sham stimulation during implicit motor sequence (serial reaction time task, SRTT) practice. We hypothesized that M1-AtDCS during practice will enhance online performance and offline learning of the implicit motor sequence. In contrast, we also hypothesized that PMd-AtDCS will attenuate performance and retention of the implicit motor sequence. Implicit sequence performance was assessed at baseline, at the end of acquisition (EoA), and 24 h after practice (retention test, RET). M1-AtDCS during practice significantly improved practice performance and supported offline stabilization compared with Sham tDCS. Performance change from EoA to RET revealed that PMd-AtDCS during practice attenuated offline stabilization compared with M1-AtDCS and sham stimulation. The results support the role of M1 in implementing online performance gains and offline stabilization for implicit motor sequence learning. In contrast, enhancing the activity within explicit motor memory network nodes such as the PMd during practice may be detrimental to offline stabilization of the learned implicit motor sequence. These results support the notion of competition between implicit and explicit motor memory systems and identify underlying neural substrates that are engaged in this competition. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.
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Expanding the base for teaching of percutaneous coronary interventions: the explicit approach.
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.
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Valuing flexibilities in the design of urban water management systems.
Deng, Yinghan; Cardin, Michel-Alexandre; Babovic, Vladan; Santhanakrishnan, Deepak; Schmitter, Petra; Meshgi, Ali
2013-12-15
Climate change and rapid urbanization requires decision-makers to develop a long-term forward assessment on sustainable urban water management projects. This is further complicated by the difficulties of assessing sustainable designs and various design scenarios from an economic standpoint. A conventional valuation approach for urban water management projects, like Discounted Cash Flow (DCF) analysis, fails to incorporate uncertainties, such as amount of rainfall, unit cost of water, and other uncertainties associated with future changes in technological domains. Such approach also fails to include the value of flexibility, which enables managers to adapt and reconfigure systems over time as uncertainty unfolds. This work describes an integrated framework to value investments in urban water management systems under uncertainty. It also extends the conventional DCF analysis through explicit considerations of flexibility in systems design and management. The approach incorporates flexibility as intelligent decision-making mechanisms that enable systems to avoid future downside risks and increase opportunities for upside gains over a range of possible futures. A water catchment area in Singapore was chosen to assess the value of a flexible extension of standard drainage canals and a flexible deployment of a novel water catchment technology based on green roofs and porous pavements. Results show that integrating uncertainty and flexibility explicitly into the decision-making process can reduce initial capital expenditure, improve value for investment, and enable decision-makers to learn more about system requirements during the lifetime of the project. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Bayesian methods to estimate urban growth potential
Smith, Jordan W.; Smart, Lindsey S.; Dorning, Monica; Dupéy, Lauren Nicole; Méley, Andréanne; Meentemeyer, Ross K.
2017-01-01
Urban growth often influences the production of ecosystem services. The impacts of urbanization on landscapes can subsequently affect landowners’ perceptions, values and decisions regarding their land. Within land-use and land-change research, very few models of dynamic landscape-scale processes like urbanization incorporate empirically-grounded landowner decision-making processes. Very little attention has focused on the heterogeneous decision-making processes that aggregate to influence broader-scale patterns of urbanization. We examine the land-use tradeoffs faced by individual landowners in one of the United States’ most rapidly urbanizing regions − the urban area surrounding Charlotte, North Carolina. We focus on the land-use decisions of non-industrial private forest owners located across the region’s development gradient. A discrete choice experiment is used to determine the critical factors influencing individual forest owners’ intent to sell their undeveloped properties across a series of experimentally varied scenarios of urban growth. Data are analyzed using a hierarchical Bayesian approach. The estimates derived from the survey data are used to modify a spatially-explicit trend-based urban development potential model, derived from remotely-sensed imagery and observed changes in the region’s socioeconomic and infrastructural characteristics between 2000 and 2011. This modeling approach combines the theoretical underpinnings of behavioral economics with spatiotemporal data describing a region’s historical development patterns. By integrating empirical social preference data into spatially-explicit urban growth models, we begin to more realistically capture processes as well as patterns that drive the location, magnitude and rates of urban growth.
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Zhang, Xiaoling; Huang, Kai; Zou, Rui; Liu, Yong; Yu, Yajuan
2013-01-01
The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of "low risk and high return efficiency" in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management.
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Zou, Rui; Liu, Yong; Yu, Yajuan
2013-01-01
The conflict of water environment protection and economic development has brought severe water pollution and restricted the sustainable development in the watershed. A risk explicit interval linear programming (REILP) method was used to solve integrated watershed environmental-economic optimization problem. Interval linear programming (ILP) and REILP models for uncertainty-based environmental economic optimization at the watershed scale were developed for the management of Lake Fuxian watershed, China. Scenario analysis was introduced into model solution process to ensure the practicality and operability of optimization schemes. Decision makers' preferences for risk levels can be expressed through inputting different discrete aspiration level values into the REILP model in three periods under two scenarios. Through balancing the optimal system returns and corresponding system risks, decision makers can develop an efficient industrial restructuring scheme based directly on the window of “low risk and high return efficiency” in the trade-off curve. The representative schemes at the turning points of two scenarios were interpreted and compared to identify a preferable planning alternative, which has the relatively low risks and nearly maximum benefits. This study provides new insights and proposes a tool, which was REILP, for decision makers to develop an effectively environmental economic optimization scheme in integrated watershed management. PMID:24191144
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Disclosing incidental findings in brain research: the rights of minors in decision-making.
Di Pietro, Nina C; Illes, Judy
2013-11-01
MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity-adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. Copyright © 2013 Wiley Periodicals, Inc.
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Implicit Valuation of the Near-Miss is Dependent on Outcome Context.
Banks, Parker J; Tata, Matthew S; Bennett, Patrick J; Sekuler, Allison B; Gruber, Aaron J
2018-03-01
Gambling studies have described a "near-miss effect" wherein the experience of almost winning increases gambling persistence. The near-miss has been proposed to inflate the value of preceding actions through its perceptual similarity to wins. We demonstrate here, however, that it acts as a conditioned stimulus to positively or negatively influence valuation, dependent on reward expectation and cognitive engagement. When subjects are asked to choose between two simulated slot machines, near-misses increase valuation of machines with a low payout rate, whereas they decrease valuation of high payout machines. This contextual effect impairs decisions and persists regardless of manipulations to outcome feedback or financial incentive provided for good performance. It is consistent with proposals that near-misses cause frustration when wins are expected, and we propose that it increases choice stochasticity and overrides avoidance of low-valued options. Intriguingly, the near-miss effect disappears when subjects are required to explicitly value machines by placing bets, rather than choosing between them. We propose that this task increases cognitive engagement and recruits participation of brain regions involved in cognitive processing, causing inhibition of otherwise dominant systems of decision-making. Our results reveal that only implicit, rather than explicit strategies of decision-making are affected by near-misses, and that the brain can fluidly shift between these strategies according to task demands.
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Pertl, Marie-Theres; Zamarian, Laura; Delazer, Margarete
2017-08-01
In this study, we assessed to what extent reasoning improves performance in decision making under risk in a laboratory gambling task (Game of Dice Task-Double, GDT-D). We also investigated to what degree individuals with above average mathematical competence decide better than those with average mathematical competence. Eighty-five participants performed the GDT-D and several numerical tasks. Forty-two individuals were asked to calculate the probabilities and the outcomes associated with the different options of the GDT-D before performing it. The other 43 individuals performed the GDT-D at the beginning of the test session. Both reasoning and mathematical competence had a positive effect on decision making. Different measures of mathematical competence correlated with advantageous performance in decision making. Results suggest that decision making under explicit risk conditions improves when individuals are encouraged to reflect about the contingencies of a decision situation. Interventions based on numerical reasoning may also be useful for patients with difficulties in decision making.
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Implicit and explicit processing of emotional facial expressions in Parkinson's disease.
Wagenbreth, Caroline; Wattenberg, Lena; Heinze, Hans-Jochen; Zaehle, Tino
2016-04-15
Besides motor problems, Parkinson's disease (PD) is associated with detrimental emotional and cognitive functioning. Deficient explicit emotional processing has been observed, whilst patients also show impaired Theory of Mind (ToM) abilities. However, it is unclear whether this PD patients' ToM deficit is based on an inability to infer otherś emotional states or whether it is due to explicit emotional processing deficits. We investigated implicit and explicit emotional processing in PD with an affective priming paradigm in which we used pictures of human eyes for emotional primes and a lexical decision task (LDT) with emotional connoted words for target stimuli. Sixteen PD patients and sixteen matched healthy controls performed a LTD combined with an emotional priming paradigm providing emotional information through the facial eye region to assess implicit emotional processing. Second, participants explicitly evaluated the emotional status of eyes and words used in the implicit task. Compared to controls implicit emotional processing abilities were generally preserved in PD with, however, considerable alterations for happiness and disgust processing. Furthermore, we observed a general impairment of patients for explicit evaluation of emotional stimuli, which was augmented for the rating of facial expressions. This is the first study reporting results for affective priming with facial eye expressions in PD patients. Our findings indicate largely preserved implicit emotional processing, with a specific altered processing of disgust and happiness. Explicit emotional processing was considerably impaired for semantic and especially for facial stimulus material. Poor ToM abilities in PD patients might be based on deficient explicit emotional processing, with preserved ability to implicitly infer other people's feelings. Copyright © 2016 Elsevier B.V. All rights reserved.
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Decision Support | Solar Research | NREL
informed solar decision making with credible, objective, accessible, and timely resources. Solar Energy Decision Support Decision Support NREL provides technical and analytical support to support provide unbiased information on solar policies and issues for state and local government decision makers
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Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L
2016-04-01
To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.
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Mueller, Silke M; Schiebener, Johannes; Delazer, Margarete; Brand, Matthias
2018-01-22
Many decision situations in everyday life involve mathematical considerations. In decisions under objective risk, i.e., when explicit numeric information is available, executive functions and abilities to handle exact numbers and ratios are predictors of objectively advantageous choices. Although still debated, exact numeric abilities, e.g., normative calculation skills, are assumed to be related to approximate number processing skills. The current study investigates the effects of approximative numeric abilities on decision making under objective risk. Participants (N = 153) performed a paradigm measuring number-comparison, quantity-estimation, risk-estimation, and decision-making skills on the basis of rapid dot comparisons. Additionally, a risky decision-making task with exact numeric information was administered, as well as tasks measuring executive functions and exact numeric abilities, e.g., mental calculation and ratio processing skills, were conducted. Approximative numeric abilities significantly predicted advantageous decision making, even beyond the effects of executive functions and exact numeric skills. Especially being able to make accurate risk estimations seemed to contribute to superior choices. We recommend approximation skills and approximate number processing to be subject of future investigations on decision making under risk.
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Decision-Making Under Risk: Integrating Perspectives From Biology, Economics, and Psychology.
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.
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NASA Astrophysics Data System (ADS)
Ohl, Ricky
In this case study, computer supported argument visualisation has been applied to the analysis and representation of the draft South East Queensland Regional Plan Consultation discourse, demonstrating how argument mapping can help deliver the transparency and accountability required in participatory democracy. Consultative democracy for regional planning falls into a category of problems known as “wicked problems”. Inherent in this environment is heterogeneous viewpoints, agendas and voices, built on disparate and often contradictory logic. An argument ontology and notation that was designed specifically to deal with consultative urban planning around wicked problems is the Issue Based Information System (IBIS) and IBIS notation (Rittel & Webber, 1984). The software used for argument visualisation in this case was Compendium, a derivative of IBIS. The high volume of stakeholders and discourse heterogeneity in this environment calls for a unique approach to argument mapping. The map design model developed from this research has been titled a “Consultation Map”. The design incorporates the IBIS ontology within a hybrid of mapping approaches, amalgamating elements from concept, dialogue, argument, debate, thematic and tree-mapping. The consultation maps developed from the draft South East Queensland Regional Plan Consultation provide a transparent visual record to give evidence of the themes of citizen issues within the consultation discourse. The consultation maps also link the elicited discourse themes to related policies from the SEQ Regional Plan providing explicit evidence of SEQ Regional Plan policy-decisions matching citizen concerns. The final consultation map in the series provides explicit links between SEQ Regional Plan policy items and monitoring activities reporting on the ongoing implementation of the SEQ Regional Plan. This map provides updatable evidence of and accountability for SEQ Regional Plan policy implementation and developments.
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Bal, Mert; Amasyali, M Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse
2014-01-01
The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.
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Stead, Martine; Tagg, Stephen; MacKintosh, Anne Marie; Eadie, Douglas
2005-02-01
The Theory of Planned Behaviour (TPB) has been widely applied to the explanation of health and social behaviours. However, despite its potential to inform behaviour change efforts, there have been surprisingly few attempts to use the TPB to design actual interventions. In 1998, the Scottish Road Safety Campaign implemented a 3-year mass media campaign to reduce speeding on Scotland's roads which was explicitly shaped by the TPB's three main predictors: Attitude, Subjective Norms and Perceived Behavioural Control. A 4-year longitudinal cohort study examined the impact of the campaign on communications outcomes and on TPB constructs. Overall, empirical support was found for the decision to use TPB as the theoretical underpinning of the advertising. The advertising was effective in triggering desired communications outcomes, and was associated with significant changes in attitudes and affective beliefs about speeding. In conclusion, future directions for road safety advertising and for TPB research are discussed.
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Metadata behind the Interoperability of Wireless Sensor Networks
Ballari, Daniela; Wachowicz, Monica; Callejo, Miguel Angel Manso
2009-01-01
Wireless Sensor Networks (WSNs) produce changes of status that are frequent, dynamic and unpredictable, and cannot be represented using a linear cause-effect approach. Consequently, a new approach is needed to handle these changes in order to support dynamic interoperability. Our approach is to introduce the notion of context as an explicit representation of changes of a WSN status inferred from metadata elements, which in turn, leads towards a decision-making process about how to maintain dynamic interoperability. This paper describes the developed context model to represent and reason over different WSN status based on four types of contexts, which have been identified as sensing, node, network and organisational contexts. The reasoning has been addressed by developing contextualising and bridges rules. As a result, we were able to demonstrate how contextualising rules have been used to reason on changes of WSN status as a first step towards maintaining dynamic interoperability. PMID:22412330
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Metadata behind the Interoperability of Wireless Sensor Networks.
Ballari, Daniela; Wachowicz, Monica; Callejo, Miguel Angel Manso
2009-01-01
Wireless Sensor Networks (WSNs) produce changes of status that are frequent, dynamic and unpredictable, and cannot be represented using a linear cause-effect approach. Consequently, a new approach is needed to handle these changes in order to support dynamic interoperability. Our approach is to introduce the notion of context as an explicit representation of changes of a WSN status inferred from metadata elements, which in turn, leads towards a decision-making process about how to maintain dynamic interoperability. This paper describes the developed context model to represent and reason over different WSN status based on four types of contexts, which have been identified as sensing, node, network and organisational contexts. The reasoning has been addressed by developing contextualising and bridges rules. As a result, we were able to demonstrate how contextualising rules have been used to reason on changes of WSN status as a first step towards maintaining dynamic interoperability.
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Evolution of Secondary Software Businesses: Understanding Industry Dynamics
NASA Astrophysics Data System (ADS)
Tyrväinen, Pasi; Warsta, Juhani; Seppänen, Veikko
Primary software industry originates from IBM's decision to unbundle software-related computer system development activities to external partners. This kind of outsourcing from an enterprise internal software development activity is a common means to start a new software business serving a vertical software market. It combines knowledge of the vertical market process with competence in software development. In this research, we present and analyze the key figures of the Finnish secondary software industry, in order to quantify its interaction with the primary software industry during the period of 2000-2003. On the basis of the empirical data, we present a model for evolution of a secondary software business, which makes explicit the industry dynamics. It represents the shift from internal software developed for competitive advantage to development of products supporting standard business processes on top of standardized technologies. We also discuss the implications for software business strategies in each phase.
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Decomposing task-switching costs with the diffusion model.
Schmitz, Florian; Voss, Andreas
2012-02-01
In four experiments, task-switching processes were investigated with variants of the alternating runs paradigm and the explicit cueing paradigm. The classical diffusion model for binary decisions (Ratcliff, 1978) was used to dissociate different components of task-switching costs. Findings can be reconciled with the view that task-switching processes take place in successive phases as postulated by multiple-components models of task switching (e.g., Mayr & Kliegl, 2003; Ruthruff, Remington, & Johnston, 2001). At an earlier phase, task-set reconfiguration (Rogers & Monsell, 1995) or cue-encoding (Schneider & Logan, 2005) takes place, at a later phase, the response is selected in accord with constraints set in the first phase. Inertia effects (Allport, Styles, & Hsieh, 1994; Allport & Wylie, 2000) were shown to affect this later stage. Additionally, findings support the notion that response caution contributes to both global as well as to local switching costs when task switches are predictable.
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Guikema, Seth
2012-07-01
Intelligent adversary modeling has become increasingly important for risk analysis, and a number of different approaches have been proposed for incorporating intelligent adversaries in risk analysis models. However, these approaches are based on a range of often-implicit assumptions about the desirable properties of intelligent adversary models. This "Perspective" paper aims to further risk analysis for situations involving intelligent adversaries by fostering a discussion of the desirable properties for these models. A set of four basic necessary conditions for intelligent adversary models is proposed and discussed. These are: (1) behavioral accuracy to the degree possible, (2) computational tractability to support decision making, (3) explicit consideration of uncertainty, and (4) ability to gain confidence in the model. It is hoped that these suggested necessary conditions foster discussion about the goals and assumptions underlying intelligent adversary modeling in risk analysis. © 2011 Society for Risk Analysis.
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Steele, Vaughn R.; Bernat, Edward M.; van den Broek, Paul; Collins, Paul F.; Patrick, Christopher J.; Marsolek, Chad J.
2012-01-01
Successful comprehension during reading often requires inferring information not explicitly presented. This information is readily accessible when subsequently encountered, and a neural correlate of this is an attenuation of the N400 event-related potential (ERP). We used ERPs and time-frequency (TF) analysis to investigate neural correlates of processing inferred information after a causal coherence inference had been generated during text comprehension. Participants read short texts, some of which promoted inference generation. After each text, they performed lexical decisions to target words that were unrelated or inference-related to the preceding text. Consistent with previous findings, inference-related words elicited an attenuated N400 relative to unrelated words. TF analyses revealed unique contributions to the N400 from activity occurring at 1–6 Hz (theta) and 0–2 Hz (delta), supporting the view that multiple, sequential processes underlie the N400. PMID:23165117
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[Environmental impact assessment based on planning support system].
Chen, Wen-Bo; Carsjens, Gerrit-Jan
2011-02-01
How to assess environmental impact is one of the keys in land use planning. This article described in detail the concepts of activities, impact zones, functions, and sensitivities, as well as the development of STEPP (strategic tool for integrating environmental aspects in planning procedures) based on Avenue, the secondary developing language of ArcView GIS. The system makes it convenient for planning practitioners exchanging information, and can spatially, visually and quantitatively describe environmental impact and its change. In this study, the urban-rural combination area located between EDE and Veenendaal of The Netherlands was taken as case, and the results indicated that the environment was incorporated well in the planning procedure based on the concepts, and could also demonstrate the effects of planning measures on environment spatially, explicitly, and in real-time, facilitating the participation of planning practitioners and decision-making. Some proposals of how to promote STEEP application in China were suggested.
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Managing the Alert Process at NewYork-Presbyterian Hospital
Kuperman, Gilad J; Diamente, Rosanna; Khatu, Vrinda; Chan-Kraushar, Terri; Stetson, Pete; Boyer, Aurelia; Cooper, Mary
2005-01-01
Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources. PMID:16779073
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An economic theory of cigarette addiction.
Suranovic, S M; Goldfarb, R S; Leonard, T C
1999-01-01
In this paper we present a model in which individuals act in their own best interest, to explain many behaviors associated with cigarette addiction. There are two key features of the model. First, there is an explicit representation of the withdrawal effects experienced when smokers attempt to quit smoking. Second, there is explicit recognition that the negative effects of smoking generally appear late in an individual's life. Among the things we use the model to explain are: (1) how individuals can become trapped in their decision to smoke; (2) the conditions under which cold-turkey quitting and gradual quitting may occur; and (3) a reason for the existence of quit-smoking treatments.
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Making the morally relevant features explicit: a response to Carson Strong.
Gert, Bernard
2006-03-01
Carson Strong criticizes the application of my moral theory to bioethics cases. Some of his criticisms are due to my failure to make explicit that both the irrationality or rationality of a decision and the irrationality or rationality of the ranking of evils are part of morally relevant feature 3. Other criticisms are the result of his not using the two-step procedure in a sufficiently rigorous way. His claim that I come up with a wrong answer depends upon his incorrectly regarding a weakly justified violation as one that all impartial rational persons would agree was permitted, rather than as one about which rational persons disagree.
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Influence of biases in numerical magnitude allocation on human prosocial decision making.
Arshad, Qadeer; Nigmatullina, Yuliya; Siddiqui, Shuaib; Franka, Mustafa; Mediratta, Saniya; Ramachandaran, Sanjeev; Lobo, Rhannon; Malhotra, Paresh A; Roberts, R E; Bronstein, Adolfo M
2017-12-01
Over the past decade neuroscientific research has attempted to probe the neurobiological underpinnings of human prosocial decision making. Such research has almost ubiquitously employed tasks such as the dictator game or similar variations (i.e., ultimatum game). Considering the explicit numerical nature of such tasks, it is surprising that the influence of numerical cognition on decision making during task performance remains unknown. While performing these tasks, participants typically tend to anchor on a 50:50 split that necessitates an explicit numerical judgement (i.e., number-pair bisection). Accordingly, we hypothesize that the decision-making process during the dictator game recruits overlapping cognitive processes to those known to be engaged during number-pair bisection. We observed that biases in numerical magnitude allocation correlated with the formulation of decisions during the dictator game. That is, intrinsic biases toward smaller numerical magnitudes were associated with the formulation of less favorable decisions, whereas biases toward larger magnitudes were associated with more favorable choices. We proceeded to corroborate this relationship by subliminally and systematically inducing biases in numerical magnitude toward either higher or lower numbers using a visuo-vestibular stimulation paradigm. Such subliminal alterations in numerical magnitude allocation led to proportional and corresponding changes to an individual's decision making during the dictator game. Critically, no relationship was observed between neither intrinsic nor induced biases in numerical magnitude on decision making when assessed using a nonnumerical-based prosocial questionnaire. Our findings demonstrate numerical influences on decisions formulated during the dictator game and highlight the necessity to control for confounds associated with numerical cognition in human decision-making paradigms. NEW & NOTEWORTHY We demonstrate that intrinsic biases in numerical magnitude can directly predict the amount of money donated by an individual to an anonymous stranger during the dictator game. Furthermore, subliminally inducing perceptual biases in numerical-magnitude allocation can actively drive prosocial choices in the corresponding direction. Our findings provide evidence for numerical influences on decision making during performance of the dictator game. Accordingly, without the implementation of an adequate control for numerical influences, the dictator game and other tasks with an inherent numerical component (i.e., ultimatum game) should be employed with caution in the assessment of human behavior. Copyright © 2017 the American Physiological Society.
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Adapting Cognitive Task Analysis to Explore Young Children's Thinking Competence
ERIC Educational Resources Information Center
Lee, Scott W. F.
2013-01-01
Researchers and educators recognize that performance assessments and naturalistic observations are well suited for assessing young children's thinking abilities and understanding. The need to establish explicit evaluation criteria to guide assessment decisions has led to the widespread use of rubrics. Rubrics tend to channel assessors to look for…
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Decomposing Task-Switching Costs with the Diffusion Model
ERIC Educational Resources Information Center
Schmitz, Florian; Voss, Andreas
2012-01-01
In four experiments, task-switching processes were investigated with variants of the alternating runs paradigm and the explicit cueing paradigm. The classical diffusion model for binary decisions (Ratcliff, 1978) was used to dissociate different components of task-switching costs. Findings can be reconciled with the view that task-switching…
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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…
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Differentiation and Social Selectivity in German Higher Education
ERIC Educational Resources Information Center
Schindler, Steffen; Reimer, David
2011-01-01
In this paper we investigate social selectivity in access to higher education in Germany and, unlike most previous studies, explicitly devote attention to semi-tertiary institutions such as the so-called universities of cooperative education. Drawing on rational choice models of educational decisions we seek to understand which factors influence…
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US Policies toward Tehran: Redefining Counterproliferation for the Twenty-First Century
2011-01-01
latent weapons power, purposefully not constructing an explicit, fully weaponized arsenal, but rather cultivating and maintaining a hedged nuclear...decisively dropping the popular but empirically dubious assump tion that Iran’s primary intent is to put mushroom clouds over Tel Aviv and Washington as
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A Three-Question Framework to Facilitate Clinical Decision Making
ERIC Educational Resources Information Center
Sibold, Jeremy
2012-01-01
Context: Highly developed critical thinking and the ability to discriminate among many possible therapeutic interventions is a core behavior for the practicing athletic trainer. However, while athletic training students receive a great deal of clinically applicable information, many are not explicitly trained in efficient methods for channeling…
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ERIC Educational Resources Information Center
Cappelli, Peter; Rogovsky, Nikolai
1998-01-01
Organizational citizenship--behavior that promotes organizations without explicit reward--was measured in a survey of 512 employees and 91 supervisors. Involvement in work organization increased citizenship behavior indirectly by changing job characteristics. Involvement in decisions about employment practices had little or no effect. (SK)
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Bringing Consequences and Side Effects of Testing and Assessment to the Foreground
ERIC Educational Resources Information Center
Zumbo, Bruno D.; Hubley, Anita M.
2016-01-01
Ultimately, measures in research, testing, assessment and evaluation are used, or have implications, for ranking, intervention, feedback, decision-making or policy purposes. Explicit recognition of this fact brings the often-ignored and sometimes maligned concept of consequences to the fore. Given that measures have personal and social…
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Spatially explicit animal response to composition of habitat
Benjamin P. Pauli; Nicholas P. McCann; Patrick A. Zollner; Robert Cummings; Jonathan H. Gilbert; Eric J. Gustafson
2013-01-01
Complex decisions dramatically affect animal dispersal and space use. Dispersing individuals respond to a combination of fine-scale environmental stimuli and internal attributes. Individual-based modeling offers a valuable approach for the investigation of such interactions because it combines the heterogeneity of animal behaviors with spatial detail. Most individual-...
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75 FR 70677 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-18
... research and through the promotion of improvements in clinical and health system practices, including the... publicly accessible Web-based database of evidence-based clinical practice guidelines meeting explicit... encouraging the use of evidence to make informed health care decisions. The NGC is a vehicle for such...
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The Partisan Battle over Academic Freedom
ERIC Educational Resources Information Center
Chronicle of Higher Education, 2007
2007-01-01
Citing a pattern of outside interest groups aggressively seeking to impose their influence on recent collegiate hiring and tenure decisions, five prominent professors have formed the Ad Hoc Committee to Defend the University. They are circulating an online petition that takes explicit aim at "groups portraying themselves as defenders of Israel,"…
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Democratic Parenting: Paradoxical Messages in Democratic Parent Education Theories
ERIC Educational Resources Information Center
Oryan, Shlomit; Gastil, John
2013-01-01
Some prominent parent education theories in the United States and other Western countries base their educational viewpoint explicitly on democratic values, such as mutual respect, equality and personal freedom. These democratic parenting theories advocate sharing power with children and including them in family decision making. This study presents…
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Island ecosystems maintain greater endemic biodiversity such that changes in land cover can have dramatic impacts on wildlife populations that depend on unique and limited habitat. Sustainable land use decisions that minimize habitat loss require multi-faceted evaluation of cost...
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There is increasing awareness that improved environmental management can be achieved by considering more explicitly the benefits that humans receive from ecosystems. In a broad sense, the contributions of ecological systems to the health and well being of people can be considered...
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Developmental Effects of Incentives on Response Inhibition
ERIC Educational Resources Information Center
Geier, Charles F.; Luna, Beatriz
2012-01-01
Inhibitory control and incentive processes underlie decision making, yet few studies have explicitly examined their interaction across development. Here, the effects of potential rewards and losses on inhibitory control in 64 adolescents (13- to 17-year-olds) and 42 young adults (18- to 29-year-olds) were examined using an incentivized antisaccade…
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Dilemmas in rationing health care services: the case for implicit rationing.
Mechanic, D
1995-06-24
With tension between the demand for health services and the cost of providing them, rationing is increasingly evident in all medical systems. Until recently, rationing was primarily through the ability to pay or achieved implicitly by doctors working within fixed budgets. Such forms of rationing are commonly alleged to be inequitable and inefficient and explicit rationing is advocated as more appropriate. Utilisation management in the United States and quasi-markets separating purchasing from provision in the United Kingdom are seen as ways of using resources more efficiently and are increasingly explicit. There is also advocacy to ration explicitly at the point of service. Mechanic reviews the implications of these developments and explains why explicit approaches are likely to focus conflict and dissatisfaction and be politically unstable. Explicit rationing is unlikely to be as equitable as its proponents argue and is likely to make dissatisfaction and perceived deprivation more salient. Despite its limitations, implicit rationing at the point of service is more sensitive to the complexity of medical decisions and the needs and personal and cultural preferences of patients. All systems use a mix of rationing devices, but the clinical allocation of services should substantially depend on the discretion of professionals informed by practice guidelines, outcomes research, and other informational aids.
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Dilemmas in rationing health care services: the case for implicit rationing.
Mechanic, D.
1995-01-01
With tension between the demand for health services and the cost of providing them, rationing is increasingly evident in all medical systems. Until recently, rationing was primarily through the ability to pay or achieved implicitly by doctors working within fixed budgets. Such forms of rationing are commonly alleged to be inequitable and inefficient and explicit rationing is advocated as more appropriate. Utilisation management in the United States and quasi-markets separating purchasing from provision in the United Kingdom are seen as ways of using resources more efficiently and are increasingly explicit. There is also advocacy to ration explicitly at the point of service. Mechanic reviews the implications of these developments and explains why explicit approaches are likely to focus conflict and dissatisfaction and be politically unstable. Explicit rationing is unlikely to be as equitable as its proponents argue and is likely to make dissatisfaction and perceived deprivation more salient. Despite its limitations, implicit rationing at the point of service is more sensitive to the complexity of medical decisions and the needs and personal and cultural preferences of patients. All systems use a mix of rationing devices, but the clinical allocation of services should substantially depend on the discretion of professionals informed by practice guidelines, outcomes research, and other informational aids. Images p1657-a p1659-a PMID:7795458
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Bernknopf, Richard L.; Brookshire, David S.; Ganderton, Philip T.
2003-01-01
What role can geoscience information play in the assessment of risk and the value of insurance, especially for natural hazard type risks? In an earlier, related paper Ganderton and others (2000) provided subjects with relatively simple geoscience information concerning natural hazard-type risks. Their research looked at how subjects purchase insurance when faced with relatively low probability but high loss risks of the kind that characterize natural hazards and now, increasingly, manmade disasters. They found evidence to support the expected utility theory (definitions of economics terms can be found in a glossary at the end of report), yet there remained the implication that subjects with excessive aversion to risk were willing to pay considerably more for insurance than the actuarially fair price plus any reasonable risk premium. Here, we report the results of additional experiments that provide further support for the basic postulates of expected utility theory. However, these new experiments add considerably to the decision environment facing subjects by offering an option to purchase geoscientific information that would assist them when calculating expected losses from hazards more accurately. Using an Internet-based mechanism to present information and gather data in an experimental setting, this research provided subjects with considerable textual and graphical information, and time to process it. Over a period of three months, almost 400 subjects participated in on-line experiments that generated approximately 22,000 usable data points for the empirical analysis discussed in this report. In the design of the experiment, we modeled the decisions to purchase (1) a detailed map giving subjects more information regarding the distribution of losses from a hazard and (2) insurance to indemnify them from any losses should they occur. On the basis of this design, we find strong evidence in support of the expected utility theory. Many of the findings reinforce those found in the early, similar study (Ganderton and others, 2000). However, this research also finds interactions between the decision to become better informed and the decision to insure. We chose an empirical framework that allows for both explicit and implicit (unobservable) correlations between the two decisions. The results suggest that at the end of the computer game subjects recognize the benefits of greater geoscience information. They take advantage of it, but are sensitive to its cost. When subjects use the more detailed information, they are more likely to purchase insurance when it offers a net benefit.
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Advancing reservoir operation description in physically based hydrological models
NASA Astrophysics Data System (ADS)
Anghileri, Daniela; Giudici, Federico; Castelletti, Andrea; Burlando, Paolo
2016-04-01
Last decades have seen significant advances in our capacity of characterizing and reproducing hydrological processes within physically based models. Yet, when the human component is considered (e.g. reservoirs, water distribution systems), the associated decisions are generally modeled with very simplistic rules, which might underperform in reproducing the actual operators' behaviour on a daily or sub-daily basis. For example, reservoir operations are usually described by a target-level rule curve, which represents the level that the reservoir should track during normal operating conditions. The associated release decision is determined by the current state of the reservoir relative to the rule curve. This modeling approach can reasonably reproduce the seasonal water volume shift due to reservoir operation. Still, it cannot capture more complex decision making processes in response, e.g., to the fluctuations of energy prices and demands, the temporal unavailability of power plants or varying amount of snow accumulated in the basin. In this work, we link a physically explicit hydrological model with detailed hydropower behavioural models describing the decision making process by the dam operator. In particular, we consider two categories of behavioural models: explicit or rule-based behavioural models, where reservoir operating rules are empirically inferred from observational data, and implicit or optimization based behavioural models, where, following a normative economic approach, the decision maker is represented as a rational agent maximising a utility function. We compare these two alternate modelling approaches on the real-world water system of Lake Como catchment in the Italian Alps. The water system is characterized by the presence of 18 artificial hydropower reservoirs generating almost 13% of the Italian hydropower production. Results show to which extent the hydrological regime in the catchment is affected by different behavioural models and reservoir operating strategies.
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NASA Astrophysics Data System (ADS)
Knight, Victoria Floyd
Supported electronic text (eText), or text that has been altered to increase access and provide support to learners, may promote comprehension of science content for students with disabilities. According to CAST, Book Builder(TM) uses supported eText to promote reading for meaning for all students. Although little research has been conducted in the area of supported eText for students with autism spectrum disorders (ASD), technology (e.g., computer assisted instruction) has been used for over 35 years to instruct students with ASD in academic areas. The purpose of this study was to evaluate the effects of a supported eText and explicit instruction on the science vocabulary and comprehension of four middle school students with ASD. Researchers used a multiple probe across participants design to evaluate the Book Builder (TM) program on measures of vocabulary, literal comprehension, and application questions. Results indicated a functional relation between the Book Builder(TM) and explicit instruction (i.e., model-lead-test, examples and non-examples, and referral to the definition) and the number of correct responses on the probe. In addition, students were able to generalize concepts to untrained exemplars. Finally, teachers and students validate the program as practical and useful.
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Visual sensory networks and effective information transfer in animal groups.
Strandburg-Peshkin, Ariana; Twomey, Colin R; Bode, Nikolai W F; Kao, Albert B; Katz, Yael; Ioannou, Christos C; Rosenthal, Sara B; Torney, Colin J; Wu, Hai Shan; Levin, Simon A; Couzin, Iain D
2013-09-09
Social transmission of information is vital for many group-living animals, allowing coordination of motion and effective response to complex environments. Revealing the interaction networks underlying information flow within these groups is a central challenge. Previous work has modeled interactions between individuals based directly on their relative spatial positions: each individual is considered to interact with all neighbors within a fixed distance (metric range), a fixed number of nearest neighbors (topological range), a 'shell' of near neighbors (Voronoi range), or some combination (Figure 1A). However, conclusive evidence to support these assumptions is lacking. Here, we employ a novel approach that considers individual movement decisions to be based explicitly on the sensory information available to the organism. In other words, we consider that while spatial relations do inform interactions between individuals, they do so indirectly, through individuals' detection of sensory cues. We reconstruct computationally the visual field of each individual throughout experiments designed to investigate information propagation within fish schools (golden shiners, Notemigonus crysoleucas). Explicitly considering visual sensing allows us to more accurately predict the propagation of behavioral change in these groups during leadership events. Furthermore, we find that structural properties of visual interaction networks differ markedly from those of metric and topological counterparts, suggesting that previous assumptions may not appropriately reflect information flow in animal groups. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Student portfolios and the hidden curriculum on gender: mapping exclusion.
Phillips, Christine B
2009-09-01
The hidden curriculum - the norms, values and practices that are transmitted to students through modelling by preceptors and teachers, and decisions about curricular exclusions and inclusions - can be profoundly important in the socialising of trainee doctors. However, tracking the hidden curriculum as it evolves can be challenging for medical schools. This study aimed to explore the content of student e-portfolios on gender issues, a key perspective often taught through a hidden curriculum. Online posts for a gender and medicine e-portfolio task completed by two cohorts of students in Year 3 of a 4-year medical course (n = 167, 66% female) were analysed using a grounded theory approach. A process of gendered 'othering' was applied to both men and women in the medical school using different pedagogical strategies. Curricular emphases on women's health and lack of support for male students to acquire gynaecological examination skills were seen as explicit ways of excluding males. For female medical students, exclusion tended to be implicit, operating through modelling and aphoristic comments about so-called 'female-friendly' career choices and the negative impact of motherhood on career. E-portfolios can be a useful way of tracking the hidden curriculum as it evolves. Responses to gendered exclusion may be developed more readily for the explicit processes impacting on male students than for the implicit processes impacting on female students, which often reflect structural issues related to training and employment.
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Creating and sharing clinical decision support content with Web 2.0: Issues and examples.
Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F
2009-04-01
Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.
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Reducing uncertainty about objective functions in adaptive management
Williams, B.K.
2012-01-01
This paper extends the uncertainty framework of adaptive management to include uncertainty about the objectives to be used in guiding decisions. Adaptive decision making typically assumes explicit and agreed-upon objectives for management, but allows for uncertainty as to the structure of the decision process that generates change through time. Yet it is not unusual for there to be uncertainty (or disagreement) about objectives, with different stakeholders expressing different views not only about resource responses to management but also about the appropriate management objectives. In this paper I extend the treatment of uncertainty in adaptive management, and describe a stochastic structure for the joint occurrence of uncertainty about objectives as well as models, and show how adaptive decision making and the assessment of post-decision monitoring data can be used to reduce uncertainties of both kinds. Different degrees of association between model and objective uncertainty lead to different patterns of learning about objectives. ?? 2011.
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A model for making project funding decisions at the National Cancer Institute.
Hall, N G; Hershey, J C; Kessler, L G; Stotts, R C
1992-01-01
This paper describes the development of a model for making project funding decisions at The National Cancer Institute (NCI). The American Stop Smoking Intervention Study (ASSIST) is a multiple-year, multiple-site demonstration project, aimed at reducing smoking prevalence. The initial request for ASSIST proposals was answered by about twice as many states as could be funded. Scientific peer review of the proposals was the primary criterion used for funding decisions. However, a modified Delphi process made explicit several criteria of secondary importance. A structured questionnaire identified the relative importance of these secondary criteria, some of which we incorporated into a composite preference function. We modeled the proposal funding decision as a zero-one program, and adjusted the preference function and available budget parametrically to generate many suitable outcomes. The actual funding decision, identified by our model, offers significant advantages over manually generated solutions found by experts at NCI.
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From moral to legal judgment: the influence of normative context in lawyers and other academics
Spranger, Tade M.; Erk, Susanne; Walter, Henrik
2011-01-01
Various kinds of normative judgments are an integral part of everyday life. We extended the scrutiny of social cognitive neuroscience into the domain of legal decisions, investigating two groups, lawyers and other academics, during moral and legal decision-making. While we found activation of brain areas comprising the so-called ‘moral brain’ in both conditions, there was stronger activation in the left dorsolateral prefrontal cortex and middle temporal gyrus particularly when subjects made legal decisions, suggesting that these were made in respect to more explicit rules and demanded more complex semantic processing. Comparing both groups, our data show that behaviorally lawyers conceived themselves as emotionally less involved during normative decision-making in general. A group × condition interaction in the dorsal anterior cingulate cortex suggests a modulation of normative decision-making by attention based on subjects’ normative expertise. PMID:20194515
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From moral to legal judgment: the influence of normative context in lawyers and other academics.
Schleim, Stephan; Spranger, Tade M; Erk, Susanne; Walter, Henrik
2011-01-01
Various kinds of normative judgments are an integral part of everyday life. We extended the scrutiny of social cognitive neuroscience into the domain of legal decisions, investigating two groups, lawyers and other academics, during moral and legal decision-making. While we found activation of brain areas comprising the so-called 'moral brain' in both conditions, there was stronger activation in the left dorsolateral prefrontal cortex and middle temporal gyrus particularly when subjects made legal decisions, suggesting that these were made in respect to more explicit rules and demanded more complex semantic processing. Comparing both groups, our data show that behaviorally lawyers conceived themselves as emotionally less involved during normative decision-making in general. A group × condition interaction in the dorsal anterior cingulate cortex suggests a modulation of normative decision-making by attention based on subjects' normative expertise.
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Implicit and explicit processing of kanji and kana words and non-words studied with fMRI.
Thuy, Dinh Ha Duy; Matsuo, Kayako; Nakamura, Kimihiro; Toma, Keiichiro; Oga, Tatsuhide; Nakai, Toshiharu; Shibasaki, Hiroshi; Fukuyama, Hidenao
2004-11-01
Using functional magnetic resonance imaging (fMRI), we investigated the implicit language processing of kanji and kana words (i.e., hiragana transcriptions of normally written kanji words) and non-words. Twelve right-handed native Japanese speakers performed size judgments for character stimuli (implicit language task for linguistic stimuli), size judgments for scrambled-character stimuli (implicit language task for non-linguistic stimuli), and lexical decisions (explicit language task). The size judgments for scrambled-kanji stimuli and scrambled-kana stimuli produced activations on the bilateral lingual gyri (BA 18), the bilateral occipitotemporal regions (BA 19/37), and the bilateral superior and inferior parietal cortices (BA 7/40). Interestingly, besides these areas, activations of the left inferior frontal region (Broca's area, BA 44/45) and the left posterior inferior temporal cortex (PITC, BA 37), which have been considered as language areas, were additionally activated during size judgment for kanji character stimuli. Size judgment for kana character stimuli also activated Broca's area, the left PITC, and the left supramarginal gyrus (SMG, BA 40). The activations of these language areas were replicated in the lexical decisions for both kanji and kana. These findings suggest that language processing of both kanji and kana scripts is obligatory to literate Japanese subjects. Moreover, comparison between the scrambled kanji and the scrambled kana showed no activation in the language areas, while greater activation in the bilateral fusiform gyri (left-side predominant) was found in kanji vs. kana comparison during the size judgment and the lexical decision. Kana minus kanji activated the left SMG during the size judgment, and Broca's area and the left middle/superior temporal junction during the lexical decision. These results probably reflect that in implicit or explicit reading of kanji words and kana words (i.e., hiragana transcriptions of kanji words), although using largely overlapping cortical regions, there are still some differences. Kanji reading may involve more heavily visual orthographic retrieval and lexical-semantic system through the ventral route, while kana transcriptions of kanji words require phonological recoding to gain semantic access through the dorsal route.
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Decision theory and the evaluation of risks and benefits of clinical trials.
Bernabe, Rosemarie D C; van Thiel, Ghislaine J M W; Raaijmakers, Jan A M; van Delden, Johannes J M
2012-12-01
Research ethics committees (RECs) are tasked to assess the risks and the benefits of a clinical trial. In previous studies, it was shown that RECs find this task difficult, if not impossible, to do. The current approaches to benefit-risk assessment (i.e. Component Analysis and the Net Risk Test) confound the various risk-benefit tasks, and as such, make balancing impossible. In this article, we show that decision theory, specifically through the expected utility theory and multiattribute utility theory, enable for an explicit and ethically weighted risk-benefit evaluation. This makes a balanced ethical justification possible, and thus a more rationally defensible decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Algorithms for optimizing the treatment of depression: making the right decision at the right time.
Adli, M; Rush, A J; Möller, H-J; Bauer, M
2003-11-01
Medication algorithms for the treatment of depression are designed to optimize both treatment implementation and the appropriateness of treatment strategies. Thus, they are essential tools for treating and avoiding refractory depression. Treatment algorithms are explicit treatment protocols that provide specific therapeutic pathways and decision-making tools at critical decision points throughout the treatment process. The present article provides an overview of major projects of algorithm research in the field of antidepressant therapy. The Berlin Algorithm Project and the Texas Medication Algorithm Project (TMAP) compare algorithm-guided treatments with treatment as usual. The Sequenced Treatment Alternatives to Relieve Depression Project (STAR*D) compares different treatment strategies in treatment-resistant patients.
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Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L
2016-01-01
OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058
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Haeffel, Gerald J; Abramson, Lyn Y; Brazy, Paige C; Shah, James Y; Teachman, Bethany A; Nosek, Brian A
2007-06-01
Two studies were conducted to test a dual-process theory of cognitive vulnerability to depression. According to this theory, implicit and explicit cognitive processes have differential effects on depressive reactions to stressful life events. Implicit processes are hypothesized to be critical in determining an individual's immediate affective reaction to stress whereas explicit cognitions are thought to be more involved in long-term depressive reactions. Consistent with hypotheses, the results of study 1 (cross-sectional; N=237) showed that implicit, but not explicit, cognitions predicted immediate affective reactions to a lab stressor. Study 2 (longitudinal; N=251) also supported the dual-process model of cognitive vulnerability to depression. Results showed that both the implicit and explicit measures interacted with life stress to predict prospective changes in depressive symptoms, respectively. However, when both implicit and explicit predictors were entered into a regression equation simultaneously, only the explicit measure interacted with stress to remain a unique predictor of depressive symptoms over the five-week prospective interval.
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Wood, Alexander
2004-01-01
This interim report describes an alternative approach for evaluating the efficacy of using mercury (Hg) offsets to improve water quality. Hg-offset programs may allow dischargers facing higher-pollution control costs to meet their regulatory obligations by making more cost effective pollutant-reduction decisions. Efficient Hg management requires methods to translate that science and economics into a regulatory decision framework. This report documents the work in progress by the U.S. Geological Surveys Western Geographic Science Center in collaboration with Stanford University toward developing this decision framework to help managers, regulators, and other stakeholders decide whether offsets can cost effectively meet the Hg total maximum daily load (TMDL) requirements in the Sacramento River watershed. Two key approaches being considered are: (1) a probabilistic approach that explicitly incorporates scientific uncertainty, cost information, and value judgments; and (2) a quantitative approach that captures uncertainty in testing the feasibility of Hg offsets. Current fate and transport-process models commonly attempt to predict chemical transformations and transport pathways deterministically. However, the physical, chemical, and biologic processes controlling the fate and transport of Hg in aquatic environments are complex and poorly understood. Deterministic models of Hg environmental behavior contain large uncertainties, reflecting this lack of understanding. The uncertainty in these underlying physical processes may produce similarly large uncertainties in the decisionmaking process. However, decisions about control strategies are still being made despite the large uncertainties in current Hg loadings, the relations between total Hg (HgT) loading and methylmercury (MeHg) formation, and the relations between control efforts and Hg content in fish. The research presented here focuses on an alternative analytical approach to the current use of safety factors and deterministic methods for Hg TMDL decision support, one that is fully compatible with an adaptive management approach. This alternative approach uses empirical data and informed judgment to provide a scientific and technical basis for helping National Pollutant Discharge Elimination System (NPDES) permit holders make management decisions. An Hg-offset system would be an option if a wastewater-treatment plant could not achieve NPDES permit requirements for HgT reduction. We develop a probabilistic decision-analytical model consisting of three submodels for HgT loading, MeHg, and cost mitigation within a Bayesian network that integrates information of varying rigor and detail into a simple model of a complex system. Hg processes are identified and quantified by using a combination of historical data, statistical models, and expert judgment. Such an integrated approach to uncertainty analysis allows easy updating of prediction and inference when observations of model variables are made. We demonstrate our approach with data from the Cache Creek watershed (a subbasin of the Sacramento River watershed). The empirical models used to generate the needed probability distributions are based on the same empirical models currently being used by the Central Valley Regional Water Quality Control Cache Creek Hg TMDL working group. The significant difference is that input uncertainty and error are explicitly included in the model and propagated throughout its algorithms. This work demonstrates how to integrate uncertainty into the complex and highly uncertain Hg TMDL decisionmaking process. The various sources of uncertainty are propagated as decision risk that allows decisionmakers to simultaneously consider uncertainties in remediation/implementation costs while attempting to meet environmental/ecologic targets. We must note that this research is on going. As more data are collected, the HgT and cost-mitigation submodels are updated and the uncer
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van Tuijl, Lonneke A; de Jong, Peter J; Sportel, B Esther; de Hullu, Eva; Nauta, Maaike H
2014-03-01
A negative self-view is a prominent factor in most cognitive vulnerability models of depression and anxiety. Recently, there has been increased attention to differentiate between the implicit (automatic) and the explicit (reflective) processing of self-related evaluations. This longitudinal study aimed to test the association between implicit and explicit self-esteem and symptoms of adolescent depression and social anxiety disorder. Two complementary models were tested: the vulnerability model and the scarring effect model. Participants were 1641 first and second year pupils of secondary schools in the Netherlands. The Rosenberg Self-Esteem Scale, self-esteem Implicit Association Test and Revised Child Anxiety and Depression Scale were completed to measure explicit self-esteem, implicit self-esteem and symptoms of social anxiety disorder (SAD) and major depressive disorder (MDD), respectively, at baseline and two-year follow-up. Explicit self-esteem at baseline was associated with symptoms of MDD and SAD at follow-up. Symptomatology at baseline was not associated with explicit self-esteem at follow-up. Implicit self-esteem was not associated with symptoms of MDD or SAD in either direction. We relied on self-report measures of MDD and SAD symptomatology. Also, findings are based on a non-clinical sample. Our findings support the vulnerability model, and not the scarring effect model. The implications of these findings suggest support of an explicit self-esteem intervention to prevent increases in MDD and SAD symptomatology in non-clinical adolescents. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Collaborative decision-analytic framework to maximize resilience of tidal marshes to climate change
Thorne, Karen M.; Mattsson, Brady J.; Takekawa, John Y.; Cummings, Jonathan; Crouse, Debby; Block, Giselle; Bloom, Valary; Gerhart, Matt; Goldbeck, Steve; Huning, Beth; Sloop, Christina; Stewart, Mendel; Taylor, Karen; Valoppi, Laura
2015-01-01
Decision makers that are responsible for stewardship of natural resources face many challenges, which are complicated by uncertainty about impacts from climate change, expanding human development, and intensifying land uses. A systematic process for evaluating the social and ecological risks, trade-offs, and cobenefits associated with future changes is critical to maximize resilience and conserve ecosystem services. This is particularly true in coastal areas where human populations and landscape conversion are increasing, and where intensifying storms and sea-level rise pose unprecedented threats to coastal ecosystems. We applied collaborative decision analysis with a diverse team of stakeholders who preserve, manage, or restore tidal marshes across the San Francisco Bay estuary, California, USA, as a case study. Specifically, we followed a structured decision-making approach, and we using expert judgment developed alternative management strategies to increase the capacity and adaptability to manage tidal marsh resilience while considering uncertainties through 2050. Because sea-level rise projections are relatively confident to 2050, we focused on uncertainties regarding intensity and frequency of storms and funding. Elicitation methods allowed us to make predictions in the absence of fully compatible models and to assess short- and long-term trade-offs. Specifically we addressed two questions. (1) Can collaborative decision analysis lead to consensus among a diverse set of decision makers responsible for environmental stewardship and faced with uncertainties about climate change, funding, and stakeholder values? (2) What is an optimal strategy for the conservation of tidal marshes, and what strategy is robust to the aforementioned uncertainties? We found that when taking this approach, consensus was reached among the stakeholders about the best management strategies to maintain tidal marsh integrity. A Bayesian decision network revealed that a strategy considering sea-level rise and storms explicitly in wetland restoration planning and designs was optimal, and it was robust to uncertainties about management effectiveness and budgets. We found that strategies that avoided explicitly accounting for future climate change had the lowest expected performance based on input from the team. Our decision-analytic framework is sufficiently general to offer an adaptable template, which can be modified for use in other areas that include a diverse and engaged stakeholder group.
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Adaptive management of large aquatic ecosystem recovery programs in the United States.
Thom, Ronald; St Clair, Tom; Burns, Rebecca; Anderson, Michael
2016-12-01
Adaptive management (AM) is being employed in a number of programs in the United States to guide actions to restore aquatic ecosystems because these programs are both expensive and are faced with significant uncertainties. Many of these uncertainties are associated with prioritizing when, where, and what kind of actions are needed to meet the objectives of enhancing ecosystem services and recovering threatened and endangered species. We interviewed nine large-scale aquatic ecosystem restoration programs across the United States to document the lessons learned from implementing AM. In addition, we recorded information on ecological drivers (e.g., endangered fish species) for the program, and inferred how these drivers reflected more generic ecosystem services. Ecosystem services (e.g., genetic diversity, cultural heritage), albeit not explicit drivers, were either important to the recovery or enhancement of the drivers, or were additional benefits associated with actions to recover or enhance the program drivers. Implementing programs using AM lessons learned has apparently helped achieve better results regarding enhancing ecosystem services and restoring target species populations. The interviews yielded several recommendations. The science and AM program must be integrated into how the overall restoration program operates in order to gain understanding and support, and effectively inform management decision-making. Governance and decision-making varied based on its particular circumstances. Open communication within and among agency and stakeholder groups and extensive vetting lead up to decisions. It was important to have an internal agency staff member to implement the AM plan, and a clear designation of roles and responsibilities, and long-term commitment of other involved parties. The most important management questions and information needs must be identified up front. It was imperative to clearly identify, link and continually reinforce the essential components of an AM plan, including objectives, constraints, uncertainties, hypotheses, management actions, decision criteria and triggers, monitoring, and research. Some employed predictive models and the results of research on uncertainties to vet options for actions. Many relied on best available science and professional judgment to decide if adjustments to actions were needed. All programs emphasized the need to be nimble enough to be responsive to new information and make necessary adjustments to management action implementation. We recommend that ecosystem services be explicit drivers of restoration programs to facilitate needed funding and communicate to the general public and with the global efforts on restoring and conserving ecosystems. Copyright © 2016 Elsevier Ltd. All rights reserved.
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How We Choose One over Another: Predicting Trial-by-Trial Preference Decision
Bhushan, Vidya; Saha, Goutam; Lindsen, Job; Shimojo, Shinsuke; Bhattacharya, Joydeep
2012-01-01
Preference formation is a complex problem as it is subjective, involves emotion, is led by implicit processes, and changes depending on the context even within the same individual. Thus, scientific attempts to predict preference are challenging, yet quite important for basic understanding of human decision making mechanisms, but prediction in a group-average sense has only a limited significance. In this study, we predicted preferential decisions on a trial by trial basis based on brain responses occurring before the individuals made their decisions explicit. Participants made a binary preference decision of approachability based on faces while their electrophysiological responses were recorded. An artificial neural network based pattern-classifier was used with time-frequency resolved patterns of a functional connectivity measure as features for the classifier. We were able to predict preference decisions with a mean accuracy of 74.3±2.79% at participant-independent level and of 91.4±3.8% at participant-dependent level. Further, we revealed a causal role of the first impression on final decision and demonstrated the temporal trajectory of preference decision formation. PMID:22912859
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Sarriot, Eric G; Kouletio, Michelle; Jahan, Dr Shamim; Rasul, Izaz; Musha, Akm
2014-08-26
Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project. Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan,, and repeated stakeholder engagement in analysis and decisions . Formal assessments took place up to 5 years post-project (2009). Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap achieved during the project were largely maintained post-project. Sustainability is dynamic and results from local systems processes, which can be strengthened through both implicit and explicit systems thinking steps applied with constancy of purpose.
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NASA Technical Reports Server (NTRS)
Shepard, Timothy J.; Partridge, Craig; Coulter, Robert
1997-01-01
The designers of the TCP/IP protocol suite explicitly included support of satellites in their design goals. The goal of the Internet Project was to design a protocol which could be layered over different networking technologies to allow them to be concatenated into an internet. The results of this project included two protocols, IP and TCP. IP is the protocol used by all elements in the network and it defines the standard packet format for IP datagrams. TCP is the end-to-end transport protocol commonly used between end systems on the Internet to derive a reliable bi-directional byte-pipe service from the underlying unreliable IP datagram service. Satellite links are explicitly mentioned in Vint Cerf's 2-page article which appeared in 1980 in CCR [2] to introduce the specifications for IP and TCP. In the past fifteen years, TCP has been demonstrated to work over many differing networking technologies, including over paths including satellites links. So if satellite links were in the minds of the designers from the beginning, what is the problem? The problem is that the performance of TCP has in some cases been disappointing. A goal of the authors of the original specification of TCP was to specify only enough behavior to ensure interoperability. The specification left a number of important decisions, in particular how much data is to be sent when, to the implementor. This was deliberately' done. By leaving performance-related decisions to the implementor, this would allow the protocol TCP to be tuned and adapted to different networks and situations in the future without the need to revise the specification of the protocol, or break interoperability. Interoperability would continue while future implementations would be allowed flexibility to adapt to needs which could not be anticipated at the time of the original protocol design.
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Labiosa, Bill; Forney, William M.; Hearn,, Paul P.; Hogan, Dianna M.; Strong, David R.; Swain, Eric D.; Esnard, Ann-Margaret; Mitsova-Boneva, D.; Bernknopf, R.; Pearlstine, Leonard; Gladwin, Hugh
2013-01-01
Land-use land-cover change is one of the most important and direct drivers of changes in ecosystem functions and services. Given the complexity of the decision-making, there is a need for Internet-based decision support systems with scenario evaluation capabilities to help planners, resource managers and communities visualize, compare and consider trade-offs among the many values at stake in land use planning. This article presents details on an Ecosystem Portfolio Model (EPM) prototype that integrates ecological, socio-economic information and associated values of relevance to decision-makers and stakeholders. The EPM uses a multi-criteria scenario evaluation framework, Geographic Information Systems (GIS) analysis and spatially-explicit land-use/land-cover change-sensitive models to characterize changes in important land-cover related ecosystem values related to ecosystem services and functions, land parcel prices, and community quality-of-life (QoL) metrics. Parameters in the underlying models can be modified through the interface, allowing users in a facilitated group setting to explore simultaneously issues of scientific uncertainty and divergence in the preferences of stakeholders. One application of the South Florida EPM prototype reported in this article shows the modeled changes (which are significant) in aggregate ecological value, landscape patterns and fragmentation, biodiversity potential and ecological restoration potential for current land uses compared to the 2050 land-use scenario. Ongoing refinements to EPM, and future work especially in regard to modifiable sea level rise scenarios are also discussed.
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NASA Astrophysics Data System (ADS)
Lamelas, M. T.; Hoppe, A.; de la Riva, J.; Marinoni, O.
2009-10-01
Land-use decisions are usually made on the basis of a variety of criteria. While it is common practice to integrate economic, ecological and social (triple bottom line) criteria, explicit geoscientific factors are relatively rarely considered. If a planned land use involves an interaction with the geosphere, geoscientific aspects should be playing a more important role in the process. With the objective to facilitate a sustainable land-use decision-making a research project was initiated. The area around the city of Zaragoza, in the Ebro Basin of northern Spain, was chosen due to its high degree of industrialisation and urbanization. The area is exposed to several geohazards (e.g., sinkholes and erosion) that may have significant negative effects on current and future land uses. Geographical Information System (GIS) technologies are used to process the complex geoscientific information. Further GIS analysis comprised the creation of an erosion susceptibility map that follows the ITC (International Institute for Geo-Information Science and Earth Observation) system of terrain analysis. The agricultural capability of the soil was determined using the Microleis System. We identify geomorphologic units that show high susceptibility to erosion and high agricultural potential and suggest a method to implement this information in a land-use planning process. Degraded slopes developed upon Tertiary rocks show the highest susceptibility to erosion and low values of agricultural capability, whereas the flat valley bottoms and irrigated flood plains have the highest values of agricultural capability.
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Electronic decision support for diagnostic imaging in a primary care setting
Reed, Martin H
2011-01-01
Methods Clinical guideline adherence for diagnostic imaging (DI) and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 DI orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. Results Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their DI order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their work flow, which dropped to 16% as physicians gained experience with the software. Conclusions Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine work flow. PMID:21486884
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Moreno Zegbe, Estephania; Becerril Montekio, Víctor; Alcalde Rabanal, Jacqueline
To identify coincidences and differences in the identification and prioritization of maternal healthcare service problems in Mexico based on the perspective of tacit knowledge and explicit knowledge that may offer evidence that can contribute to attaining the Sustainable Development Goals. Mixed study performed in three stages: 1) systematization of maternal healthcare service problems identified by tacit knowledge (derived from professional experience); 2) identification of maternal healthcare service problems in Latin America addressed by explicit knowledge (scientific publications); 3) comparison between the problems identified by tacit and explicit knowledge. The main problems of maternal health services identified by tacit knowledge are related to poor quality of care, while the predominant problems studied in the scientific literature are related to access barriers to health services. Approximately, 70% of the problems identified by tacit knowledge are also mentioned in the explicit knowledge. Conversely, 70% of the problems identified in the literature are also considered by tacit knowledge. Nevertheless, when looking at the problems taken one by one, no statistically significant similarities were found. The study discovered that the identification of maternal health service problems by tacit knowledge and explicit knowledge is fairly comparable, according to the comparability index used in the study, and highlights the interest of integrating both approaches in order to improve prioritization and decision making towards the Sustainable Development Goals. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
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Watson, Joanne; Wilson, Erin; Hagiliassis, Nick
2017-11-01
The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life. All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference. Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life. © 2017 John Wiley & Sons Ltd.
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Kaner, Eileen; Heaven, Ben; Rapley, Tim; Murtagh, Madeleine; Graham, Ruth; Thomson, Richard; May, Carl
2007-01-10
Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. Median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19-26) minutes to work through compared to 31 (16-41) minutes for the implicit tool; and 44 (39-55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58-66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation Irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary care.
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Spatial-explicit modeling of social vulnerability to malaria in East Africa
2014-01-01
Background Despite efforts in eradication and control, malaria remains a global challenge, particularly affecting vulnerable groups. Despite the recession in malaria cases, previously malaria free areas are increasingly confronted with epidemics as a result of changing environmental and socioeconomic conditions. Next to modeling transmission intensities and probabilities, integrated spatial methods targeting the complex interplay of factors that contribute to social vulnerability are required to effectively reduce malaria burden. We propose an integrative method for mapping relative levels of social vulnerability in a spatially explicit manner to support the identification of intervention measures. Methods Based on a literature review, a holistic risk and vulnerability framework has been developed to guide the assessment of social vulnerability to water-related vector-borne diseases (VBDs) in the context of changing environmental and societal conditions. Building on the framework, this paper applies spatially explicit modeling for delineating homogeneous regions of social vulnerability to malaria in eastern Africa, while taking into account expert knowledge for weighting the single vulnerability indicators. To assess the influence of the selected indicators on the final index a local sensitivity analysis is carried out. Results Results indicate that high levels of malaria vulnerability are concentrated in the highlands, where immunity within the population is currently low. Additionally, regions with a lack of access to education and health services aggravate vulnerability. Lower values can be found in regions with relatively low poverty, low population pressure, low conflict density and reduced contributions from the biological susceptibility domain. Overall, the factors characterizing vulnerability vary spatially in the region. The vulnerability index reveals a high level of robustness in regard to the final choice of input datasets, with the exception of the immunity indicator which has a marked impact on the composite vulnerability index. Conclusions We introduce a conceptual framework for modeling risk and vulnerability to VBDs. Drawing on the framework we modeled social vulnerability to malaria in the context of global change using a spatially explicit approach. The results provide decision makers with place-specific options for targeting interventions that aim at reducing the burden of the disease amongst the different vulnerable population groups. PMID:25127688
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Ludvig, Elliot A; Spetch, Marcia L
2011-01-01
When faced with risky decisions, people tend to be risk averse for gains and risk seeking for losses (the reflection effect). Studies examining this risk-sensitive decision making, however, typically ask people directly what they would do in hypothetical choice scenarios. A recent flurry of studies has shown that when these risky decisions include rare outcomes, people make different choices for explicitly described probabilities than for experienced probabilistic outcomes. Specifically, rare outcomes are overweighted when described and underweighted when experienced. In two experiments, we examined risk-sensitive decision making when the risky option had two equally probable (50%) outcomes. For experience-based decisions, there was a reversal of the reflection effect with greater risk seeking for gains than for losses, as compared to description-based decisions. This fundamental difference in experienced and described choices cannot be explained by the weighting of rare events and suggests a separate subjective utility curve for experience.