Resource Guide: Selected Early Childhood/Early Intervention Training Materials. 9th Edition. Systems Change in Personnel Preparation.

ERIC Educational Resources Information Center

Catlett, Camille, Ed.; Winton, Pamela J., Ed.

This resource guide identifies and describes early childhood education teaching, training, and staff development materials that meet three basic criteria: good, readily available, and inexpensive. It is designed to provide educators, trainers, supervisors, and other personnel preparation decision makers with resources for designing quality…

Experience in Decision Making for Students of Social and Industrial Psychology: A Guided Design Project in Industrial Consulting.

ERIC Educational Resources Information Center

Miller, Duane I.

According to Wales and Stager, Guided Design is an instructional strategy built on an eclectic integration of psychological principles and viewpoints, wbich incorporates the learning principles of practice, modeling, organizations, and reinforcements; capitalizes on the motivational principles of affiliation, achievement and self-actualization;…

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Helping Youth Decide: A Workshop Guide.

ERIC Educational Resources Information Center

Duquette, Donna Marie; Boo, Katherine

This guide was written to complement the publication "Helping Youth Decide," a manual designed to help parents develop effective parent-child communication and help their children make responsible decisions during the adolescent years. The workshop guide is intended to assist people who work with families to provide additional information and…

76 FR 56466 - Notice of Intent to Prepare an Environmental Document and Proposed Plan Amendment for the West...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... Vehicle Access Element of the CDCA Plan for the WEMO area; and (2) Alternative processes for designating.... Identification of the process and decision criteria that should be used to designate routes in the sub-regional... analysis, and guide the entire process from plan decision-making to route designation review in order to...

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

PubMed Central

Hitchcock, Elaine R.; Ferron, John

2017-01-01

Purpose Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. Method This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Conclusions Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders. PMID:28595354

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders.

PubMed

Byun, Tara McAllister; Hitchcock, Elaine R; Ferron, John

2017-06-10

Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

Rural expressway intersection safety toolbox : desktop reference.

DOT National Transportation Integrated Search

2011-06-01

This document is intended to be a guide for planning-level decisions concerning safety : issues and subsequent potential improvements at rural expressway intersections. It is : NOT a design guide. It simply presents the gamut of safety treatment opti...

Philosophy versus Student Need? A Reply to Smith and Hilton.

ERIC Educational Resources Information Center

Rainforth, Beverly

1994-01-01

This response to Smith and Hilton (1994) suggests that those authors reject philosophical bases for decision making regarding program design for students with mental retardation while actually proposing their own philosophical base for such decision making. The importance of philosophy in guiding decisions and practice over the last several…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 3.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 3, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 1.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 1, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 2.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 2, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 4.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 4, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 6.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 6, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Making Nutrition Education Count: A Guide for Nutrition Education K-6. Grade 5.

ERIC Educational Resources Information Center

Kratky, Patricia; Haigh, Lois

This curriculum guide for nutrition education grade 5, was designed to incorporate knowledge of thirteen concepts into the child's decision-making processes as a food consumer. These concepts, as covered by the guide, are: affecting bodily well-being through nutrition; affecting dental health through nutrition; models for diet selection;…

Oakland County Science Safety Series: Reference Guide for Elementary Science.

ERIC Educational Resources Information Center

Crowder, Betty Pogue; And Others

This reference guide is designed to organize and suggest acceptable practices and procedures for dealing with safety in elementary science instruction. It is intended as a reference for teachers, administrators, and other school staff in planning for science activities and in making daily safety decisions. Topics covered in the guide include: (1)…

The Balancing Act: How Utility Rates Are Decided. Teacher/Facilitator's Guide.

ERIC Educational Resources Information Center

American Gas Association, Arlington, VA. Educational Services.

Designed for secondary level students, this guide describes the process of establishing utility rates for gas, electricity, telephone, or water services. Insights are presented into the parties and interests involved in rate changes, along with procedures and issues that influence decision-making. The goals of this teaching guide include: (1)…

The role of analogy-guided learning experiences in enhancing students' clinical decision-making skills.

PubMed

Edelen, Bonnie Gilbert; Bell, Alexandra Alice

2011-08-01

The purpose of this study was to address the need for effective educational interventions to promote students' clinical decision making (CDM) within clinical practice environments. Researchers used a quasi-experimental, non-equivalent groups, posttest-only design to assess differences in CDM ability between intervention group students who participated in analogy-guided learning activities and control group students who participated in traditional activities. For the intervention, analogy-guided learning activities were incorporated into weekly group discussions, reflective journal writing, and questioning with clinical faculty. The researcher-designed Assessment of Clinical Decision Making Rubric was used to assess indicators of CDM ability in all students' reflective journal entries. Results indicated that the intervention group demonstrated significantly higher levels of CDM ability in their journals compared with the control group (ES(sm) = 0.52). Recommendations provide nurse educators with strategies to maximize students' development of CDM ability, better preparing students for the demands they face when they enter the profession. Copyright 2011, SLACK Incorporated.

Structuring Disaster Recovery Infrastructure Decisions: Lessons from Boulder County's 2013 Flood Recovery

NASA Astrophysics Data System (ADS)

Clavin, C.; Petropoulos, Z.

2017-12-01

Recovery phase decision making processes, as compared to mitigation and response phase decision making processes, require communities make significant financial and capital decisions in the months after a disaster. Collectively, these investments may significantly contribute to the resilience of a community to future hazards. Pre-disaster administrative decisions are well-established within existing planning processes. Post-event recovery requires community decision makers to quickly evaluate technical proposals and manage significant recovery financial resources to ensure their community rebuilds in a manner that will be more resilient to future events. These technical and administrative hurdles in the aftermath of a disaster create a challenging atmosphere to make sound, scientifically-informed decisions leading to resilient recovery. In September 2013, a 1,000-year rain event that resulted in flooding throughout the Front Range of Colorado, significantly impacting Boulder County. While the event is long past, disaster recovery efforts still continue in parts of Boulder County. Boulder County officials formed a county collaborative that adapted the NIST Community Resilience Planning Guide for Buildings and Infrastructure Systems to facilitate a goals-based multi-criteria decision making process. Rather than use hazard-based information to guide infrastructure design, the county's decision process established time-to-recovery goals for infrastructure systems that were used as criteria for project design. This presentation explores the decision-making process employed by Boulder County to specify design standards for resilient rebuilding of infrastructure systems and examine how this infrastructure planning model could be extrapolated to other situations where there is uncertainty regarding future infrastructure design standards.

Virtual Beach 3: User's Guide

EPA Science Inventory

Virtual Beach version 3 (VB3) is a decision support tool that constructs site-specific statistical models to predict fecal indicator bacteria (FIB) concentrations at recreational beaches. VB3 is primarily designed for beach managers responsible for making decisions regarding beac...

Resource Analysis of Cognitive Process Flow Used to Achieve Autonomy

DTIC Science & Technology

2016-03-01

to be used as a decision - making aid to guide system designers and program managers not necessarily familiar with cognitive pro- cessing, or resource...implementing end-to-end cognitive processing flows multiplies and the impact of these design decisions on efficiency and effectiveness increases [1]. The...end-to-end cognitive systems and alternative computing technologies, then system design and acquisition personnel could make systematic analyses and

Justice. Law in a Free Society Series. Level VI. Teacher's Guide. Second Edition.

ERIC Educational Resources Information Center

Center for Civic Education, Calabasas, CA.

This teacher's curriculum guide is designed to help high school teachers guide students to develop a better understanding of difficult issues raised by questions of justice. It is hoped that the ideas, observations, questions, and procedures students learn in the curriculum will help them to make informed decisions about how to promote justice and…

The World of Work. A Curriculum Guide for Grades One through Twelve.

ERIC Educational Resources Information Center

Pointer, Leah J., Ed.

Developed by a committee of principals, counselors, and teachers as part of the local World of Work program, this curriculum guide is designed to aid in providing occupational information and career decision-making skills for grades K-12. Major purposes of the guide are to: (1) provide occupational information that is both educational and…

Beyond Decision Making for Outdoor Leaders: Expanding the Safety Behavior Research Agenda

ERIC Educational Resources Information Center

Jackson, Jeff S.

2016-01-01

The study of safety behaviour of designated outdoor leaders primarily revolves around their decision making and judgement. The last ten years, however, have seen relatively little peer-reviewed research regarding guide or instructor safety cognition and behaviour. The narrow decision making focus of modern work makes for a field of study…

Building professional capacity in ITS : guidelines for staffing, hiring, and designing ideal project teams

DOT National Transportation Integrated Search

1999-04-01

This guide is intended to help decision makers develop strategies and programs for building and maintaining organizational professional capacity. The guide covers seven different types of local, state and federal agencies and their involvement in twe...

User's Guide for SeedCalc: A Decision-Support System for Integrated Pest Management in Slash Pine Seed Orchards

Treesearch

Carl W. Fatzinger; Wayne N. Dixon

1996-01-01

SeedCalc, a decision-support system designed for use on personal computers, evaluates the consequences of different pest management strategies in slash pine (Pinus ellliottii Engelm. var. elliottii) seed orchards.

Adding It Up: A Guide for Mapping Public Resources for Children, Youth and Families

ERIC Educational Resources Information Center

Flynn-Khan, Margaret; Ferber, Thaddeus; Gaines, Elizabeth; Pittman, Karen

2006-01-01

This guide is a joint effort from the Forum for Youth Investment and the Finance Project designed to help decision makers and community leaders both learn the importance of a good children youth and families (CYF) resource map and lay out the process of creating or improving a CYF resource map of their own. The handbook has been designed to…

Apparel. Teacher's Instructional Guide.

ERIC Educational Resources Information Center

Rambo, Patti

This instructional guide for a one-half credit technological laboratory course for grades 10-12 focuses on apparel from the perspectives of personal decision making related to apparel, the apparel industry, and career preparation. Introductory materials are a course description; overview of course design; facilities, equipment, and resources; and…

Women Shaping the Future. The Future of Work Discussion Kit.

ERIC Educational Resources Information Center

Pine, Janet; Jackson, Sue; MacNeill, Kate

Designed to inform and empower women to participate in debates and decisions about the future of work in Australia, this kit provides everything needed to run a discussion session on the future of work with women in the community. It consists of a guide for users, workshop guide, topic sheets, and background reading. The guide for users introduces…

Library Subject Guides: A Content Management Case Study at the Open University, UK

ERIC Educational Resources Information Center

Wales, Tim

2005-01-01

Purpose: To share the experiences and challenges faced by the Open University Library (OUL) in developing a content management (CM) system for its subject guides. Design/methodology/approach: A summary of multi-format subject guide production at the OUL is provided to justify the decision to develop a new system for their production using a…

DeMAID/GA USER'S GUIDE Design Manager's Aid for Intelligent Decomposition with a Genetic Algorithm

NASA Technical Reports Server (NTRS)

Rogers, James L.

1996-01-01

Many companies are looking for new tools and techniques to aid a design manager in making decisions that can reduce the time and cost of a design cycle. One tool that is available to aid in this decision making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). Since the initial release of DEMAID in 1989, numerous enhancements have been added to aid the design manager in saving both cost and time in a design cycle. The key enhancement is a genetic algorithm (GA) and the enhanced version is called DeMAID/GA. The GA orders the sequence of design processes to minimize the cost and time to converge to a solution. These enhancements as well as the existing features of the original version of DEMAID are described. Two sample problems are used to show how these enhancements can be applied to improve the design cycle. This report serves as a user's guide for DeMAID/GA.

Behaviour change in overweight and obese pregnancy: a decision tree to support the development of antenatal lifestyle interventions.

PubMed

Ainscough, Kate M; Lindsay, Karen L; O'Sullivan, Elizabeth J; Gibney, Eileen R; McAuliffe, Fionnuala M

2017-10-01

Antenatal healthy lifestyle interventions are frequently implemented in overweight and obese pregnancy, yet there is inconsistent reporting of the behaviour-change methods and behavioural outcomes. This limits our understanding of how and why such interventions were successful or not. The current paper discusses the application of behaviour-change theories and techniques within complex lifestyle interventions in overweight and obese pregnancy. The authors propose a decision tree to help guide researchers through intervention design, implementation and evaluation. The implications for adopting behaviour-change theories and techniques, and using appropriate guidance when constructing and evaluating interventions in research and clinical practice are also discussed. To enhance the evidence base for successful behaviour-change interventions during pregnancy, adoption of behaviour-change theories and techniques, and use of published guidelines when designing lifestyle interventions are necessary. The proposed decision tree may be a useful guide for researchers working to develop effective behaviour-change interventions in clinical settings. This guide directs researchers towards key literature sources that will be important in each stage of study development.

Alcohol Education: Curriculum Guide for Grades K-6.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Bureau of Drug Education.

This alcohol curriculum guide was designed to assist school personnel to more effectively combat the alcohol problem through education as a primary prevention vehicle. "Practice experiences" comprise the most important components of the elementary health education curriculum for decision making. There are units with separate sections at…

Choosing the route to traveler information systems deployment : decision factors for creating public-private business plans : an action guide

DOT National Transportation Integrated Search

1998-01-01

This document presents a guide designed to help public private partnerships in their efforts to provide Advanced Traveler Information Systems (ATIS) services. It first examines why ATIS can be useful in managing transportation networks and increasing...

Test Resource Guide, 1987.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Div. of Special Education.

The Test Resource Guide (TRG) is designed to provide professionals in the New York City (New York) Public Schools with a compendium of assessment devices for use in decision making; specifically, determining eligibility for special education services, planning an instructional program, and charting progress. The introduction to TRG describes: (1)…

Consumerism: Life Centered Curriculum Program (Elementary Career Education).

ERIC Educational Resources Information Center

Syracuse City School District, NY.

The mid-intermediate elementary level curriculum guide on consumerism is designed to help students better define their own value system, develop an improved decision-making procedure, evaluate alternatives in the marketplace, and understand their consumer rights and responsibilities. The guide contains five sections related to five major…

The Contribution of Cognitive Engineering to the Effective Design and Use of Information Systems.

ERIC Educational Resources Information Center

Garg-Janardan, Chaya; Salvendy, Gavriel

1986-01-01

Examines the role of human information processing and decision-making capabilities and limitations in the design of effective human-computer interfaces. Several cognitive engineering principles that should guide the design process are outlined. (48 references) (Author/CLB)

A Manager's Guide to Objectives. Revised Edition.

ERIC Educational Resources Information Center

Miller, Donald R.; And Others

This guide, focusing on participative management and the requirements of public decision-making in education, is designed as a management referent for the development and use of verifiable performance objectives. In addition to an indexed main section, the volume contains an anlysis matrix for educational objectives; formats for and examples of…

Cable Economics.

ERIC Educational Resources Information Center

Cable Television Information Center, Washington, DC.

A guide to the economic factors that influence cable television systems is presented. Designed for local officials who must have some familiarity with cable operations in order to make optimum decisions, the guide analyzes the financial framework of a cable system, not only from the operators viewpoint, but also from the perspective of the…

Feeding & Management of Dairy Calves & Heifers. Teacher's Guide.

ERIC Educational Resources Information Center

Bjoraker, Walt

This guide is designed to assist postsecondary and secondary teachers of agriculture in their use of the University of Wisconsin bulletin "Raising Dairy Replacements" in their dairy science instructional program. Eight lessons are provided in this unit: breeding decisions, management of cows from breeding to calving, care at calving time, the…

A Guide to Curriculum Planning in Reading. Bulletin No. 6305.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

Defining reading as a dynamic, interactive process involving the reader in constructing meaning, this guide for the elementary and secondary curriculum was designed to facilitate effective and creative decision making by teachers for (1) integrating reading and writing across the curriculum, (2) developing readers who can independently apply…

Homebuyer's Guide.

ERIC Educational Resources Information Center

Sindt, Roger P.; Harris, Jack

Designed to assist prospective buyers in making such important decisions as whether to buy a new or older home and within what price range, the guide provides information on the purchase process. Discussion of the purchase process covers the life-cycle costs (recurring homeownership costs that must be met every month); selection of a home;…

Ecosystem Matters: Activity and Resource Guide for Environmental Educators.

ERIC Educational Resources Information Center

Adams, Mary; And Others

An ecological approach involved making conscious decisions which result in actions that responsibly contribute to the long-term stewardship of natural resources. This activity and resource guide was designed for use by both educators and resource managers to supplement existing courses and programs concerning ecological matters. These…

Decision making for wildfires: A guide for applying a risk management process at the incident level

Treesearch

Mary A. Taber; Lisa M. Elenz; Paul G. Langowski

2013-01-01

This publication focuses on the thought processes and considerations surrounding a risk management process for decision making on wildfires. The publication introduces a six element risk management cycle designed to encourage sound risk-informed decision making in accordance with Federal wildland fire policy, although the process is equally applicable to non-Federal...

Checkerboard--A Way to Financial Awareness.

ERIC Educational Resources Information Center

Dawson, Rod

1986-01-01

Describes Checkerboard, a game-like exercise designed to teach financial awareness, control, and appraisal to managers and reinforce the principle that all people in managerial positions make decisions, all of which incur costs and generate benefits. Students are guided by discovery and discussion toward improved financial decision making. (MBR)

User-centered design and the development of patient decision aids: protocol for a systematic review.

PubMed

Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

2015-01-26

Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely to be optimal. This systematic review will provide evidence of current practices to inform approaches for involving patients and other stakeholders in the development of patient decision aids. We anticipate that the results will help move towards the establishment of best practices for the development of patient-centered tools and, in turn, help improve the experiences of people who face difficult health decisions. PROSPERO CRD42014013241.

Decisions for Today and Tomorrow: Student Guide. Issues in Science-Technology-Society. A Multidisciplinary Approach to Problem-Solving and Critical-Thinking.

ERIC Educational Resources Information Center

Iozzi, Louis A.; Bastardo, Peter J.

This student guide was designed to be used with senior high school level classes as a supplement to existing programs in the areas of science and social studies. Each of the 12 chapters included in the guide may be used independently or may be combined into a separate course on the relationships between science, technology, and society. The…

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

PubMed Central

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

2014-01-01

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

Practical Guide for the Selection of Audio Visual Media. General Criteria System and Evaluation Procedure for Educational Media Decisions.

ERIC Educational Resources Information Center

Klepzig, H. J.; Weiss, M.

Designed to aid in making concrete decisions on the acquisition and use of media, the criteria system and evaluation procedure described is a multiphase, objective-based decision making process. This report includes guidelines for setting up goal systems and developing criteria for the evaluation of media based on a goal system; an outline of…

Local navigation and fuzzy control realization for autonomous guided vehicle

NASA Astrophysics Data System (ADS)

El-Konyaly, El-Sayed H.; Saraya, Sabry F.; Shehata, Raef S.

1996-10-01

This paper addresses the problem of local navigation for an autonomous guided vehicle (AGV) in a structured environment that contains static and dynamic obstacles. Information about the environment is obtained via a CCD camera. The problem is formulated as a dynamic feedback control problem in which speed and steering decisions are made on the fly while the AGV is moving. A decision element (DE) that uses local information is proposed. The DE guides the vehicle in the environment by producing appropriate navigation decisions. Dynamic models of a three-wheeled vehicle for driving and steering mechanisms are derived. The interaction between them is performed via the local feedback DE. A controller, based on fuzzy logic, is designed to drive the vehicle safely in an intelligent and human-like manner. The effectiveness of the navigation and control strategies in driving the AGV is illustrated and evaluated.

A Guide to Trade-offs.

ERIC Educational Resources Information Center

Meszaros, Bonnie; Saunders, Phillip

The guide is designed to accompany fifteen 20-minute economic education film/television programs for ages nine to 13. The emphasis is on economic decision making and problem solving. A statement of key concepts, suggestions for introducing the program, a summary, questions to help students resolve the problem posed at the end of the program, and…

Environmental Assessment. Instructor Guide. Working for Clean Water: An Information Program for Advisory Groups.

ERIC Educational Resources Information Center

Buskirk, E. Drannon, Jr.

Described is an hour-long learning session on environmental assessment that is designed to help citizen advisory groups improve decision making in water quality planning. The instructor's guide addresses: (1) environmental considerations in water quality planning, and (2) the identification of primary and secondary impacts of wastewater projects.…

Science 9. DeSoto Parish Curriculum Guide.

ERIC Educational Resources Information Center

DeSoto Parish School Board, Mansfield, LA.

This guide is designed to aid the teacher in planning and teaching a ninth-grade science course. It should provide students with a functional system of knowledge which is applicable to new situations and will serve as the basis for future decisions. Five units outlined are entitled: Introduction to Service; The Earth's Storehouse; The Earth's…

Oakland County Science Safety Series: Reference Guide for Biology.

ERIC Educational Resources Information Center

Bury, Dan; And Others

This reference guide is designed to organize and suggest acceptable practices and procedures for dealing with safety in the area of biology instruction. It is intended as a reference for teachers, administrators, and other school staff in planning for science activities and in making daily safety decisions. Discussions deal with responsibility for…

Suicide Prevention. A Guide to Curriculum Planning. Bulletin No. 0500.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

This guide is intended to reduce the youth suicide rate by teaching decision-making skills and coping mechanisms, and helping students develop self-esteem and communication skills. It was designed to be used by a local suicide prevention curriculum committee or team responsible for the development, implementation, and evaluation of the local…

Maximizing Energy Savings for Small Businesses | Buildings | NREL

Science.gov Websites

significant amounts of money and energy, increase profits, promote their business, and cut greenhouse gas goals and save money: NREL's four-page lender's guide with discussion on timing and low-cost methods for information and design and decision support guides, available for free download The USDA's Business and

NED-2 User's Guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2011-01-01

This is the user's guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows...

NED-2 reference guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2012-01-01

This is the reference guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows-...

Manual para Compradores de Casas (Homebuyer's Guide).

ERIC Educational Resources Information Center

Sindt, Roger P.; Harris, Jack

Designed to assist prospective buyers in making such important decisions as whether to buy a new or older home and within what price range, the guide, written in Spanish, provides information on the purchase process. Discussion of the purchase process covers the life-cycle costs (recurring homeownership costs that must be met every month);…

Development of a knowledge management system for complex domains.

PubMed

Perott, André; Schader, Nils; Bruder, Ralph; Leonhardt, Jörg

2012-01-01

Deutsche Flugsicherung GmbH, the German Air Navigation Service Provider, follows a systematic approach, called HERA, for investigating incidents. The HERA analysis shows a distinctive occurrence of incidents in German air traffic control in which the visual perception of information plays a key role. The reasons can be partially traced back to workstation design, where basic ergonomic rules and principles are not sufficiently followed by the designers in some cases. In cooperation with the Institute of Ergonomics in Darmstadt the DFS investigated possible approaches that may support designers to implement ergonomic systems. None of the currently available tools were found to be able to meet the identified user requirements holistically. Therefore it was suggested to develop an enhanced software tool called Design Process Guide. The name Design Process Guide indicates that this tool exceeds the classic functions of currently available Knowledge Management Systems. It offers "design element" based access, shows processual and content related topics, and shows the implications of certain design decisions. Furthermore, it serves as documentation, detailing why a designer made to a decision under a particular set of conditions.

A definition of high-level decisions in the engineering of systems

NASA Astrophysics Data System (ADS)

Powell, Robert Anthony

The role of the systems engineer defines that he or she be proactive and guide the program manager and their customers through their decisions to enhance the effectiveness of system development---producing faster, better, and cheaper systems. The present lack of coverage in literature on what these decisions are and how they relate to each other may be a contributing factor to the high rate of failure among system projects. At the onset of the system development process, decisions have an integral role in the design of a system that meets stakeholders' needs. This is apparent during the design and qualification of both the Development System and the Operational System. The performance, cost and schedule of the Development System affect the performance of the Operational System and are affected by decisions that influence physical elements of the Development System. The performance, cost, and schedule of the Operational System is affected by decisions that influence physical elements of the Operational System. Traditionally, product and process have been designed using know-how and trial and error. However, the empiricism of engineers and program managers is limited which can, and has led to costly mistakes. To date, very little research has explored decisions made in the engineering of a system. In government, literature exists on procurement processes for major system development; but in general literature on decisions, how they relate to each other, and the key information requirements within one of two systems and across the two systems is not readily available. This research hopes to improve the processes inherent in the engineering of systems. The primary focus of this research is on department of defense (DoD) military systems, specifically aerospace systems and may generalize more broadly. The result of this research is a process tool, a Decision System Model, which can be used by systems engineers to guide the program manager and their customers through the decisions about concurrently designing and qualifying both the Development and Operational systems.

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics.

PubMed

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-02-01

It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface--in particular 'effective information presentation', 'consistency', 'efficient interactions', 'effective use of language', and 'minimizing cognitive load'--seemed to improve perceived usability and confidence in the system.

Practical Steps for Informing Literacy Instruction: A Diagnostic Decision-Making Model.

ERIC Educational Resources Information Center

Kibby, Michael W.

This monograph presents a diagnostic decision-making model for reading, elementary, and special education teachers to use as a guide in assessing and evaluating students' reading abilities to design and provide more appropriate reading instruction. The model in the monograph gives an overall perspective or gestalt of the components and strategies…

Infusing Qualitative Traditions in Counseling Research Designs

ERIC Educational Resources Information Center

Hays, Danica G.; Wood, Chris

2011-01-01

Research traditions serve as a blueprint or guide for a variety of design decisions throughout qualitative inquiry. This article presents 6 qualitative research traditions: grounded theory, phenomenology, consensual qualitative research, ethnography, narratology, and participatory action research. For each tradition, the authors describe its…

How School Administrators and Board Members Are Improving Learning and Saving Money. Energy-Smart Building Choices.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC.

This guide shows ways that school administrators and board members can contribute to energy choice decisions for educational facilities, and it discusses how reducing operating costs also can create better learning environments. The guide reveals how design guidelines help create high-performance school buildings. It explains the use of energy…

Toward Hazardless Waste: A Guide for Safe Use and Disposal of Hazardous Household Products.

ERIC Educational Resources Information Center

Toteff, Sally; Zehner, Cheri

This guide is designed to help individuals make responsible decisions about safe use and disposal of household products. It consists of eight sections dealing with: (1) hazardous chemicals in the home, how hazaradous products become hazardous waste, and whether a hazardous waste problem exists in Puget Sound; (2) which household wastes are…

Career Development via Counselor/Teacher Teams; Guide for Implementation.

ERIC Educational Resources Information Center

Royal Oak City School District, MI.

The career development modules of the implementation guide, designed by counselor/teacher teams in Royal Oak, Michigan for junior high students, are intended to be used as a working copy for counselor/teacher teams. Career education concepts of self-awareness, assessment, and decision-making are correlated with the broad questions of: Who am I?…

An Administrator's Guide to Microcomputer Resources. Research & Development Series No. 239B.

ERIC Educational Resources Information Center

Zahniser, Gale; And Others

This guide is designed to help educators sort through the vast amount of information that exists about the educational use of microcomputers. The first of five chapters takes the educational administrator through the decision process that is typically associated with choosing and adopting microcomputers for the school. For each point in this…

Hierarchical Thinking: A Cognitive Tool for Guiding Coherent Decision Making in Design Problem Solving

ERIC Educational Resources Information Center

Haupt, Grietjie

2018-01-01

This paper builds on two concepts, the first of which is the extended information processing model of expert design cognition. This proposes twelve internal psychological characteristics interacting with the external world of expert designers during the early phases of the design process. Here, I explore one of the characteristics, hierarchical…

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Distinction between Externally vs. Internally Guided Decision-Making: Operational Differences, Meta-Analytical Comparisons and Their Theoretical Implications

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

Most experimental studies of decision-making have specifically examined situations in which a single less-predictable correct answer exists (externally guided decision-making under uncertainty). Along with such externally guided decision-making, there are instances of decision-making in which no correct answer based on external circumstances is available for the subject (internally guided decision-making). Such decisions are usually made in the context of moral decision-making as well as in preference judgment, where the answer depends on the subject’s own, i.e., internal, preferences rather than on external, i.e., circumstantial, criteria. The neuronal and psychological mechanisms that allow guidance of decisions based on more internally oriented criteria in the absence of external ones remain unclear. This study was undertaken to compare decision-making of these two kinds empirically and theoretically. First, we reviewed studies of decision-making to clarify experimental–operational differences between externally guided and internally guided decision-making. Second, using multi-level kernel density analysis, a whole-brain-based quantitative meta-analysis of neuroimaging studies was performed. Our meta-analysis revealed that the neural network used predominantly for internally guided decision-making differs from that for externally guided decision-making under uncertainty. This result suggests that studying only externally guided decision-making under uncertainty is insufficient to account for decision-making processes in the brain. Finally, based on the review and results of the meta-analysis, we discuss the differences and relations between decision-making of these two types in terms of their operational, neuronal, and theoretical characteristics. PMID:22403525

SEE Action Guide for States: Energy Efficiency as a Least-Cost Strategy to Reduce Greenhouse Gases and Air Pollution and Meet Energy Needs in the Power Sector

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

Schwartz, Lisa; Leventis, Greg; Schiller, Steven R.

This guide is designed to provide information to state decision makers and staff on options to advance energy efficiency through strategies designed or implemented at the state and local levels of government and in the private sector.1 The information in this guide is intended to be useful to a wide variety of partners and stakeholders involved in energy-related discussions and decision-making at state and local levels. These energy efficiency options, or “pathways” as they are identified in this guide, can assist states in using energy efficiency to meet air pollution reduction and other policy objectives such as energy affordability andmore » reliability. A pathway is a set of interdependent actions that results in measurable energy savings streams and associated avoided air emissions and other benefits over a period of time. These activities can include state, local, or private sector regulations, policies, programs and other activities. For each of five broad pathways that offer sizable cost-effective energy savings, the guide addresses likely questions policy makers and regulators face when screening for the best opportunities to advance energy efficiency in their state.« less

Designing a Clinical Framework to Guide Gross Motor Intervention Decisions for Infants and Young Children with Hypotonia

ERIC Educational Resources Information Center

Darrah, Johanna; O'Donnell, Maureen; Lam, Joyce; Story, Maureen; Wickenheiser, Diane; Xu, Kaishou; Jin, Xiaokun

2013-01-01

Clinical practice frameworks are a valuable component of clinical education, promoting informed clinical decision making based on the best available evidence and/or clinical experience. They encourage standardized intervention approaches and evaluation of practice. Based on an international project to support the development of an enhanced service…

Naval Systems Engineering Guide

DTIC Science & Technology

2004-10-01

Decision Critical Design Review System Integration Activities IOC FRP Decision Review Production & Deployment Sustainment IOT & FOC Sustainmen...reentered when things change significantly, such as funding, requirements, or schedule. This process must start at the very beginning of a Major...outputs through sub-processes will reveal a number of things : a. Determine the level of process applicability and tailoring required. b. Additional

Gathering Sensitive Stories

ERIC Educational Resources Information Center

Daley, Kathryn

2012-01-01

Discussions of research ethics are often focused on research ethics guidelines. These guidelines are useful in designing ethical research projects but are not designed to guide the interpersonal interactions that occur once researchers are out in the field. Drawing from Noddings' care theory, this article argues that making ethical decisions when…

Decisions for Today and Tomorrow: Teaching Notes. Issues in Science-Technology-Society.

ERIC Educational Resources Information Center

Iozzi, Louis A.; Bastardo, Peter J.

This teacher's guide was designed to be used with senior high school level classes as a supplement to existing programs in the areas of science and social studies. Each of the 12 chapters included in the guide may be used independently or may be combined into a separate course on the relationships between science, technology, and society. The…

How Parents and Teachers Are Helping To Create Better Environments for Learning. Energy-Smart Building Choices.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC.

This guide explores the contributions that parents and teachers can make to enhance energy choice decisions that affect the design and operation of educational facilities. It also examines how making the right choice can create better learning environments. The guide reveals how schools have turned energy improvements into powerful teaching tools;…

Mission Information: Worksite Interview, Shadow Community Workers, Work Experience Program. CHOICE (Challenging Options in Career Education).

ERIC Educational Resources Information Center

Gans, Connie; And Others

The work-study guide is the third volume in the advanced level of a career education curriculum for elementary-secondary migrant children. Complementing the secondary level job information text and a workbook about decision making and self-awareness, the work-study guide is designed to accompany work exploration and experience programs. It…

Responsible for Fire Safety. Seventh Grade. Fire Safety for Texans: Fire and Burn Prevention Curriculum Guide.

ERIC Educational Resources Information Center

Texas State Commission on Fire Protection, Austin.

This booklet comprises the seventh grade component of a series of curriculum guides on fire and burn prevention. Designed to meet the age-specific needs of seventh grade students, its objectives include: (1) practicing responsible decision-making regarding fire and burn hazards, including peer pressure related to fire risks; and (2) practicing…

Moderator's Guide To Eighth-Grade Mathematics Lessons: United States, Japan, and Germany. TIMSS as a Starting Point To Examine Teaching.

ERIC Educational Resources Information Center

Office of Educational Research and Improvement (ED), Washington, DC.

This teaching module with its 80-minute videotape of lessons from U.S., Japanese, and German classrooms is designed to help moderators facilitate discussion among educators. This guide is intended to help moderators make appropriate decisions about sessions and suggest items to consider when discussing the Third International Mathematics and…

Learning Design Rashomon I--Supporting the Design of One Lesson through Different Approaches

ERIC Educational Resources Information Center

Persico, Donatella; Pozzi, Francesca; Anastopoulou, Stamatina; Conole, Grainne; Craft, Brock; Dimitriadis, Yannis; Hernandez-Leo, Davinia; Kali, Yael; Mor, Yishay; Perez-Sanagustin, Mar; Walmsley, Helen

2013-01-01

This paper presents and compares a variety of approaches that have been developed to guide the decision-making process in learning design. Together with the companion Learning Design Rashomon II (Prieto "et al.," 2013), devoted to existing tools to support the same process, it aims to provide a view on relevant research results in this…

Context Matters: The Value of Analyzing Human Factors within Educational Contexts as a Way of Informing Technology-Related Decisions within Design Research

ERIC Educational Resources Information Center

MacKinnon, Kim

2012-01-01

While design research can be useful for designing effective technology integrations within complex social settings, it currently fails to provide concrete methodological guidelines for gathering and organizing information about the research context, or for determining how such analyses ought to guide the iterative design and innovation process. A…

Designing and Assessing Courses and Curricula: A Practical Guide. Second Edition. The Jossey-Bass Higher and Adult Education Series.

ERIC Educational Resources Information Center

Diamond, Robert M.

This book is intended to help college faculty effectively design and evaluate courses and curricula. The 16 chapters address the following topics: a learning-centered approach to course and curriculum design; a systematic design model (showing benefits); the decision to begin a curriculum project; getting started; linking goals, courses, and…

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics

PubMed Central

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-01-01

Context It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. Objective The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. Materials and methods We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. Results SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. Discussion/conclusion The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface—in particular ‘effective information presentation’, ‘consistency’, ‘efficient interactions’, ‘effective use of language’, and ‘minimizing cognitive load’—seemed to improve perceived usability and confidence in the system. PMID:24008427

Designing Tools for Supporting User Decision-Making in e-Commerce

NASA Astrophysics Data System (ADS)

Sutcliffe, Alistair; Al-Qaed, Faisal

The paper describes a set of tools designed to support a variety of user decision-making strategies. The tools are complemented by an online advisor so they can be adapted to different domains and users can be guided to adopt appropriate tools for different choices in e-commerce, e.g. purchasing high-value products, exploring product fit to users’ needs, or selecting products which satisfy requirements. The tools range from simple recommenders to decision support by interactive querying and comparison matrices. They were evaluated in a scenario-based experiment which varied the users’ task and motivation, with and without an advisor agent. The results show the tools and advisor were effective in supporting users and agreed with the predictions of ADM (adaptive decision making) theory, on which the design of the tools was based.

Skill Transfer and Virtual Training for IND Response Decision-Making: Game Design for Disaster Response Training

DTIC Science & Technology

2016-01-01

Guild Awards: Videogame Nominees,” Writer’s Guild of America, 2015. [Online]. Available: http://www.wga.org/wga-awards/nominees- winners.aspx... videogame . [Accessed 2015]. [22] S. Jackson, “Amazing Errors in Prototyping,” in Kobold Guide to Board Game Design, Open Design LLC / Wolfgang Baur, 2011

Motivational Activities for High School Economics, Keyed to the New York State Syllabus "Economics and Economic Decision Making."

ERIC Educational Resources Information Center

Dawson, George G.

This manual provides secondary school teachers with ideas for relating economics to student needs, interests, and experiences. The tentative syllabus "Economics and Economic Decision Making," designed for 12th grade social studies by the New York State Education Department in 1987, is used as a guide. Motivational activities for the 18…

Oh, Garbage! Decisions about Waste Disposal. Creative Role-Playing Exercises in Science and Technology Series.

ERIC Educational Resources Information Center

Parisi, Lynn; Pearson, Janice

This document is one of a series of role plays that focus on science-related social issues of concern in contemporary public policy formation. The role plays are designed to help students develop information-processing and decision making skills needed to deal effectively with such issues. The role plays guide students in analyzing science related…

Greening Federal Facilities: An Energy, Environmental, and Economic Resource Guide for Federal Facility Managers and Designers; Second Edition

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

Wilson, A.

2001-05-16

Greening Federal Facilities, Second Edition, is a nuts-and-bolts resource guide compiled to increase energy and resource efficiency, cut waste, and improve the performance of Federal buildings and facilities. The guide highlights practical actions that facility managers, design and construction staff, procurement officials, and facility planners can take to save energy and money, improve the comfort and productivity of employees, and benefit the environment. It supports a national effort to promote energy and environmental efficiency in the nation's 500,000 Federal buildings and facilities. Topics covered include current Federal regulations; environmental and energy decision-making; site and landscape issues; building design; energy systems;more » water and wastewater; materials; waste management, and recycling; indoor environmental quality; and managing buildings.« less

Perceived Need for a Parental Decision Aid for the HPV Vaccine: Content and Format Preferences

PubMed Central

Lechuga, Julia; Swain, Geoffrey; Weinhardt, Lance S.

2014-01-01

The human papillomavirus (HPV) is a precursor of cervical cancer. In 2006, the Federal Drug Administration licensed a vaccine to protect against four types of HPV. Three years postlicensure of the vaccine, HPV vaccination is still fraught with controversy. To date, research suggests that contrary to popular notions, parents are less concerned with controversies on moral issues and more with uncertainty regarding because long-term safety of a drug is resolved after licensure. This study was designed to understand whether mothers from diverse ethnicities perceive a need for a decision support tool. Results suggest that the design of a culturally tailored decision support tool may help guide parents through the decision-making process. PMID:21444922

Perceived need of a parental decision aid for the HPV vaccine: content and format preferences.

PubMed

Lechuga, Julia; Swain, Geoffrey; Weinhardt, Lance S

2012-03-01

The human papillomavirus (HPV) is a precursor of cervical cancer. In 2006, the Federal Drug Administration licensed a vaccine to protect against four types of HPV. Three years postlicensure of the vaccine, HPV vaccination is still fraught with controversy. To date, research suggests that contrary to popular notions, parents are less concerned with controversies on moral issues and more with uncertainty regarding because long-term safety of a drug is resolved after licensure. This study was designed to understand whether mothers from diverse ethnicities perceive a need for a decision support tool. Results suggest that the design of a culturally tailored decision support tool may help guide parents through the decision-making process.

A Guide to Career Decisions. The Sky Is the Limit. Florida VIEW Careerbook.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee. Bureau of Career Development.

This guide is designed to help junior high school students get to know themselves better and relate what they find out about themselves to job information in the Florida VIEW (Vital Information for Education and Work) System. The book is intended to help students select a number of occupations that might meet their needs and interests. Section 1…

A Predictive Algorithm to Detect Opioid Use Disorder

PubMed Central

Lee, Chee; Sharma, Maneesh; Kantorovich, Svetlana

2018-01-01

Purpose: The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. Methods: A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. Results: Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. Conclusions: The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced. PMID:29383324

A Predictive Algorithm to Detect Opioid Use Disorder: What Is the Utility in a Primary Care Setting?

PubMed

Lee, Chee; Sharma, Maneesh; Kantorovich, Svetlana; Brenton, Ashley

2018-01-01

The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced.

Safety Guided Design Based on Stamp/STPA for Manned Vehicle in Concept Design Phase

NASA Astrophysics Data System (ADS)

Ujiie, Ryo; Katahira, Masafumi; Miyamoto, Yuko; Umeda, Hiroki; Leveson, Nancy; Hoshino, Nobuyuki

2013-09-01

In manned vehicles, such as the Soyuz and the Space Shuttle, the crew and computer system cooperate to succeed in returning to the earth. While computers increase the functionality of system, they also increase the complexity of the interaction between the controllers (human and computer) and the target dynamics. In some cases, the complexity can produce a serious accident. To prevent such losses, traditional hazard analysis such as FTA has been applied to system development, however it can be used after creating a detailed system because it focuses on detailed component failures. As a result, it's more difficult to eliminate hazard cause early in the process when it is most feasible.STAMP/STPA is a new hazard analysis that can be applied from the early development phase, with the analysis being refined as more detailed decisions are made. In essence, the analysis and design decisions are intertwined and go hand-in-hand. We have applied STAMP/STPA to a concept design of a new JAXA manned vehicle and tried safety guided design of the vehicle. As a result of this trial, it has been shown that STAMP/STPA can be accepted easily by system engineers and the design has been made more sophisticated from a safety viewpoint. The result also shows that the consequences of human errors on system safety can be analysed in the early development phase and the system designed to prevent them. Finally, the paper will discuss an effective way to harmonize this safety guided design approach with system engineering process based on the result of this experience in this project.

Spatial education: improving conservation delivery through space-structured decision making

USGS Publications Warehouse

Moore, Clinton T.; Shaffer, Terry L.; Gannon, Jill J.

2013-01-01

Adaptive management is a form of structured decision making designed to guide management of natural resource systems when their behaviors are uncertain. Where decision making can be replicated across units of a landscape, learning can be accelerated, and biological processes can be understood in a larger spatial context. Broad-based partnerships among land management agencies, exemplified by Landscape Conservation Cooperatives (conservation partnerships created through the U.S. Department of the Interior), are potentially ideal environments for implementing spatially structured adaptive management programs.

Risk management for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Buchbinder, Ben

1993-01-01

Probabilistic Risk Assessment (PRA) is a quantitative engineering process that provides the analytic structure and decision-making framework for total programmatic risk management. Ideally, it is initiated in the conceptual design phase and used throughout the program life cycle. Although PRA was developed for assessment of safety, reliability, and availability risk, it has far greater application. Throughout the design phase, PRA can guide trade-off studies among system performance, safety, reliability, cost, and schedule. These studies are based on the assessment of the risk of meeting each parameter goal, with full consideration of the uncertainties. Quantitative trade-off studies are essential, but without full identification, propagation, and display of uncertainties, poor decisions may result. PRA also can focus attention on risk drivers in situations where risk is too high. For example, if safety risk is unacceptable, the PRA prioritizes the risk contributors to guide the use of resources for risk mitigation. PRA is used in the Space Exploration Initiative (SEI) Program. To meet the stringent requirements of the SEI mission, within strict budgetary constraints, the PRA structure supports informed and traceable decision-making. This paper briefly describes the SEI PRA process.

The design of patient decision support interventions: addressing the theory-practice gap.

PubMed

Elwyn, Glyn; Stiel, Mareike; Durand, Marie-Anne; Boivin, Jacky

2011-08-01

Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions. © 2010 Blackwell Publishing Ltd.

Reliability and criterion-related validity testing (construct) of the Endotracheal Suction Assessment Tool (ESAT©).

PubMed

Davies, Kylie; Bulsara, Max K; Ramelet, Anne-Sylvie; Monterosso, Leanne

2018-05-01

To establish criterion-related construct validity and test-retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©). Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented. Observational testing was used to measure construct validity and determine whether the ESAT© could guide "inexperienced" paediatric intensive care nurses' decision-making regarding endotracheal tube suction. Test-retest reliability of the ESAT© was performed at two time points. The researchers and paediatric intensive care nurse "experts" developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. "Experienced" (n = 12) and "inexperienced" (n = 14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision-making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the "experts" (n = 9). Test-retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with "experienced" and "inexperienced" paediatric intensive care nurses using the same scenarios and tool to guide decision-making. No differences were observed between endotracheal tube suction decisions made by "experts" (n = 9), "inexperienced" (n = 14) and "experienced" (n = 12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2. Criterion-related construct validity and test-retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the "inexperienced" nurse to guide decision-making related to endotracheal tube suction. The ESAT© is the first validated tool to systematically guide endotracheal nursing practice for the "inexperienced" nurse. © 2018 John Wiley & Sons Ltd.

Cognitive considerations for helmet-mounted display design

NASA Astrophysics Data System (ADS)

Francis, Gregory; Rash, Clarence E.

2010-04-01

Helmet-mounted displays (HMDs) are designed as a tool to increase performance. To achieve this, there must be an accurate transfer of information from the HMD to the user. Ideally, an HMD would be designed to accommodate the abilities and limitations of users' cognitive processes. It is not enough for the information (whether visual, auditory, or tactual) to be displayed; the information must be perceived, attended, remembered, and organized in a way that guides appropriate decision-making, judgment, and action. Following a general overview, specific subtopics of cognition, including perception, attention, memory, knowledge, decision-making, and problem solving are explored within the context of HMDs.

Visual Sample Plan Version 7.0 User's Guide

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

Matzke, Brett D.; Newburn, Lisa LN; Hathaway, John E.

2014-03-01

User's guide for VSP 7.0 This user's guide describes Visual Sample Plan (VSP) Version 7.0 and provides instructions for using the software. VSP selects the appropriate number and location of environmental samples to ensure that the results of statistical tests performed to provide input to risk decisions have the required confidence and performance. VSP Version 7.0 provides sample-size equations or algorithms needed by specific statistical tests appropriate for specific environmental sampling objectives. It also provides data quality assessment and statistical analysis functions to support evaluation of the data and determine whether the data support decisions regarding sites suspected of contamination.more » The easy-to-use program is highly visual and graphic. VSP runs on personal computers with Microsoft Windows operating systems (XP, Vista, Windows 7, and Windows 8). Designed primarily for project managers and users without expertise in statistics, VSP is applicable to two- and three-dimensional populations to be sampled (e.g., rooms and buildings, surface soil, a defined layer of subsurface soil, water bodies, and other similar applications) for studies of environmental quality. VSP is also applicable for designing sampling plans for assessing chem/rad/bio threat and hazard identification within rooms and buildings, and for designing geophysical surveys for unexploded ordnance (UXO) identification.« less

Involving people with dementia in developing an interactive web tool for shared decision-making: experiences with a participatory design approach.

PubMed

Span, Marijke; Hettinga, Marike; Groen-van de Ven, Leontine; Jukema, Jan; Janssen, Ruud; Vernooij-Dassen, Myrra; Eefsting, Jan; Smits, Carolien

2018-06-01

The aim of this study was at gaining insight into the participatory design approach of involving people with dementia in the development of the DecideGuide, an interactive web tool facilitating shared decision-making in their care networks. An explanatory case study design was used when developing the DecideGuide. A secondary analysis focused on the data gathered from the participating people with dementia during the development stages: semi-structured interviews (n = 23), four focus group interviews (n = 18), usability tests (n = 3), and a field study (n = 4). Content analysis was applied to the data. Four themes showed to be important regarding the participation experiences of involving people with dementia in research: valuable feedback on content and design of the DecideGuide, motivation to participate, perspectives of people with dementia and others about distress related to involvement, and time investment. People with dementia can give essential feedback and, therefore, their contribution is useful and valuable. Meaningful participation of people with dementia takes time that should be taken into account. It is important for people with dementia to be able to reciprocate the efforts others make and to feel of significance to others. Implications for Rehabilitation People with dementia can contribute meaningfully to the content and design and their perspective is essential for developing useful and user-friendly tools. Participating in research activities may contribute to social inclusion, empowerment, and quality of life of people with dementia.

Possible Road Map Seen in Dover Case: Judge's Rejection of Intelligent Design Could Guide Policymakers, Educators

ERIC Educational Resources Information Center

Cavanagh, Sean

2006-01-01

In this article, the author points out the decision of U.S. District Judge John E. Jones III, issued Dec. 20, regarding the constitutionality of Dover, Pa., district's policy that promotes "intelligent design" in public school sciences. In the ruling, Judge Jones not only found the district's policy promoting intelligent design…

Academic Libraries as High-Tech Gateways: A Guide to Design & Space Decisions. Second Edition.

ERIC Educational Resources Information Center

Bazillion, Richard J.; Braun, Connie L.

This book, based on research about libraries around the country, provides tools that can be used for planning and building an academic library space that streamlines access to information. It explains how to incorporate the latest innovations in academic library facility design; how to make the facility flexible for changing information technology…

Putting Safety in the Frame: Nurses' Sensemaking at Work.

PubMed

O'Keeffe, Valerie Jean; Thompson, Kirrilly Rebecca; Tuckey, Michelle Rae; Blewett, Verna Lesley

2015-01-01

Current patient safety policy focuses nursing on patient care goals, often overriding nurses' safety. Without understanding how nurses construct work health and safety (WHS), patient and nurse safety cannot be reconciled. Using ethnography, we examine social contexts of safety, studying 72 nurses across five Australian hospitals making decisions during patient encounters. In enacting safe practice, nurses used "frames" built from their contextual experiences to guide their behavior. Frames are produced by nurses, and they structure how nurses make sense of their work. Using thematic analysis, we identify four frames that inform nurses' decisions about WHS: (a) communicating builds knowledge, (b) experiencing situations guides decisions, (c) adapting procedures streamlines work, and (d) team working promotes safe working. Nurses' frames question current policy and practice by challenging how nurses' safety is positioned relative to patient safety. Recognizing these frames can assist the design and implementation of effective WHS management.

Putting Safety in the Frame

PubMed Central

O’Keeffe, Valerie Jean; Thompson, Kirrilly Rebecca; Tuckey, Michelle Rae; Blewett, Verna Lesley

2015-01-01

Current patient safety policy focuses nursing on patient care goals, often overriding nurses’ safety. Without understanding how nurses construct work health and safety (WHS), patient and nurse safety cannot be reconciled. Using ethnography, we examine social contexts of safety, studying 72 nurses across five Australian hospitals making decisions during patient encounters. In enacting safe practice, nurses used “frames” built from their contextual experiences to guide their behavior. Frames are produced by nurses, and they structure how nurses make sense of their work. Using thematic analysis, we identify four frames that inform nurses’ decisions about WHS: (a) communicating builds knowledge, (b) experiencing situations guides decisions, (c) adapting procedures streamlines work, and (d) team working promotes safe working. Nurses’ frames question current policy and practice by challenging how nurses’ safety is positioned relative to patient safety. Recognizing these frames can assist the design and implementation of effective WHS management. PMID:28462311

Risk-based analysis and decision making in multi-disciplinary environments

NASA Technical Reports Server (NTRS)

Feather, Martin S.; Cornford, Steven L.; Moran, Kelly

2003-01-01

A risk-based decision-making process conceived of and developed at JPL and NASA, has been used to help plan and guide novel technology applications for use on spacecraft. These applications exemplify key challenges inherent in multi-disciplinary design of novel technologies deployed in mission-critical settings. 1) Cross-disciplinary concerns are numerous (e.g., spacecraft involve navigation, propulsion, telecommunications). These concems are cross-coupled and interact in multiple ways (e.g., electromagnetic interference, heat transfer). 2) Time and budget pressures constrain development, operational resources constrain the resulting system (e.g., mass, volume, power). 3) Spacecraft are critical systems that must operate correctly the first time in only partially understood environments, with no chance for repair. 4) Past experience provides only a partial guide: New mission concepts are enhanced and enabled by new technologies, for which past experience is lacking. The decision-making process rests on quantitative assessments of the relationships between three classes of information - objectives (the things the system is to accomplish and constraints on its operation and development), risks (whose occurrence detracts from objectives), and mitigations (options for reducing the likelihood and or severity of risks). The process successfully guides experts to pool their knowledge, using custom-built software to support information gathering and decision-making.

Assessing Sustainment Operations in a Decisive Action Training Environment

DTIC Science & Technology

2017-05-01

The findings in this Research Product are not to be construed as an official Department of the Army position, unless so designated by other authorized...Combat Training Center (CTC) rotations. The research design allowed for comparison of a control and experimental group. The experimental group received...CP Operations performance. The pocket-sized guide was designed as a quick reference for the proper planning, execution, and follow up of CP

A psychosocial analysis of parents' decisions for limiting their young child's screen time: An examination of attitudes, social norms and roles, and control perceptions.

PubMed

Hamilton, Kyra; Spinks, Teagan; White, Katherine M; Kavanagh, David J; Walsh, Anne M

2016-05-01

Preschool-aged children spend substantial amounts of time engaged in screen-based activities. As parents have considerable control over their child's health behaviours during the younger years, it is important to understand those influences that guide parents' decisions about their child's screen time behaviours. A prospective design with two waves of data collection, 1 week apart, was adopted. Parents (n = 207) completed a Theory of Planned Behaviour (TPB)-based questionnaire, with the addition of parental role construction (i.e., parents' expectations and beliefs of responsibility for their child's behaviour) and past behaviour. A number of underlying beliefs identified in a prior pilot study were also assessed. The model explained 77% (with past behaviour accounting for 5%) of the variance in intention and 50% (with past behaviour accounting for 3%) of the variance in parental decisions to limit child screen time. Attitude, subjective norms, perceived behavioural control, parental role construction, and past behaviour predicted intentions, and intentions and past behaviour predicted follow-up behaviour. Underlying screen time beliefs (e.g., increased parental distress, pressure from friends, inconvenience) were also identified as guiding parents' decisions. Results support the TPB and highlight the importance of beliefs for understanding parental decisions for children's screen time behaviours, as well as the addition of parental role construction. This formative research provides necessary depth of understanding of sedentary lifestyle behaviours in young children which can be adopted in future interventions to test the efficacy of the TPB mechanisms in changing parental behaviour for their child's health. What is already known on this subject? Identifying determinants of child screen time behaviour is vital to the health of young people. Social-cognitive and parental role constructions are key influences of parental decision-making. Little is known about the processes guiding parents' decisions to limit their child's screen time. What does this study add? Parental role construction and TPB social-cognitive factors influence parental decisions. The beliefs of parents for their child's behaviour were identified. A range of beliefs guide parents' decisions for their child's screen time viewing. © 2015 The British Psychological Society.

DECIDE: a Decision Support Tool to Facilitate Parents' Choices Regarding Genome-Wide Sequencing.

PubMed

Birch, Patricia; Adam, S; Bansback, N; Coe, R R; Hicklin, J; Lehman, A; Li, K C; Friedman, J M

2016-12-01

We describe the rationale, development, and usability testing for an integrated e-learning tool and decision aid for parents facing decisions about genome-wide sequencing (GWS) for their children with a suspected genetic condition. The online tool, DECIDE, is designed to provide decision-support and to promote high quality decisions about undergoing GWS with or without return of optional incidental finding results. DECIDE works by integrating educational material with decision aids. Users may tailor their learning by controlling both the amount of information and its format - text and diagrams and/or short videos. The decision aid guides users to weigh the importance of various relevant factors in their own lives and circumstances. After considering the pros and cons of GWS and return of incidental findings, DECIDE summarizes the user's responses and apparent preferred choices. In a usability study of 16 parents who had already chosen GWS after conventional genetic counselling, all participants found DECIDE to be helpful. Many would have been satisfied to use it alone to guide their GWS decisions, but most would prefer to have the option of consulting a health care professional as well to aid their decision. Further testing is necessary to establish the effectiveness of using DECIDE as an adjunct to or instead of conventional pre-test genetic counselling for clinical genome-wide sequencing.

Virtual Beach v2.2 User Guide

EPA Science Inventory

Virtual Beach version 2.2 (VB 2.2) is a decision support tool. It is designed to construct site-specific Multi-Linear Regression (MLR) models to predict pathogen indicator levels (or fecal indicator bacteria, FIB) at recreational beaches. MLR analysis has outperformed persisten...

Generalized linear models and point count data: statistical considerations for the design and analysis of monitoring studies

Treesearch

Nathaniel E. Seavy; Suhel Quader; John D. Alexander; C. John Ralph

2005-01-01

The success of avian monitoring programs to effectively guide management decisions requires that studies be efficiently designed and data be properly analyzed. A complicating factor is that point count surveys often generate data with non-normal distributional properties. In this paper we review methods of dealing with deviations from normal assumptions, and we focus...

Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

PubMed

Goethals, S; Dierckx de Casterlé, B; Gastmans, C

2013-05-01

The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users.

PubMed

Jibaja-Weiss, Maria L; Volk, Robert J

2007-01-01

Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.

"She Just Doesn't Know Him Like We Do": Illuminating Complexities in Surrogate Decision Making.

PubMed

Eves, Margot M; Esplin, Bryn S

2015-01-01

When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients' views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a common presumption is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, "Given the current medical condition, what would this person want?" risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient's preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Bumps on the road to Magnet designation: achieving organizational excellence.

PubMed

Steinbinder, Amy

2009-01-01

The chief nursing officer is in a unique position to guide his or her organization to excellence by creating a compelling vision; maintaining objectivity regarding the nursing department's accomplishments; holding senior nurse leaders accountable as Magnet champions; demonstrating strategic thinking, business planning development, operational connection, and awareness of clinical aspects of care; and establishing levels of ownership and decision making within the nursing department's operational framework. The clear definition of terms including responsibility, authority, delegation, accountability, and empowerment are necessary and, coupled with specific actions, skills, and measures of success, guide individual and group processes to achieve organizational excellence and ultimately Magnet designation.

Decision-making about prenatal genetic testing among pregnant Korean-American women.

PubMed

Jun, Myunghee; Thongpriwan, Vipavee; Choi, Jeeyae; Sook Choi, Kyung; Anderson, Gwen

2018-01-01

to understand the prenatal genetic testing decision-making processes among pregnant Korean-American women. a qualitative, descriptive research design. referrals and snowball sampling techniques were used to recruit 10 Korean-American women who had been recommended for amniocentesis during pregnancy in the United States (U.S.). All participants were born in Korea and had immigrated to the U.S. The number of years living in the U.S. ranged from 4 to 11 (M=5.7). various regional areas of the U.S. the researchers conducted face-to-face or phone interviews using semi-structured interview guides. The interviews were conducted in the Korean language and lasted approximately 50-100minutes. The interview guides focused on the decision-making process and experiences with prenatal genetic testing, as well as reflections on the decisions. Four core themes emerged related to the participants' decision-making processes, according to their descriptions. These themes are (1) facing the challenges of decision-making, (2) seeking support, (3) determining one's preferred role in the decision-making process, and (4) feeling uncomfortable with the degree of patient autonomy in U.S. health care. researchers concluded that many distinctive factors influence the decision-making processes used by pregnant Korean-American women. The results have the potential to improve shared decision-making practices regarding prenatal genetic testing. clinicians need to understand the sociocultural underpinnings of pregnant Korean-American immigrants regarding prenatal genetic screening and testing as an initial step to engage these patients in shared decision-making. Published by Elsevier Ltd.

A prospective, longitudinal study to evaluate the clinical utility of a predictive algorithm that detects risk of opioid use disorder.

PubMed

Brenton, Ashley; Lee, Chee; Lewis, Katrina; Sharma, Maneesh; Kantorovich, Svetlana; Smith, Gregory A; Meshkin, Brian

2018-01-01

The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use. Specifically, we sought to assess how physicians were using the profile in patient care and how its use affected patient outcomes. A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 5,397 patients across 100 clinics in the USA. Using a patent-protected, validated algorithm combining specific genetic risk factors with phenotypic traits, patients were categorized into low-, moderate-, and high-risk patients for opioid abuse. Physicians who ordered precision medicine testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. The patient outcomes associated with each treatment action were carefully documented. Physicians used the profile to guide treatment decisions for over half of the patients. Of those, guided treatment decisions for 24.5% of the patients were opioid related, including changing the opioid prescribed, starting an opioid, or titrating a patient off the opioid. Treatment guidance was strongly influenced by profile-predicted opioid use disorder (OUD) risk. Most importantly, patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, including better pain management by medication adjustments, with an average pain decrease of 3.4 points on a scale of 1-10. Patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, as measured by decreased pain levels resulting from better pain management with prescribed medications. The clinical utility of the profile is twofold. It provides clinically actionable recommendations that can be used to 1) prevent OUD through limiting initial opioid prescriptions and 2) reduce pain in patients at low risk of developing OUD.

A prospective, longitudinal study to evaluate the clinical utility of a predictive algorithm that detects risk of opioid use disorder

PubMed Central

Brenton, Ashley; Lee, Chee; Lewis, Katrina; Sharma, Maneesh; Kantorovich, Svetlana; Smith, Gregory A; Meshkin, Brian

2018-01-01

Purpose The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use. Specifically, we sought to assess how physicians were using the profile in patient care and how its use affected patient outcomes. Patients and methods A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 5,397 patients across 100 clinics in the USA. Using a patent-protected, validated algorithm combining specific genetic risk factors with phenotypic traits, patients were categorized into low-, moderate-, and high-risk patients for opioid abuse. Physicians who ordered precision medicine testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. The patient outcomes associated with each treatment action were carefully documented. Results Physicians used the profile to guide treatment decisions for over half of the patients. Of those, guided treatment decisions for 24.5% of the patients were opioid related, including changing the opioid prescribed, starting an opioid, or titrating a patient off the opioid. Treatment guidance was strongly influenced by profile-predicted opioid use disorder (OUD) risk. Most importantly, patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, including better pain management by medication adjustments, with an average pain decrease of 3.4 points on a scale of 1–10. Conclusion Patients whose physicians used the profile to guide opioid-related treatment decisions had improved clinical outcomes, as measured by decreased pain levels resulting from better pain management with prescribed medications. The clinical utility of the profile is twofold. It provides clinically actionable recommendations that can be used to 1) prevent OUD through limiting initial opioid prescriptions and 2) reduce pain in patients at low risk of developing OUD. PMID:29379313

Human factors phase II: design and evaluation of decision aids for control of high-speed trains: experiments and model

DOT National Transportation Integrated Search

1996-12-01

Although the speed of some guided ground transportation systems continues to increase, the reaction time and the sensory : and information processing capacities of railroad personnel remain constant. This second report in a series examining : critica...

The Development and Implementation of an Integrating Pharmacy Practice Laboratory.

ERIC Educational Resources Information Center

Newton, Gail D.; And Others

1990-01-01

The intent of an integrating laboratory was to help pharmacy students learn to solve problems, make decisions, and develop good communication skills. Educational units included exercises in guided design, patient profile review, patient inquiries, extemporaneous prescription compounding, clinical literature evaluation, and videotapes of simulated…

AMEE Education Guide no. 29: evaluating educational programmes.

PubMed

Goldie, John

2006-05-01

Evaluation has become an applied science in its own right in the last 40 years. This guide reviews the history of programme evaluation through its initial concern with methodology, giving way to concern with the context of evaluation practice and into the challenge of fitting evaluation results into highly politicized and decentralized systems. It provides a framework for potential evaluators considering undertaking evaluation. The role of the evaluator; the ethics of evaluation; choosing the questions to be asked; evaluation design, including the dimensions of evaluation and the range of evaluation approaches available to guide evaluators; interpreting and disseminating the findings; and influencing decision making are covered.

onlineDeCISion.org: a web-based decision aid for DCIS treatment.

PubMed

Ozanne, Elissa M; Schneider, Katharine H; Soeteman, Djøra; Stout, Natasha; Schrag, Deborah; Fordis, Michael; Punglia, Rinaa S

2015-11-01

Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.​org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.​org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions.

Multiparametric MRI followed by targeted prostate biopsy for men with suspected prostate cancer: a clinical decision analysis

PubMed Central

Willis, Sarah R; Ahmed, Hashim U; Moore, Caroline M; Donaldson, Ian; Emberton, Mark; Miners, Alec H; van der Meulen, Jan

2014-01-01

Objective To compare the diagnostic outcomes of the current approach of transrectal ultrasound (TRUS)-guided biopsy in men with suspected prostate cancer to an alternative approach using multiparametric MRI (mpMRI), followed by MRI-targeted biopsy if positive. Design Clinical decision analysis was used to synthesise data from recently emerging evidence in a format that is relevant for clinical decision making. Population A hypothetical cohort of 1000 men with suspected prostate cancer. Interventions mpMRI and, if positive, MRI-targeted biopsy compared with TRUS-guided biopsy in all men. Outcome measures We report the number of men expected to undergo a biopsy as well as the numbers of correctly identified patients with or without prostate cancer. A probabilistic sensitivity analysis was carried out using Monte Carlo simulation to explore the impact of statistical uncertainty in the diagnostic parameters. Results In 1000 men, mpMRI followed by MRI-targeted biopsy ‘clinically dominates’ TRUS-guided biopsy as it results in fewer expected biopsies (600 vs 1000), more men being correctly identified as having clinically significant cancer (320 vs 250), and fewer men being falsely identified (20 vs 50). The mpMRI-based strategy dominated TRUS-guided biopsy in 86% of the simulations in the probabilistic sensitivity analysis. Conclusions Our analysis suggests that mpMRI followed by MRI-targeted biopsy is likely to result in fewer and better biopsies than TRUS-guided biopsy. Future research in prostate cancer should focus on providing precise estimates of key diagnostic parameters. PMID:24934207

Image-guided decision support system for pulmonary nodule classification in 3D thoracic CT images

NASA Astrophysics Data System (ADS)

Kawata, Yoshiki; Niki, Noboru; Ohmatsu, Hironobu; Kusumoto, Masahiro; Kakinuma, Ryutaro; Mori, Kiyoshi; Yamada, Kozo; Nishiyama, Hiroyuki; Eguchi, Kenji; Kaneko, Masahiro; Moriyama, Noriyuki

2004-05-01

The purpose of this study is to develop an image-guided decision support system that assists decision-making in clinical differential diagnosis of pulmonary nodules. This approach retrieves and displays nodules that exhibit morphological and internal profiles consistent to the nodule in question. It uses a three-dimensional (3-D) CT image database of pulmonary nodules for which diagnosis is known. In order to build the system, there are following issues that should be solved: 1) to categorize the nodule database with respect to morphological and internal features, 2) to quickly search nodule images similar to an indeterminate nodule from a large database, and 3) to reveal malignancy likelihood computed by using similar nodule images. Especially, the first problem influences the design of other issues. The successful categorization of nodule pattern might lead physicians to find important cues that characterize benign and malignant nodules. This paper focuses on an approach to categorize the nodule database with respect to nodule shape and CT density patterns inside nodule.

USER'S GUIDE TO CLOSURE EVALUATION SYSTEM: CES BETA-TEST VERSION 1.0

EPA Science Inventory

The Closure Evaluation System (CES) is a decision support tool, developed by the U.S. EPA's Risk Reduction Engineering Laboratory, to assist reviewers and preparers of Resource Conservation and Recovery Act (RCRA) Part B permit applications. CES is designed to serve as a checklis...

Affirmative Action Now: A Guide for Students, Families, and Counselors

ERIC Educational Resources Information Center

Beckman, James A.

2006-01-01

Designed for students, parents, and counselors, this timely work addresses the present state of affirmative action in higher education after the landmark decisions of "Gratz v. Bollinger" and "Grutter v. Bollinger." Informative chapters provide an overall understanding of the history of affirmative action in higher education in…

Consumer Education (A High School One Semester Course).

ERIC Educational Resources Information Center

Hawaii State Dept. of Education, Honolulu. Office of Instructional Services.

Designed for a one-semester high school social studies elective course, this curriculum guide uses a multidisciplinary approach to teach consumer education. Eight units of study cover the marketplace, consumer protection, decision making, money management, credit and taxes, basic necessities, housing, and future security. Within each unit, an…

Science and Civics: Sustaining Wildlife

ERIC Educational Resources Information Center

Council for Environmental Education, 2011

2011-01-01

Project WILD's new high school curriculum, "Science and Civics: Sustaining Wildlife", is designed to serve as a guide for involving students in environmental action projects aimed at benefitting the local wildlife found in a community. It involves young people in decisions affecting people, wildlife, and their shared habitat in the community. The…

Cable Television: A Handbook For Decision-Making.

ERIC Educational Resources Information Center

Baer, Walter S.

Basic information about cable television (CATV) and significant related issues is presented. The book is designed to serve both as a college text for communications students and as a reference and guide for government officials, educators, and other citizens. The individual chapters deal with the following topics: 1) an introduction to cable…

Using E-Learning to Improve Prescribing Practice in Emerging Prescribers

ERIC Educational Resources Information Center

Baskett, Karen

2011-01-01

This paper reports on "The National Prescribing Curriculum" (NPC), a series of online, case-based modules designed to improve prescribing performance and confidence in emerging Australian prescribers. The modules mirror the decision-making process outlined in the "WHO Guide to Good Prescribing" (de Vries "et al.",…

Farmer responses to multiple stresses in the face of global change: Assessing five case studies to enhance adaptation

NASA Astrophysics Data System (ADS)

Nicholas, K. A.; Feola, G.; Lerner, A. M.; Jain, M.; Montefrio, M.

2013-12-01

The global challenge of sustaining agricultural livelihoods and yields in the face of growing populations and increasing climate change is the topic of intense research. The role of on-the-ground decision-making by individual farmers actually producing food, fuel, and fiber is often studied in individual cases to determine its environmental, economic, and social effects. However, there are few efforts to link across studies in a way that provides opportunities to better understand empirical farmer behavior, design effective policies, and be able to aggregate from case studies to a broader scale. Here we synthesize existing literature to identify four general factors affecting farmer decision-making: local technical and socio-cultural contexts; actors and institutions involved in decision-making; multiple stressors at broader scales; and the temporal gradient of decision-making. We use these factors to compare five cases that illustrate agricultural decision-making and its impacts: cotton and castor farming in Gujarat, India; swidden cultivation of upland rice in the Philippines; potato cultivation in Andean Colombia; winegrowing in Northern California; and maize production in peri-urban central Mexico. These cases span a geographic and economic range of production systems, but we find that we are able to make valid comparisons and draw lessons common across all cases by using the four factors as an organizing principle. We also find that our understanding of why farmers make the decisions they do changes if we neglect to examine even one of the four general factors guiding decision-making. This suggests that these four factors are important to understanding farmer decision-making, and can be used to guide the design and interpretation of future studies, as well as be the subject of further research in and of themselves to promote an agricultural system that is resilient to climate and other global environmental changes.

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis

PubMed Central

Miller, Matthew James; McGuire, Kerry M.; Feigh, Karen M.

2016-01-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity. The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design. PMID:28491008

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis.

PubMed

Miller, Matthew James; McGuire, Kerry M; Feigh, Karen M

2017-06-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity . The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design.

Development and acceptability testing of decision trees for self-management of prosthetic socket fit in adults with lower limb amputation.

PubMed

Lee, Daniel Joseph; Veneri, Diana A

2018-05-01

The most common complaint lower limb prosthesis users report is inadequacy of a proper socket fit. Adjustments to the residual limb-socket interface can be made by the prosthesis user without consultation of a clinician in many scenarios through skilled self-management. Decision trees guide prosthesis wearers through the self-management process, empowering them to rectify fit issues, or referring them to a clinician when necessary. This study examines the development and acceptability testing of patient-centered decision trees for lower limb prosthesis users. Decision trees underwent a four-stage process: literature review and expert consultation, designing, two-rounds of expert panel review and revisions, and target audience testing. Fifteen lower limb prosthesis users (average age 61 years) reviewed the decision trees and completed an acceptability questionnaire. Participants reported agreement of 80% or above in five of the eight questions related to acceptability of the decision trees. Disagreement was related to the level of experience of the respondent. Decision trees were found to be easy to use, illustrate correct solutions to common issues, and have terminology consistent with that of a new prosthesis user. Some users with greater than 1.5 years of experience would not use the decision trees based on their own self-management skills. Implications for Rehabilitation Discomfort of the residual limb-prosthetic socket interface is the most common reason for clinician visits. Prosthesis users can use decision trees to guide them through the process of obtaining a proper socket fit independently. Newer users may benefit from using the decision trees more than experienced users.

Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

PubMed Central

Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

2007-01-01

The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

PGA/MOEAD: a preference-guided evolutionary algorithm for multi-objective decision-making problems with interval-valued fuzzy preferences

NASA Astrophysics Data System (ADS)

Luo, Bin; Lin, Lin; Zhong, ShiSheng

2018-02-01

In this research, we propose a preference-guided optimisation algorithm for multi-criteria decision-making (MCDM) problems with interval-valued fuzzy preferences. The interval-valued fuzzy preferences are decomposed into a series of precise and evenly distributed preference-vectors (reference directions) regarding the objectives to be optimised on the basis of uniform design strategy firstly. Then the preference information is further incorporated into the preference-vectors based on the boundary intersection approach, meanwhile, the MCDM problem with interval-valued fuzzy preferences is reformulated into a series of single-objective optimisation sub-problems (each sub-problem corresponds to a decomposed preference-vector). Finally, a preference-guided optimisation algorithm based on MOEA/D (multi-objective evolutionary algorithm based on decomposition) is proposed to solve the sub-problems in a single run. The proposed algorithm incorporates the preference-vectors within the optimisation process for guiding the search procedure towards a more promising subset of the efficient solutions matching the interval-valued fuzzy preferences. In particular, lots of test instances and an engineering application are employed to validate the performance of the proposed algorithm, and the results demonstrate the effectiveness and feasibility of the algorithm.

Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease.

PubMed

Hussain, Shazia T; Paul, Matthias; Plein, Sven; McCann, Gerry P; Shah, Ajay M; Marber, Michael S; Chiribiri, Amedeo; Morton, Geraint; Redwood, Simon; MacCarthy, Philip; Schuster, Andreas; Ishida, Masaki; Westwood, Mark A; Perera, Divaka; Nagel, Eike

2012-09-19

In patients with stable coronary artery disease (CAD), decisions regarding revascularisation are primarily driven by the severity and extent of coronary luminal stenoses as determined by invasive coronary angiography. More recently, revascularisation decisions based on invasive fractional flow reserve (FFR) have shown improved event free survival. Cardiovascular magnetic resonance (CMR) perfusion imaging has been shown to be non-inferior to nuclear perfusion imaging in a multi-centre setting and superior in a single centre trial. In addition, it is similar to invasively determined FFR and therefore has the potential to become the non-invasive test of choice to determine need for revascularisation. The MR-INFORM study is a prospective, multi-centre, randomised controlled non-inferiority, outcome trial. The objective is to compare the efficacy of two investigative strategies for the management of patients with suspected CAD. Patients presenting with stable angina are randomised into two groups: 1) The FFR-INFORMED group has subsequent management decisions guided by coronary angiography and fractional flow reserve measurements. 2) The MR-INFORMED group has decisions guided by stress perfusion CMR. The primary end-point will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at one year. Clinical trials.gov identifier NCT01236807. MR INFORM will assess whether an initial strategy of CMR perfusion is non-inferior to invasive angiography supplemented by FFR measurements to guide the management of patients with stable coronary artery disease. Non-inferiority of CMR perfusion imaging to the current invasive reference standard (FFR) would establish CMR perfusion imaging as an attractive non-invasive alternative to current diagnostic pathways.

GLIMMPSE Lite: Calculating Power and Sample Size on Smartphone Devices

PubMed Central

Munjal, Aarti; Sakhadeo, Uttara R.; Muller, Keith E.; Glueck, Deborah H.; Kreidler, Sarah M.

2014-01-01

Researchers seeking to develop complex statistical applications for mobile devices face a common set of difficult implementation issues. In this work, we discuss general solutions to the design challenges. We demonstrate the utility of the solutions for a free mobile application designed to provide power and sample size calculations for univariate, one-way analysis of variance (ANOVA), GLIMMPSE Lite. Our design decisions provide a guide for other scientists seeking to produce statistical software for mobile platforms. PMID:25541688

Promoting advance planning for health care and research among older adults: A randomized controlled trial

PubMed Central

2012-01-01

Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments. Discussion This study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system. Trial Registration ISRCTN89993391 PMID:22221980

A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design

PubMed Central

Zheng, Hua; Rosal, Milagros C; Li, Wenjun; Borg, Amy; Yang, Wenyun; Ayers, David C

2018-01-01

Background Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants’ responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra “next page” click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients’ use. PMID:29712620

Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records.

PubMed

Darcy, Diana C; Lewis, Eleanor T; Ormond, Kelly E; Clark, David J; Trafton, Jodie A

2011-11-02

Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications.

Four principles for user interface design of computerised clinical decision support systems.

PubMed

Kanstrup, Anne Marie; Christiansen, Marion Berg; Nøhr, Christian

2011-01-01

The paper presents results from a design research project of a user interface (UI) for a Computerised Clinical Decision Support System (CDSS). The ambition has been to design Human-Computer Interaction (HCI) that can minimise medication errors. Through an iterative design process a digital prototype for prescription of medicine has been developed. This paper presents results from the formative evaluation of the prototype conducted in a simulation laboratory with ten participating physicians. Data from the simulation is analysed by use of theory on how users perceive information. The conclusion is a model, which sum up four principles of interaction for design of CDSS. The four principles for design of user interfaces for CDSS are summarised as four A's: All in one, At a glance, At hand and Attention. The model emphasises integration of all four interaction principles in the design of user interfaces for CDSS, i.e. the model is an integrated model which we suggest as a guide for interaction design when working with preventing medication errors.

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

PubMed

Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

Design criteria for noncoherent Gaussian channels with MFSK signaling and coding

NASA Technical Reports Server (NTRS)

Butman, S. A.; Levitt, B. K.; Bar-David, I.; Lyon, R. F.; Klass, M. J.

1976-01-01

This paper presents data and criteria to assess and guide the design of modems for coded noncoherent communication systems subject to practical system constraints of power, bandwidth, noise spectral density, coherence time, and number of orthogonal signals M. Three basic receiver types are analyzed for the noncoherent multifrequency-shift keying (MFSK) additive white Gaussian noise channel: hard decision, unquantized (optimum), and quantized (soft decision). Channel capacity and computational cutoff rate are computed for each type and presented as functions of the predetection signal-to-noise ratio and the number of orthogonal signals. This relates the channel constraints of power, bandwidth, coherence time, and noise power to the optimum choice of signal duration and signal number.

Critical reading and critical thinking--study design and methodology: a personal approach on how to read the clinical literature.

PubMed

Lipman, Timothy O

2013-04-01

The volume of medical literature grows exponentially. Yet we are faced with the necessity to make clinical decisions based on the availability and quality of scientific information. The general strength (reliability, robustness) of any interpretation that guides us in clinical decision making is dependent on how information was obtained. All information and medical studies and, consequently, all conclusions are not created equal. It is incumbent upon us to be able to assess the quality of the information that guides us in the care of our patients. Being able to assess medical literature critically requires use of critical reading and critical thinking skills. To achieve these skills, to be able to analyze medical literature critically, takes a combination of education and practice, practice, and more practice.

TQM and Tough Love: At Inner-City Applegate Elementary, There Are High Expectations and No Excuses.

ERIC Educational Resources Information Center

Muir, Maya

2002-01-01

A Portland (Oregon) elementary school, formerly designated a local "crisis school," has improved academic achievement through a combination of Total Quality Management, high expectations, and tough love. Quarterly assessments enable staff to keep track of each student and guide instructional decisions. Small classes, on-site professional…

Building Guided Inquiry Teams for 21st-Century Learners

ERIC Educational Resources Information Center

Kuhlthau, Carol C.; Maniotes, Leslie K.

2010-01-01

How can students learn to think for themselves, make good decisions, develop expertise, and become lifelong learners in a rapidly changing information environment? How can students learn, create, and find meaning from multiple sources of information? These are fundamental questions facing educators in designing schools for 21st-century learners.…

Better Thinking and Learning: Building Effective Teaching through Educational Research.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore. Div. of Instruction.

Presenting syntheses of research on effective instruction in 30 program areas, this paper is designed as a resource to assist teachers in expanding and refining their repertoire of teaching strategies and to guide instructional planning and decision making. For each program area, the paper presents a "finding" (a one-sentence statement…

Justice. Law in a Free Society Series. Level VI. Second Edition.

ERIC Educational Resources Information Center

Center for Civic Education, Calabasas, CA.

Designed to help high school students, this curriculum guides youngsters to develop a better understanding of difficult issues raised by questions of justice. It is hoped that the ideas, observations, questions, and procedures students learn in the curriculum will help them to make informed decisions about how to promote justice and combat…

Cultural Systems and Land Use Decision Making.

ERIC Educational Resources Information Center

Schaefer, Larry; Pressman, Rob

This material includes student guide sheets, reference material, and tape script for the audio-tutorial unit on Cultural Systems. An audio tape is used with the materials. The material is designed for use with Connecticut schools, but can be adapted to other localities. The materials in this unit consider components of cultural systems, land use…

Local Implementation and Land Use Decision Making.

ERIC Educational Resources Information Center

Garlasco, Chris; And Others

This material includes student guide sheets, reference material, and tape script for the audio-tutorial unit on Local Implementation. An audio tape is used with the materials. The material is designed for use with Connecticut schools, but can be adapted to other localities. The material in this unit emphasizes the role of planning and zoning in…

Design of an Integrated Team Project as Bachelor Thesis in Bioscience Engineering

ERIC Educational Resources Information Center

Peeters, Marie-Christine; Londers, Elsje; Van der Hoeven, Wouter

2014-01-01

Following the decision at the KU Leuven to implement the educational concept of guided independent learning and to encourage students to participate in scientific research, the Faculty of Bioscience Engineering decided to introduce a bachelor thesis. Competencies, such as communication, scientific research and teamwork, need to be present in the…

Quantitative Analysis of Variables Affecting Nursing Program Completion at Arizona State University

ERIC Educational Resources Information Center

Herrera, Cheryl

2013-01-01

This study is designed to understand the patterns of selection, preparation, retention and graduation of undergraduate pre-licensure clinical nursing students in the College of Nursing and Health Innovation at Arizona State University enrolled in 2007 and 2008. The resulting patterns may guide policy decision making regarding future cohorts in…

CHOICE (Considering Honest Options in Career Exploration).

ERIC Educational Resources Information Center

Langford, Carolyn

The Considering Honest Options in Career Exploration (CHOICE) program is a career decision-making plan designed to assist counselors and teachers in helping high school juniors and seniors develop specific written career plans that they can implement after high school. This guide includes an overview of CHOICE and three CHOICE learning modules.…

Hot Technologies for K-12 Schools: The 2005 Guide for Technology Decision Makers. COSN's Emerging Technologies Series

ERIC Educational Resources Information Center

Vockley, Martha, Ed.

2004-01-01

As technology companies introduce innovative products and services for the education market, school districts have the opportunity to invest in technologies designed to improve instruction and operations--from teaching, learning and assessments to organizational efficiency. Perhaps the greatest promise of anticipated technologies is their…

Safety of High Speed Ground Transportation Systems - Human Factors Phase II: Design and Evaluation of Decision Aids for Control of High-Speed Trains: Experiments and Model

DOT National Transportation Integrated Search

1996-12-01

Although the speed of some guided ground transportation systems continues to : increase, the reaction time and the sensory and information processing : capacities of railroad personnel remain constant. This second report in a : series examining criti...

Tree value system: users guide.

Treesearch

J.K. Ayer Sachet; D.G. Briggs; R.D. Fight

1989-01-01

This paper instructs resource analysts on use of the Tree Value System (TREEVAL). TREEVAL is a microcomputer system of programs for calculating tree or stand values and volumes based on predicted product recovery. Designed for analyzing silvicultural decisions, the system can also be used for appraisals and for evaluating log bucking. The system calculates results...

Minnesota Consumer Education Program. "Consumers of the 90s."

ERIC Educational Resources Information Center

Minnesota Council on Economic Education, Minneapolis.

This teacher's guide on consumer literacy for grades 9-12 is designed for use in the following subject areas: business education, consumer law, economics, home economics, and social studies. Four units are included: (1) consumer decision making--consumer law and protection; (2) major shopping areas--transportation dilemma; (3) housing; and (4)…

Mitigating Errors of Representation: A Practical Case Study of the University Experience Survey

ERIC Educational Resources Information Center

Whiteley, Sonia

2014-01-01

The Total Survey Error (TSE) paradigm provides a framework that supports the effective planning of research, guides decision making about data collection and contextualises the interpretation and dissemination of findings. TSE also allows researchers to systematically evaluate and improve the design and execution of ongoing survey programs and…

Screening Algorithm to Guide Decisions on Whether to Conduct a Health Impact Assessment

EPA Pesticide Factsheets

Provides a visual aid in the form of a decision algorithm that helps guide discussions about whether to proceed with an HIA. The algorithm can help structure, standardize, and document the decision process.

Development by Design in Colombia: Making Mitigation Decisions Consistent with Conservation Outcomes

PubMed Central

Saenz, Shirley; Walschburger, Tomas; González, Juan Carlos; León, Jorge; McKenney, Bruce; Kiesecker, Joseph

2013-01-01

Mitigation policy and regulatory frameworks are consistent in their strong support for the mitigation hierarchy of: (1) avoiding impacts, (2) minimizing impacts, and then (3) offsetting/compensating for residual impacts. While mitigation frameworks require developers to avoid, minimize and restore biodiversity on-site before considering an offset for residual impacts, there is a lack of quantitative guidance for this decision-making process. What are the criteria for requiring impacts be avoided altogether? Here we examine how conservation planning can guide the application of the mitigation hierarchy to address this issue. In support of the Colombian government's aim to improve siting and mitigation practices for planned development, we examined five pilot projects in landscapes expected to experience significant increases in mining, petroleum and/or infrastructure development. By blending landscape-level conservation planning with application of the mitigation hierarchy, we can proactively identify where proposed development and conservation priorities would be in conflict and where impacts should be avoided. The approach we outline here has been adopted by the Colombian Ministry of Environment and Sustainable Development to guide licensing decisions, avoid piecemeal licensing, and promote mitigation decisions that maintain landscape condition. PMID:24339972

Development by design in Colombia: making mitigation decisions consistent with conservation outcomes.

PubMed

Saenz, Shirley; Walschburger, Tomas; González, Juan Carlos; León, Jorge; McKenney, Bruce; Kiesecker, Joseph

2013-01-01

Mitigation policy and regulatory frameworks are consistent in their strong support for the mitigation hierarchy of: (1) avoiding impacts, (2) minimizing impacts, and then (3) offsetting/compensating for residual impacts. While mitigation frameworks require developers to avoid, minimize and restore biodiversity on-site before considering an offset for residual impacts, there is a lack of quantitative guidance for this decision-making process. What are the criteria for requiring impacts be avoided altogether? Here we examine how conservation planning can guide the application of the mitigation hierarchy to address this issue. In support of the Colombian government's aim to improve siting and mitigation practices for planned development, we examined five pilot projects in landscapes expected to experience significant increases in mining, petroleum and/or infrastructure development. By blending landscape-level conservation planning with application of the mitigation hierarchy, we can proactively identify where proposed development and conservation priorities would be in conflict and where impacts should be avoided. The approach we outline here has been adopted by the Colombian Ministry of Environment and Sustainable Development to guide licensing decisions, avoid piecemeal licensing, and promote mitigation decisions that maintain landscape condition.

Estimating the Growth of Internal Evidence Guiding Perceptual Decisions

ERIC Educational Resources Information Center

Ludwig, Casimir J. H.; Davies, J. Rhys

2011-01-01

Perceptual decision-making is thought to involve a gradual accrual of noisy evidence. Temporal integration of the evidence reduces the relative contribution of dynamic internal noise to the decision variable, thereby boosting its signal-to-noise ratio. We aimed to estimate the internal evidence guiding perceptual decisions over time, using a novel…

Decision Making for Democratic Leadership in a Guided Internship

ERIC Educational Resources Information Center

Klinker, JoAnn Franklin; Hoover, J. Duane; Valle, Fernando; Hardin, Fred

2014-01-01

Experience in problem-based learning, authentic experiences, on-the-job decision making, and critical reflection on decisions made formed the conceptual framework of an internship to develop democratic leadership as a professional ethic in interns. Interns in an on-the-job guided internship examined decisions over a 13-week period as they…

ENVIRONMENTAL PLANNING FOR SMALL COMMUNITIES: A GUIDE FOR LOCAL DECISION-MAKERS

EPA Science Inventory

Environmental Planning for Small Communities - A Guide for Local Decision-Makers presents a process for creating and implementing a community environmental plan. With a comprehensive environmental plan, local decision-makers can create an integrated approach to protecting the env...

Decisions Based on Science.

ERIC Educational Resources Information Center

Campbell, Vincent; Lofstrom, Jocelyn; Jerome, Brian

This guide makes the case for a decision-making focus in the science curriculum as a response to concern over preparing scientifically literate students. The student activities are organized by guided activities and independent exercises. Themes of the guided activities include xenotransplants, immunizations, household cleaning products, ozone,…

PUMP-AND-TREAT GROUND-WATER REMEDIATION: A GUIDE FOR DECISION MAKERS AND PRACTITIONERS

EPA Science Inventory

This guide presents decision makers with a foundation for evaluating the appropriateness of conventional or innovative approaches. An introduction to pump-and-treat ground-water remediation, the guide addresses the following questions: When is pump-and-treat an appropriate remedi...

Decisions, Decisions: The Countless Times Instructional Practice and Reality Meet

ERIC Educational Resources Information Center

Miranda, Martina L.

2014-01-01

This article examines critical issues related to teacher decision-making in early childhood music classrooms. Through the story of one teacher's experience, we take a closer look at specific criteria to guide decision-making, and strategies to deepen awareness of young children's needs in the music classroom and guide instructional…

Procuring Stationary Fuel Cells For CHP: A Guide for Federal Facility Decision Makers

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

Stinton, David P; McGervey, Joseph; Curran, Scott

2011-11-01

Federal agency leaders are expressing growing interest in using innovative fuel cell combined heat and power (CHP) technology at their sites, motivated by both executive branch sustainability targets and a desire to lead by example in the transition to a clean energy economy. Fuel cell CHP can deliver reliable electricity and heat with 70% to 85% efficiency. Implementing this technology can be a high efficiency, clean energy solution for agencies striving to meet ambitious sustainability requirements with limited budgets. Fuel cell CHP systems can use natural gas or renewable fuels, such as biogas. Procuring Stationary Fuel Cells for CHP: Amore » Guide for Federal Facility Decision Makers presents an overview of the process for planning and implementing a fuel cell CHP project in a concise, step-by-step format. This guide is designed to help agency leaders turn their interest in fuel cell technology into successful installations. This guide concentrates on larger (100 kW and greater) fuel cell CHP systems and does not consider other fuel cell applications such as cars, forklifts, backup power supplies or small generators (<100 kW). Because fuel cell technologies are rapidly evolving and have high up front costs, their deployment poses unique challenges. The electrical and thermal output of the CHP system must be integrated with the building s energy systems. Innovative financing mechanisms allow agencies to make a make versus buy decision to maximize savings. This guide outlines methods that federal agencies may use to procure fuel cell CHP systems with little or no capital investment. Each agency and division, however, has its own set of procurement procedures. This guide was written as a starting point, and it defers to the reader s set of rules if differences exist. The fuel cell industry is maturing, and project developers are gaining experience in working with federal agencies. Technology improvements, cost reductions, and experienced project developers are making fuel cell projects easier to put into service. In this environment, federal decision makers can focus on being smart buyers of fuel cell energy instead of attempting to become experts in fuel cell technology. For agencies that want to pursue a fuel cell CHP this guide presents a four step process for a successful project. 1. Perform a preliminary screening of the energy needs energy costs and incentives. 2. Compare a detailed project plan. 3. Make a financing and contracting decision. 4. Execute the project plan including financing, installation, and operation. The simplest procurement method is designated funding for the outright purchase of the fuel cell CHP system, although this is usually not the most cost-effective option. This guide describes the following financing options: Power purchase agreement Energy savings performance contract Utility energy services contract Enhanced use lease Fuel cell CHP technology can help federal facility managers comply with agency objectives for reducing energy consumption and air pollution emissions. Fuel cells do not generate particulate pollutants, unburned hydrocarbons or the gases that produce acid rain. Fuel cells emit less carbon dioxide (CO2) than other, less efficient technologies and use of renewable fuels can make them carbon neutral. Fuel cell CHP technology can deliver reliable electricity and heat with high efficiency (70% to 85%) in a small physical footprint with little noise, making it a cost-effective option for federal facilities.« less

Atlas-guided volumetric diffuse optical tomography enhanced by generalized linear model analysis to image risk decision-making responses in young adults.

PubMed

Lin, Zi-Jing; Li, Lin; Cazzell, Mary; Liu, Hanli

2014-08-01

Diffuse optical tomography (DOT) is a variant of functional near infrared spectroscopy and has the capability of mapping or reconstructing three dimensional (3D) hemodynamic changes due to brain activity. Common methods used in DOT image analysis to define brain activation have limitations because the selection of activation period is relatively subjective. General linear model (GLM)-based analysis can overcome this limitation. In this study, we combine the atlas-guided 3D DOT image reconstruction with GLM-based analysis (i.e., voxel-wise GLM analysis) to investigate the brain activity that is associated with risk decision-making processes. Risk decision-making is an important cognitive process and thus is an essential topic in the field of neuroscience. The Balloon Analog Risk Task (BART) is a valid experimental model and has been commonly used to assess human risk-taking actions and tendencies while facing risks. We have used the BART paradigm with a blocked design to investigate brain activations in the prefrontal and frontal cortical areas during decision-making from 37 human participants (22 males and 15 females). Voxel-wise GLM analysis was performed after a human brain atlas template and a depth compensation algorithm were combined to form atlas-guided DOT images. In this work, we wish to demonstrate the excellence of using voxel-wise GLM analysis with DOT to image and study cognitive functions in response to risk decision-making. Results have shown significant hemodynamic changes in the dorsal lateral prefrontal cortex (DLPFC) during the active-choice mode and a different activation pattern between genders; these findings correlate well with published literature in functional magnetic resonance imaging (fMRI) and fNIRS studies. Copyright © 2014 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc.

New tools for evaluating LQAS survey designs

PubMed Central

2014-01-01

Lot Quality Assurance Sampling (LQAS) surveys have become increasingly popular in global health care applications. Incorporating Bayesian ideas into LQAS survey design, such as using reasonable prior beliefs about the distribution of an indicator, can improve the selection of design parameters and decision rules. In this paper, a joint frequentist and Bayesian framework is proposed for evaluating LQAS classification accuracy and informing survey design parameters. Simple software tools are provided for calculating the positive and negative predictive value of a design with respect to an underlying coverage distribution and the selected design parameters. These tools are illustrated using a data example from two consecutive LQAS surveys measuring Oral Rehydration Solution (ORS) preparation. Using the survey tools, the dependence of classification accuracy on benchmark selection and the width of the ‘grey region’ are clarified in the context of ORS preparation across seven supervision areas. Following the completion of an LQAS survey, estimation of the distribution of coverage across areas facilitates quantifying classification accuracy and can help guide intervention decisions. PMID:24528928

New tools for evaluating LQAS survey designs.

PubMed

Hund, Lauren

2014-02-15

Lot Quality Assurance Sampling (LQAS) surveys have become increasingly popular in global health care applications. Incorporating Bayesian ideas into LQAS survey design, such as using reasonable prior beliefs about the distribution of an indicator, can improve the selection of design parameters and decision rules. In this paper, a joint frequentist and Bayesian framework is proposed for evaluating LQAS classification accuracy and informing survey design parameters. Simple software tools are provided for calculating the positive and negative predictive value of a design with respect to an underlying coverage distribution and the selected design parameters. These tools are illustrated using a data example from two consecutive LQAS surveys measuring Oral Rehydration Solution (ORS) preparation. Using the survey tools, the dependence of classification accuracy on benchmark selection and the width of the 'grey region' are clarified in the context of ORS preparation across seven supervision areas. Following the completion of an LQAS survey, estimation of the distribution of coverage across areas facilitates quantifying classification accuracy and can help guide intervention decisions.

A three-talk model for shared decision making: multistage consultation process

PubMed Central

Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-01-01

Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. PMID:29109079

The Land Combat Model (DYNCOM). Volume 2

DTIC Science & Technology

1970-01-01

maneuver units. While moving, each element guides on his maneuver unit leader who designates routes and formations. , If the maneuver unit is...occupying a stationary position, the decision to Initiate movement is made by the man- euver unit leader . ,K... •■«mriamnii-K mmäi —^-- i’fafc-Ja-M...vided a communication net known as the platoon tactical net. The platoon leaders and other elements, designated by input data, are on a net

Algorithms for optimizing the treatment of depression: making the right decision at the right time.

PubMed

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.

Enhanced Adaptive Management: Integrating Decision Analysis, Scenario Analysis and Environmental Modeling for the Everglades

PubMed Central

Convertino, Matteo; Foran, Christy M.; Keisler, Jeffrey M.; Scarlett, Lynn; LoSchiavo, Andy; Kiker, Gregory A.; Linkov, Igor

2013-01-01

We propose to enhance existing adaptive management efforts with a decision-analytical approach that can guide the initial selection of robust restoration alternative plans and inform the need to adjust these alternatives in the course of action based on continuously acquired monitoring information and changing stakeholder values. We demonstrate an application of enhanced adaptive management for a wetland restoration case study inspired by the Florida Everglades restoration effort. We find that alternatives designed to reconstruct the pre-drainage flow may have a positive ecological impact, but may also have high operational costs and only marginally contribute to meeting other objectives such as reduction of flooding. Enhanced adaptive management allows managers to guide investment in ecosystem modeling and monitoring efforts through scenario and value of information analyses to support optimal restoration strategies in the face of uncertain and changing information. PMID:24113217

Practical guide to understanding Comparative Effectiveness Research (CER).

PubMed

Neely, J Gail; Sharon, Jeffrey D; Graboyes, Evan M; Paniello, Randal C; Nussenbaum, Brian; Grindler, David J; Dassopoulos, Themistocles

2013-12-01

"Comparative effectiveness research" (CER) is not a new concept; however, recently it has been popularized as a method to develop scientifically sound actionable data by which patients, physicians, payers, and policymakers may make informed health care decisions. Fundamental to CER is that the comparative data are derived from large diverse populations of patients assembled from point-of-care general primary care practices and that measured outcomes include patient value judgments. The challenge is to obtain scientifically valid data to be acted upon by decision-making stakeholders with potentially quite diversely different agenda. The process requires very thoughtful research designs modulated by complex statistical and analytic methods. This article is composed of a guiding narrative with an extensive set of tables outlining many of the details required in performing and understanding CER. It ends with short discussions of three example papers, limitations of the method, and how a practicing physician may view such reports.

Parents of Elementary School Students Weigh in on Height, Weight, and Body Mass Index Screening at School

ERIC Educational Resources Information Center

Kubik, Martha Y.; Fulkerson, Jayne A.; Story, Mary; Rieland, Gayle

2006-01-01

School-based body mass index (BMI) screening and parent notification programs have been recommended as a childhood overweight prevention strategy. However, there are little empirical data available to guide decision making about the acceptability and safety of programs. A pilot study was conducted using a quasiexperimental research design. In fall…

An Asymptotic Approach to the Development of a Green Organic Chemistry Laboratory

ERIC Educational Resources Information Center

Goodwin, Thomas E.

2004-01-01

Green chemistry is the utilization of a set of principles that reduces or eliminates the use or generation of hazardous substances in the design, manufacture and application of chemical products. Some of the philosophical questions and practical decisions that have guided the greening of the organic chemistry laboratory at Hendrix College in…

Prevention of Drug Use. Grades 4-6. Education for Self-Responsibility II.

ERIC Educational Resources Information Center

Texas Education Agency, Austin.

This Education for Self Responsibility (ESR) curriculum guide is designed to help students learn to make intelligent decisions about health and well being, and to act responsibly when confronted with opportunities to try drugs. The program focuses on ways in which Grades 4-6 teachers can emphasize: personal development; interpersonal relations;…

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

Treesearch

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

2012-01-01

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

Energy and Human Affairs: The Power of Systematic Decision Making. Student Handbook. Experimental Edition, 1975.

ERIC Educational Resources Information Center

Meyer, Don E., Ed.

This module is designed to guide a class in analyzing and investigating energy attitudes and questions. It includes methods for establishing discussions and a classroom communication system. Sources and procedures for information gathering are suggested. Another section provides a broad overview of the energy situation with descriptions of present…

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for Middle School.

ERIC Educational Resources Information Center

Core-Gebhart, Pennie; And Others

This curriculum, directed primarily to students in grades seven and eight, is a five-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into three general areas of emphasis. These sections are divided into six units that focus the content of the…

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for High School.

ERIC Educational Resources Information Center

Core-Gebhart, Pennie; And Others

This curriculum, directed primarily to students in grades nine and ten, is a 5-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into four general areas of emphasis. Section one, "Knowing Myself," helps students feel good about who they…

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for Upper Elementary School.

ERIC Educational Resources Information Center

Young, Michael; Young, Tamera

This curriculum, directed primarily to students in grades five and six, is a 5-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into three general areas of emphasis: Knowing Myself, Reltating to Others, and Planning My Future. These sections are…

Technological Literacy for Students Aged 6-18: A New Method for Holistic Measuring of Knowledge, Capabilities, Critical Thinking and Decision-Making

ERIC Educational Resources Information Center

Avsec, Stanislav; Jamšek, Janez

2016-01-01

Technological literacy is identified as a vital achievement of technology- and engineering-intensive education. It guides the design of technology and technical components of educational systems and defines competitive employment in technological society. Existing methods for measuring technological literacy are incomplete or complicated,…

How to Represent Adaptation in e-Learning with IMS Learning Design

ERIC Educational Resources Information Center

Burgos, Daniel; Tattersall, Colin; Koper, Rob

2007-01-01

Adaptation in e-learning has been an important research topic for the last few decades in computer-based education. In adaptivity the behaviour of the user triggers some actions in the system that guides the learning process. In adaptability, the user makes changes and takes decisions. Progressing from computer-based training and adaptive…

Mini-Course on Consumer Education Teacher's Guide.

ERIC Educational Resources Information Center

Hawaii State Dept. of Education, Honolulu. Office of Instructional Services.

Consumer Education is a mini-course designed for all seniors in high school. It was developed on the premise that a student needs to evolve his own value system, develop a sound decision-makingprocedure based upon his values, evaluate alternatives in the marketplace and get the best buys for his money, understand his rights and responsibilities as…

The Use of Rainfall Forecasts as a Decision Guide for Small-Scale Farming in Limpopo Province, South Africa

ERIC Educational Resources Information Center

Moeletsi, M. E.; Mellaart, E. A. R.; Mpandeli, N. S.; Hamandawana, H.

2013-01-01

Purpose: New innovative ways of communicating agrometeorological information are needed to help farmers, especially subsistence/small-scale farmers, to cope with the high climate variability experienced in most parts of southern Africa. Design/methodology/approach: The article introduces an early warning system for farmers. It utilizes short…

Statistical sampling methods for soils monitoring

Treesearch

Ann M. Abbott

2010-01-01

Development of the best sampling design to answer a research question should be an interactive venture between the land manager or researcher and statisticians, and is the result of answering various questions. A series of questions that can be asked to guide the researcher in making decisions that will arrive at an effective sampling plan are described, and a case...

Pursuing the Human Side of Driving. A Senior Grade Level Driver Education Refresher Course Curriculum.

ERIC Educational Resources Information Center

Bradley, David L.; Sorte, Bruce M.

Designed for high school seniors, this supplemental traffic safety program serves as a catalyst for discussion and learning in the area of affective education and safe and responsible driving. The guide is comprised of seven instructional units: (1) Orientation; (2) Communication Skills; (3) Skillful Decision Maker and Why; (4) Recognizing…

Improving Instruction through Schoolwide Professional Development: Effects of the Data-on-Enacted-Curriculum Model

ERIC Educational Resources Information Center

Blank, Rolf K.; Smithson, John; Porter, Andrew; Nunnaley, Diana; Osthoff, Eric

2006-01-01

The instructional improvement model Data on Enacted Curriculum was tested with an experimental design using randomized place-based trials. The improvement model is based on using data on instructional practices and achievement to guide professional development and decisions to refocus on instruction. The model was tested in 50 U.S. middle schools…

School Turnaround Teachers: Selection Toolkit. Part of the School Turnaround Collection from Public Impact

ERIC Educational Resources Information Center

Public Impact, 2008

2008-01-01

This toolkit includes these separate sections: (1) Selection Preparation Guide; (2) Day-of-Interview Tools; (3) Candidate Rating Tools; and (4) Candidate Comparison and Decision Tools. Each of the sections is designed to be used at different stages of the selection process. The first section provides turnaround teacher competencies that are the…

School Turnaround Leaders: Selection Toolkit. Part of the School Turnaround Collection from Public Impact

ERIC Educational Resources Information Center

Public Impact, 2008

2008-01-01

This toolkit includes the following separate sections: (1) Selection Preparation Guide; (2) Day-of-Interview Tools; (3) Candidate Rating Tools; and (4) Candidate Comparison and Decision Tools. Each of the sections is designed to be used at different stages of the selection process. The first section provides a list of competencies that would…

Brave New Girls: Creative Ideas To Help Girls Be Confident, Healthy, & Happy.

ERIC Educational Resources Information Center

Gadeberg, Jeanette

This guide, designed to help girls learn more about themselves and what they want from life, presents self-esteem exercises and coping skills. It opens with questions about self-discovery and what is important to them. Some examples of voicing one's opinion and making good decisions are also offered. Recognizing and dealing with different feelings…

Getting to the Table. A Guide for Senior Managers Alternative Dispute Resolutions

DTIC Science & Technology

1990-10-01

CONTENTS I. On the Way to the Forum ..................................................................... 1 I1. Joint Decision-Making Forums : How They Differ...Designing and Building the Forum ............................. 22 Step 4. Getting Parties to the Table .......................................... 29 IV...WAY TO THE FORUM Ancient Romans created fenced areas near their marketplaces as a place for lively political discussions and public judicial

Transition: Careers and Education in Nebraska, 1995.

ERIC Educational Resources Information Center

Nebraska State Occupational Information Coordinating Committee, Lincoln.

This publication is designed to help individuals make well-informed career decisions and to guide them in the type of postsecondary education or training needed to prepare for a career. Numerous careers are listed here and grouped by interest area, such as artistic, scientific, and so on. For each career area listed, information is also given on…

Assessment and Continuous Quality Improvement: A North American Case Study.

ERIC Educational Resources Information Center

Tait, Jo; Knight, Peter

1995-01-01

Examines a five-stage assessment model used at James Madison University (Virginia) to assess student learning and to guide policy. Includes identification of program objectives, selection or design of methods that measure those outcomes, analysis of assessment data, application of data for decision making, and use of data to bid for state funding.…

How system designers think: a study of design thinking in human factors engineering.

PubMed

Papantonopoulos, Sotiris

2004-11-01

The paper presents a descriptive study of design thinking in human factors engineering. The objective of the study is to analyse the role of interpretation in design thinking and the role of design practice in guiding interpretation. The study involved 10 system designers undertaking the allocation of cognitive functions in three production planning and control task scenarios. Allocation decisions were recorded and verbal protocols of the design process were collected to elicit the subjects' thought processes. Verbal protocol analysis showed that subjects carried out the design of cognitive task allocation as a problem of applying a selected automation technology from their initial design deliberations. This design strategy stands in contrast to the predominant view of system design that stipulates that user requirements should be thoroughly analysed prior to making any decisions about technology. Theoretical frameworks from design research and ontological design showed that the system design process may be better understood by recognizing the role of design hypotheses in system design, as well as the diverse interactions between interpretation and practice, means and ends, and design practice and the designer's pre-understanding which shape the design process. Ways to balance the bias exerted on the design process were discussed.

14 CFR 1216.302 - Responsibilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... overseeing and guiding NASA's integration of NEPA into the Agency's planning and decision making. The SEO... Agency planning and decision-making processes. The SEO shall monitor this process to ensure that these... functions and guiding NASA's integration of NEPA into the Agency's planning and decision making for all NASA...

Decision making about healthcare-related tests and diagnostic test strategies. Paper 2: a review of methodological and practical challenges.

PubMed

Mustafa, Reem A; Wiercioch, Wojtek; Cheung, Adrienne; Prediger, Barbara; Brozek, Jan; Bossuyt, Patrick; Garg, Amit X; Lelgemann, Monika; Büehler, Diedrich; Schünemann, Holger J

2017-12-01

In this first of a series of five articles, we provide an overview of how and why healthcare-related tests and diagnostic strategies are currently applied. We also describe how our findings can be integrated with existing frameworks for making decisions that guide the use of healthcare-related tests and diagnostic strategies. We searched MEDLINE, references of identified articles, chapters in relevant textbooks, and identified articles citing classic literature on this topic. We provide updated frameworks for the potential roles and applications of tests with suggested definitions and practical examples. We also discuss study designs that are commonly used to assess tests' performance and the effects of tests on people's health. These designs include diagnostic randomized controlled trials and retrospective validation. We describe the utility of these and other currently suggested designs, which questions they can answer and which ones they cannot. In addition, we summarize the challenges unique to decision-making resulting from the use of tests. This overview highlights current challenges in the application of tests in decision-making in healthcare, provides clarifications, and informs the proposed solutions. Copyright © 2017 Elsevier Inc. All rights reserved.

Accounting for methodological, structural, and parameter uncertainty in decision-analytic models: a practical guide.

PubMed

Bilcke, Joke; Beutels, Philippe; Brisson, Marc; Jit, Mark

2011-01-01

Accounting for uncertainty is now a standard part of decision-analytic modeling and is recommended by many health technology agencies and published guidelines. However, the scope of such analyses is often limited, even though techniques have been developed for presenting the effects of methodological, structural, and parameter uncertainty on model results. To help bring these techniques into mainstream use, the authors present a step-by-step guide that offers an integrated approach to account for different kinds of uncertainty in the same model, along with a checklist for assessing the way in which uncertainty has been incorporated. The guide also addresses special situations such as when a source of uncertainty is difficult to parameterize, resources are limited for an ideal exploration of uncertainty, or evidence to inform the model is not available or not reliable. for identifying the sources of uncertainty that influence results most are also described. Besides guiding analysts, the guide and checklist may be useful to decision makers who need to assess how well uncertainty has been accounted for in a decision-analytic model before using the results to make a decision.

Examining the Forces That Guide Teaching Decisions

ERIC Educational Resources Information Center

Griffith, Robin; Massey, Dixie; Atkinson, Terry S.

2013-01-01

This study of two successful first grade teachers examines the forces that guide their instructional decisions. Findings reveal the complexities of forces that influence the moment-to-moment decisions made by these teachers. Teachers repeatedly attempted to balance their desires to be student-centered while addressing state standards and…

Space transfer vehicle concepts and requirements study, phase 2

NASA Technical Reports Server (NTRS)

Cannon, Jeffrey H.; Vinopal, Tim; Andrews, Dana; Richards, Bill; Weber, Gary; Paddock, Greg; Maricich, Peter; Bouton, Bruce; Hagen, Jim; Kolesar, Richard

1992-01-01

This final report is a compilation of the Phase 1 and Phase 2 study findings and is intended as a Space Transfer Vehicle (STV) 'users guide' rather than an exhaustive explanation of STV design details. It provides a database for design choices in the general areas of basing, reusability, propulsion, and staging; with selection criteria based on cost, performance, available infrastructure, risk, and technology. The report is organized into the following three parts: (1) design guide; (2) STV Phase 1 Concepts and Requirements Study Summary; and (3) STV Phase 2 Concepts and Requirements Study Summary. The overall objectives of the STV study were to: (1) define preferred STV concepts capable of accommodating future exploration missions in a cost-effective manner; (2) determine the level of technology development required to perform these missions in the most cost effective manner; and (3) develop a decision database of programmatic approaches for the development of an STV concept.

Guiding students to develop an understanding of scientific inquiry: a science skills approach to instruction and assessment.

PubMed

Stone, Elisa M

2014-01-01

New approaches for teaching and assessing scientific inquiry and practices are essential for guiding students to make the informed decisions required of an increasingly complex and global society. The Science Skills approach described here guides students to develop an understanding of the experimental skills required to perform a scientific investigation. An individual teacher's investigation of the strategies and tools she designed to promote scientific inquiry in her classroom is outlined. This teacher-driven action research in the high school biology classroom presents a simple study design that allowed for reciprocal testing of two simultaneous treatments, one that aimed to guide students to use vocabulary to identify and describe different scientific practices they were using in their investigations-for example, hypothesizing, data analysis, or use of controls-and another that focused on scientific collaboration. A knowledge integration (KI) rubric was designed to measure how students integrated their ideas about the skills and practices necessary for scientific inquiry. KI scores revealed that student understanding of scientific inquiry increased significantly after receiving instruction and using assessment tools aimed at promoting development of specific inquiry skills. General strategies for doing classroom-based action research in a straightforward and practical way are discussed, as are implications for teaching and evaluating introductory life sciences courses at the undergraduate level.

Decision making technical support study for the US Army's Chemical Stockpile Disposal Program

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

Feldman, D.L.; Dobson, J.E.

1990-08-01

This report examines the adequacy of current command and control systems designed to make timely decisions that would enable sufficient warning and protective response to an accident at the Edgewood area of Aberdeen Proving Ground (APG), Maryland, and at Pine Bluff Arsenal (PBA), Arkansas. Institutional procedures designed to facilitate rapid accident assessment, characterization, warning, notification, and response after the onset of an emergency and computer-assisted decision-making aids designed to provide salient information to on- and-off-post emergency responders are examined. The character of emergency decision making at APG and PBA, as well as potential needs for improvements to decision-making practices, procedures,more » and automated decision-support systems (ADSSs), are described and recommendations are offered to guide equipment acquisition and improve on- and off-post command and control relationships. We recommend that (1) a continued effort be made to integrate on- and off-post command control, and decision-making procedures to permit rapid decision making; (2) the pathways for alert and notification among on- and off-post officials be improved and that responsibilities and chain of command among off-post agencies be clarified; (3) greater attention be given to organizational and social context factors that affect the adequacy of response and the likelihood that decision-making systems will work as intended; and (4) faster improvements be made to on-post ADSSs being developed at APG and PBA, which hold considerable promise for depicting vast amounts of information. Phased development and procurement of computer-assisted decision-making tools should be undertaken to balance immediate needs against available resources and to ensure flexibility, equity among sites, and compatibility among on- and off-post systems. 112 refs., 6 tabs.« less

Reinstated episodic context guides sampling-based decisions for reward.

PubMed

Bornstein, Aaron M; Norman, Kenneth A

2017-07-01

How does experience inform decisions? In episodic sampling, decisions are guided by a few episodic memories of past choices. This process can yield choice patterns similar to model-free reinforcement learning; however, samples can vary from trial to trial, causing decisions to vary. Here we show that context retrieved during episodic sampling can cause choice behavior to deviate sharply from the predictions of reinforcement learning. Specifically, we show that, when a given memory is sampled, choices (in the present) are influenced by the properties of other decisions made in the same context as the sampled event. This effect is mediated by fMRI measures of context retrieval on each trial, suggesting a mechanism whereby cues trigger retrieval of context, which then triggers retrieval of other decisions from that context. This result establishes a new avenue by which experience can guide choice and, as such, has broad implications for the study of decisions.

Managing Your Money. Leader's Guide [and] Participant's Workbook.

ERIC Educational Resources Information Center

Nieuwenhuis, Ann; Hathaway, Irene

This document contains both a leader's guide and participant's workbook on money management. The leader's and participant's guides contain 10 parts each: (1) danger signs in money management; (2) what's important to you; (3) spending for the future; (4) financial fitness; (5) use credit wisely; (6) decisions, decisions; (7) shopping basics; (8)…

[Info-pocket-guide as a contribution to the prevention of mental illnesses].

PubMed

Corrieri, Sandro; Conrad, Ines; Riedel-Heller, Steffi G

2012-04-01

To assess how Info-Pocket-Guides (IPG) are judged as an overall concept, with specific consideration for their content and design in terms of a successful contribution to the prevention of mental illnesses. Altogether, eight student focus groups were conducted and differentiated according to sex, age, and educational system. Mainly, the respondents consider the IPGs as an appealing design, as well as a convenient and well-liked source of information. Some amendments regarding the range of topics were suggested. While there were doubts on the direct benefit of IPGs for the affected person, they were considered highly valuable for relatives and friends. For the acceptance of IPGs, an age-appropriate and context-involving mediation was found decisive. © Georg Thieme Verlag KG Stuttgart · New York.

Vulnerability-based evaluation of water supply design under climate change

NASA Astrophysics Data System (ADS)

Umit Taner, Mehmet; Ray, Patrick; Brown, Casey

2015-04-01

Long-lived water supply infrastructures are strategic investments in the developing world, serving the purpose of balancing water deficits compounded by both population growth and socio-economic development. Robust infrastructure design under climate change is compelling, and often addressed by focusing on the outcomes of climate model projections ('scenario-led' planning), or by identifying design options that are less vulnerable to a wide range of plausible futures ('vulnerability-based' planning). Decision-Scaling framework combines these two approaches by first applying a climate stress test on the system to explore vulnerabilities across many traces of the future, and then employing climate projections to inform the decision-making process. In this work, we develop decision scaling's nascent risk management concepts further, directing actions on vulnerabilities identified during the climate stress test. In the process, we present a new way to inform climate vulnerability space using climate projections, and demonstrate the use of multiple decision criteria to guide to a final design recommendation. The concepts are demonstrated for a water supply project in the Mombasa Province of Kenya, planned to provide domestic and irrigation supply. Six storage design capacities (from 40 to 140 million cubic meters) are explored through a stress test, under a large number climate traces representing both natural climate variability and plausible climate changes. Design outcomes are simulated over a 40-year planning period with a coupled hydrologic-water resources systems model and using standard reservoir operation rules. Resulting performance is expressed in terms of water supply reliability and economic efficiency. Ensemble climate projections are used for assigning conditional likelihoods to the climate traces using a statistical distance measure. The final design recommendations are presented and discussed for the decision criteria of expected regret, satisficing, and conditional value-at-risk (CVaR).

Differential Contributions of Nucleus Accumbens Subregions to Cue-Guided Risk/Reward Decision Making and Implementation of Conditional Rules.

PubMed

Floresco, Stan B; Montes, David R; Tse, Maric M T; van Holstein, Mieke

2018-02-21

The nucleus accumbens (NAc) is a key node within corticolimbic circuitry for guiding action selection and cost/benefit decision making in situations involving reward uncertainty. Preclinical studies have typically assessed risk/reward decision making using assays where decisions are guided by internally generated representations of choice-outcome contingencies. Yet, real-life decisions are often influenced by external stimuli that inform about likelihoods of obtaining rewards. How different subregions of the NAc mediate decision making in such situations is unclear. Here, we used a novel assay colloquially termed the "Blackjack" task that models these types of situations. Male Long-Evans rats were trained to choose between one lever that always delivered a one-pellet reward and another that delivered four pellets with different probabilities [either 50% (good-odds) or 12.5% (poor-odds)], which were signaled by one of two auditory cues. Under control conditions, rats selected the large/risky option more often on good-odds versus poor-odds trials. Inactivation of the NAc core caused indiscriminate choice patterns. In contrast, NAc shell inactivation increased risky choice, more prominently on poor-odds trials. Additional experiments revealed that both subregions contribute to auditory conditional discrimination. NAc core or shell inactivation reduced Pavlovian approach elicited by an auditory CS+, yet shell inactivation also increased responding during presentation of a CS-. These data highlight distinct contributions for NAc subregions in decision making and reward seeking guided by discriminative stimuli. The core is crucial for implementation of conditional rules, whereas the shell refines reward seeking by mitigating the allure of larger, unlikely rewards and reducing expression of inappropriate or non-rewarded actions. SIGNIFICANCE STATEMENT Using external cues to guide decision making is crucial for adaptive behavior. Deficits in cue-guided behavior have been associated with neuropsychiatric disorders, such as attention deficit hyperactivity disorder and schizophrenia, which in turn has been linked to aberrant processing in the nucleus accumbens. However, many preclinical studies have often assessed risk/reward decision making in the absence of explicit cues. The current study fills that gap by using a novel task that allows for the assessment of cue-guided risk/reward decision making in rodents. Our findings identified distinct yet complementary roles for the medial versus lateral portions of this nucleus that provide a broader understanding of the differential contributions it makes to decision making and reward seeking guided by discriminative stimuli. Copyright © 2018 the authors 0270-6474/18/381901-14$15.00/0.

Analysis of Special Operations Forces in Decision Aids: Recommendations,

DTIC Science & Technology

1994-01-01

Soviet-made armored scout cars operated by Malaysian troops. By that time, the United States had lost 102 men-18 killed and 84 wounded. Somali leaders...designation of targets; attack by F-15E and F-16C using CBU-87, -89 Execution and GBU; attack by A-10 using Maverick and 30-mm cannon; attack by B-52 using...patrolling designated areas of the battlefield and attacking individual armored vehicles with precision-guided weapons such as Maverick . Discontinuity

A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design.

PubMed

Zheng, Hua; Rosal, Milagros C; Li, Wenjun; Borg, Amy; Yang, Wenyun; Ayers, David C; Franklin, Patricia D

2018-04-30

Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra "next page" click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use. ©Hua Zheng, Milagros C Rosal, Wenjun Li, Amy Borg, Wenyun Yang, David C Ayers, Patricia D Franklin. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 30.04.2018.

Parent Choice: A Digest of the Research. [Parent Choice and the Public Schools: Volume 1].

ERIC Educational Resources Information Center

Zerchykov, Ross

This guide, first in a series of four volumes, is designed to give information to parents and other decision makers on costs and benefits of different kinds of choices of schools that children might attend. Four sections present digests of information based on research and evaluation studies. Section 1 introduces the format and purpose of the…

Every Voice Counts: Holding a Shared Leadership Event To Make Decisions Together.

ERIC Educational Resources Information Center

Strauss, Jessica

Shared leadership is a process empowering parents to exercise their civil rights, build leadership skills, and guide the design of policy positions and programs meant to improve their lives and the well-being of their children. Based on principles of family support practice, this book describes how to plan and host a 1- to 3-day shared leadership…

Careers for Chemists: A World Outside the Lab.

ERIC Educational Resources Information Center

Owens, Fred; Uhler, Roger; Marasco, Corinne

This guide is designed to help chemists who may be facing a job change or career transition. Over 80 profiles of people who are using their training in chemistry in a variety of careers are present. These profiles highlight the paths people have taken and the factors that contributed to their career decisions, and feature a summary of the skills…

The Sun's Joules: What is Renewable Energy? An Introduction to "The Sun's Joules" CD-ROM and Energy Education Program.

ERIC Educational Resources Information Center

Weiskopf, Joyce Lowry

This guide accompanies a compact disk that provides a comprehensive collection of information resources. The compact disk is organized according to energy sources and cross-referenced to issues that must be considered when making decisions about energy. This booklet, designed around questions common to high school students, illustrates how the…

People Who Live in Glass Houses. Youth Training Scheme. Core Exemplar Work Based Project.

ERIC Educational Resources Information Center

Further Education Staff Coll., Blagdon (England).

This trainer's guide is intended to assist supervisors of work-based career training projects in helping students compare the advantages and disadvantages of buying or building a greenhouse, make a decision within cost constraints, and execute the task under supervision. This project is designed to meet the needs of trainees who are of low…

Decision support system for health care resources allocation

PubMed Central

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-01-01

Background A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. Aim The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. Methods To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. Results A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. Conclusion In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff. PMID:28848645

Decision support system for health care resources allocation.

PubMed

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-06-01

A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

Uncover it, students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback.

PubMed

Alizadeh, Maryam; Mirzazadeh, Azim; Parmelee, Dean X; Peyton, Elizabeth; Janani, Leila; Hassanzadeh, Gholamreza; Nedjat, Saharnaz

2017-04-01

Little is known about best practices for teaching and learning leadership through Team-Based learning™ (TBL™) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework. The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n = 20 teams) and the other received only TBL (n = 19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions. Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p = 0.6), 2 (p = 1) or 3 (p = 1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p = 0.77), 2 (p = 0.23), or 3 (p = 0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T = -8.55, p > 0.001 adjusted on baseline; T = -8.55, p > 0.001 adjusted on gender). We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.

A three-talk model for shared decision making: multistage consultation process.

PubMed

Elwyn, Glyn; Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-11-06

Objectives  To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design  Multistage consultation process. Setting  Key informant group, communities of interest, and survey of clinical specialties. Participants  19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results  After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions  The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Clinical Intuition Exploration Guide: A Decision-Making Tool for Counselors and Supervisors

ERIC Educational Resources Information Center

Jeffrey, Aaron

2012-01-01

Clinical intuition is a common experience among counselors, yet many do not know what to do with intuition when it occurs. This article reviews the role intuition plays in clinical work and presents the research-based Clinical Intuition Exploration Guide to help counselors navigate the decision-making process. The guide consists of self-reflection…

The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia

NASA Astrophysics Data System (ADS)

Kucharski, John; Tkach, Mark; Olszewski, Jennifer; Chaudhry, Rabia; Mendoza, Guillermo

2016-04-01

This presentation demonstrates the application of Climate Risk Informed Decision Analysis (CRIDA) at Zambia's principal water treatment facility, The Iolanda Water Treatment Plant. The water treatment plant is prone to unacceptable failures during periods of low hydropower production at the Kafue Gorge Dam Hydroelectric Power Plant. The case study explores approaches of increasing the water treatment plant's ability to deliver acceptable levels of service under the range of current and potential future climate states. The objective of the study is to investigate alternative investments to build system resilience that might have been informed by the CRIDA process, and to evaluate the extra resource requirements by a bilateral donor agency to implement the CRIDA process. The case study begins with an assessment of the water treatment plant's vulnerability to climate change. It does so by following general principals described in "Confronting Climate Uncertainty in Water Resource Planning and Project Design: the Decision Tree Framework". By utilizing relatively simple bootstrapping methods a range of possible future climate states is generated while avoiding the use of more complex and costly downscaling methodologies; that are beyond the budget and technical capacity of many teams. The resulting climate vulnerabilities and uncertainty in the climate states that produce them are analyzed as part of a "Level of Concern" analysis. CRIDA principals are then applied to this Level of Concern analysis in order to arrive at a set of actionable water management decisions. The principal goals of water resource management is to transform variable, uncertain hydrology into dependable services (e.g. water supply, flood risk reduction, ecosystem benefits, hydropower production, etc…). Traditional approaches to climate adaptation require the generation of predicted future climate states but do little guide decision makers how this information should impact decision making. In this context it is not surprising that the increased hydrologic variability and uncertainty produced by many climate risk analyses bedevil water resource decision making. The Climate Risk Informed Decision Analysis (CRIDA) approach builds on work found in "Confronting Climate Uncertainty in Water Resource Planning and Project Design: the Decision Tree Framework" which provide guidance of vulnerability assessments. It guides practitioners through a "Level of Concern" analysis where climate vulnerabilities are analyzed to produce actionable alternatives and decisions.

Ethical decision-making in the dilemma of the intersex infant.

PubMed

Lathrop, Breanna L; Cheney, Teresa B; Hayman, Annette B

2014-03-01

The Making Ethical Decisions about Surgical Intervention (MEDSI) tool is designed to guide health care professionals, patients, and families faced with ethically charged decisions regarding surgical interventions for pediatric patients. MEDSI is built on the principles of beneficence, nonmaleficence, and patient autonomy and created to promote truth-telling, compassion, respect for patient cultural and religious preferences, and appropriate follow up in the clinical setting. Following an overview of the 8 steps that compose MEDSI, the tool is applied to the management of intersex infants. The birth of a child with a disorder of sexual development (DSD) and ambiguous genitalia presents an ethically challenging situation for the family and health care team. The use of the MEDSI model is demonstrated in a case study involving the decision of surgical intervention in the management of an intersex child.

Toward a Democratic Ethic of Curricular Decision-Making: A Guide for Educational Practitioners

ERIC Educational Resources Information Center

Simpson, Douglas J.; Jackson, Michael J. B.; Bunuan, Rommel L.; Chan, Yoke-Meng; Collins, B. Renee; King, Erica L.; Mosley, Linder K.

2004-01-01

In this article, the authors present a philosophical exploration of the import of a democratic ethic in making decisions concerning curricula. Specifically, the authors offer a guide for ethical decision making that is concerned with promoting fairness and acting on social justice principles. The ethical responsibilities of educators are explored,…

Market analysis and program for use for energy conservation manuals: a marketing plan. Final report

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

Not Available

1977-02-25

The FEA, with a mission to analyze total national energy usage, formulate policy, and stimulate actions that will increase domestic energy supply and decrease energy demand, decided to develop effective energy conservation manuals for decision makers in existing buildings. The manuals developed are: Building Owner's and Manager's Guide to Energy Conservation; Building Operator's Guide to Energy Conservation; and Architect's and Engineer's Guide to Energy Conservation. The background and scope of the entire project which led to the development of the manuals is discussed in the introduction of this publication. Part II, Market Analysis, provides insight into the character of themore » designated audiences for the manuals. Part III, Program for Use, is a marketing and promotion plan for the manuals.« less

Maintenance decision support system deployment guide

DOT National Transportation Integrated Search

2008-07-01

This is a guide for transportation professionals on why and how to deploy winter Maintenance Decision Support Systems (MDSS). Adverse winter weather can cause traffic delays and crashes. Treating the effects of winter weather can also have impacts on...

A review of the literature: midwifery decision-making and birth.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2010-12-01

Clinical decision-making was initially studied in medicine where hypothetico-deductive reasoning is the model for decision-making. The nursing perspective on clinical decision-making has largely been shaped by Patricia Benner's ground breaking work. Benner claimed expert nurses use humanistic-intuitive ways of making clinical decisions rather than the 'rational reasoning' as claimed by medicine. Clinical decision-making in midwifery is not the same as either nursing or medical decision-making because of the woman-midwife partnership where the woman is the ultimate decision-maker. CINHAL, Medline and Cochrane databases were systematically searched using key words derived from the guiding question. A review of the decision-making research literature in midwifery was undertaken where studies were published in English. The selection criteria for papers were: only research papers of direct relevance to the guiding research question were included in the review. Decision-making is under-researched in midwifery and more specifically birth, as only 4 research articles met the inclusion criteria in this review. Three of the studies involved qualified midwives, and one involved student midwives. Two studies were undertaken in England, one in Scotland and one in Sweden. The major findings synthesised from this review, are that; (1) midwifery decision-making during birth is socially negotiated involving hierarchies of surveillance and control; (2) the role of the woman in shared decision-making during birth has not been explored by midwifery research; (3) clinical decision-making encompasses clinical reasoning as essential but not sufficient for midwives to actually implement their preferred decision. We argue that existing research does not inform the discipline of the complexity of midwifery clinical decision-making during birth. A well-designed study would involve investigating the clinical reasoning skills of the midwife, her relationship with the woman, the context of the particular birthing unit and the employment status of the midwife. The role of the woman as decision-maker in her own care during birth also needs careful research attention. Copyright © 2010 Australian College of Midwives. All rights reserved.

Evaluation of the acceptability and usability of a decision support system to encourage safe and effective use of opioid therapy for chronic, noncancer pain by primary care providers.

PubMed

Trafton, Jodie; Martins, Susana; Michel, Martha; Lewis, Eleanor; Wang, Dan; Combs, Ann; Scates, Naquell; Tu, Samson; Goldstein, Mary K

2010-04-01

To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain. CDSS development and iterative evaluation using the analysis, design, development, implementation, and evaluation process including simulation-based and in-clinic assessments of usability for providers followed by targeted system revisions. Volunteers provided detailed feedback to guide improvements in the graphical user interface, and content and design changes to increase clinical usefulness, understandability, clinical workflow fit, and ease of completing guideline recommended practices. Revisions based on feedback increased CDSS usability ratings over time. Practice concerns outside the scope of the CDSS were also identified. Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues.

“Kinect-ing” With Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation

PubMed Central

Levac, Danielle; Espy, Deborah; Fox, Emily; Pradhan, Sujata

2015-01-01

Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice. PMID:25256741

Does probability guided hysteroscopy reduce costs in women investigated for postmenopausal bleeding?

PubMed

Breijer, M C; van Hanegem, N; Visser, N C M; Verheijen, R H M; Mol, B W J; Pijnenborg, J M A; Opmeer, B C; Timmermans, A

2015-01-01

To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy. Model based cost-minimization analysis. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses. Costs for the different strategies. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.

"Kinect-ing" with clinicians: a knowledge translation resource to support decision making about video game use in rehabilitation.

PubMed

Levac, Danielle; Espy, Deborah; Fox, Emily; Pradhan, Sujata; Deutsch, Judith E

2015-03-01

Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection and implementation that address individual therapeutic goals. This article describes the development and preliminary evaluation of a knowledge translation (KT) resource to support clinical decision making about selection and use of Kinect games in physical therapy. The knowledge-to-action framework guided the development of the Kinecting With Clinicians (KWiC) resource. Five physical therapists with VR and video game expertise analyzed the Kinect Adventure games. A consensus-building method was used to arrive at categories to organize clinically relevant attributes guiding game selection and game play. The process and results of an exploratory usability evaluation of the KWiC resource by clinicians through interviews and focus groups at 4 clinical sites is described. Subsequent steps in the evaluation and KT process are proposed, including making the KWiC resource Web-based and evaluating the utility of the online resource in clinical practice. © 2015 American Physical Therapy Association.

Health care consumer reports: an evaluation of employer perspectives.

PubMed

Longo, Daniel R

2004-01-01

The proliferation of health care consumer reports (also known as "consumer guides," "report cards," and "performance reports") designed to assist consumers in making more informed health care decisions makes it vital to understand the perspective of employers who provide the vast majority of health insurance to the working population regarding the use of these reports. There is little empirical evidence on how consumer reports are used by employers to make health care purchasing decisions. This study fills that gap by surveying 154 businesses in Boone County, Missouri, regarding their evaluation of a consumer guide. The majority of employers surveyed indicate that the report will not have a direct effect on their health care purchasing decisions. However, they indicate that the reports are "positive and worthwhile" and their responses reflect a favorable view of the health care organization that developed and disseminated the report. Additionally, findings indicate that employers generally prefer consumer reports as a means to compare local health care institutions, rather than reviewing national averages to locate the same information. Report developers should take precautions to determine the intent of such reports, as they may not achieve the objective of changing employers' health care purchasing behavior.

Development and Validation of a Primary Care-Based Family Health History and Decision Support Program (MeTree)

PubMed Central

Orlando, Lori A.; Buchanan, Adam H.; Hahn, Susan E.; Christianson, Carol A.; Powell, Karen P.; Skinner, Celette Sugg; Chesnut, Blair; Blach, Colette; Due, Barbara; Ginsburg, Geoffrey S.; Henrich, Vincent C.

2016-01-01

INTRODUCTION Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to guide selection of primary prevention strategies. However, the collection and synthesis of such information is not well integrated into clinical practice. To address barriers to collection and use of family health histories, the Genomedical Connection developed and validated MeTree, a Web-based, patient-facing family health history collection and clinical decision support tool. MeTree is designed for integration into primary care practices as part of the genomic medicine model for primary care. METHODS We describe the guiding principles, operational characteristics, algorithm development, and coding used to develop MeTree. Validation was performed through stakeholder cognitive interviewing, a genetic counseling pilot program, and clinical practice pilot programs in 2 community-based primary care clinics. RESULTS Stakeholder feedback resulted in changes to MeTree’s interface and changes to the phrasing of clinical decision support documents. The pilot studies resulted in the identification and correction of coding errors and the reformatting of clinical decision support documents. MeTree’s strengths in comparison with other tools are its seamless integration into clinical practice and its provision of action-oriented recommendations guided by providers’ needs. LIMITATIONS The tool was validated in a small cohort. CONCLUSION MeTree can be integrated into primary care practices to help providers collect and synthesize family health history information from patients with the goal of improving adherence to risk-stratified evidence-based guidelines. PMID:24044145

How To Differentiate Instruction. Adapted from Chapter 3 of "Powerful Lesson Planning Models: The Art of 1,000 Decisions." A Skylight Guide. Grades K-12.

ERIC Educational Resources Information Center

Skowron, Janice

This booklet helps teachers understand how to increase student motivation and interest and how to design lively, creative, and interactive lessons that will enrich learning. Chapter 1, "The Differences That Impact Learning," describes the differentiated classroom and provides teachers with an understanding of the many variations of how…

A Key to Evaluation: The Transition Competence Battery for Deaf Adolescents and Young Adults

ERIC Educational Resources Information Center

Davis, Cheryl; Leonard, Annette

2007-01-01

Guiding deaf and hard of hearing students in making important decisions about their adult careers can be a difficult task. Twenty years after its inception, the TCB, as adapted for deaf and hard of hearing students, may help. The TCB is a unique assessment tool designed to measure the transition skills of deaf high school adolescents and young…

What Can I Be? A Guide to 525 Liberal Arts and Business Careers.

ERIC Educational Resources Information Center

Lieberman, Leo

This book is designed to aid high school students who plan to go to college, as well as college students and graduates, in making suitable career decisions. It is divided into two parts. The first names 20 typical college majors, and lists under each one a wide range of occupations to which the major can lead. A college graduate having difficulty…

Microgrid Design Toolkit (MDT) User Guide Software v1.2.

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

Eddy, John P.

2017-08-01

The Microgrid Design Toolkit (MDT) supports decision analysis for new ("greenfield") microgrid designs as well as microgrids with existing infrastructure. The current version of MDT includes two main capabilities. The first capability, the Microgrid Sizing Capability (MSC), is used to determine the size and composition of a new, grid connected microgrid in the early stages of the design process. MSC is focused on developing a microgrid that is economically viable when connected to the grid. The second capability is focused on designing a microgrid for operation in islanded mode. This second capability relies on two models: the Technology Management Optimizationmore » (TMO) model and Performance Reliability Model (PRM).« less

Guiding Students to Develop an Understanding of Scientific Inquiry: A Science Skills Approach to Instruction and Assessment

PubMed Central

Stone, Elisa M.

2014-01-01

New approaches for teaching and assessing scientific inquiry and practices are essential for guiding students to make the informed decisions required of an increasingly complex and global society. The Science Skills approach described here guides students to develop an understanding of the experimental skills required to perform a scientific investigation. An individual teacher's investigation of the strategies and tools she designed to promote scientific inquiry in her classroom is outlined. This teacher-driven action research in the high school biology classroom presents a simple study design that allowed for reciprocal testing of two simultaneous treatments, one that aimed to guide students to use vocabulary to identify and describe different scientific practices they were using in their investigations—for example, hypothesizing, data analysis, or use of controls—and another that focused on scientific collaboration. A knowledge integration (KI) rubric was designed to measure how students integrated their ideas about the skills and practices necessary for scientific inquiry. KI scores revealed that student understanding of scientific inquiry increased significantly after receiving instruction and using assessment tools aimed at promoting development of specific inquiry skills. General strategies for doing classroom-based action research in a straightforward and practical way are discussed, as are implications for teaching and evaluating introductory life sciences courses at the undergraduate level. PMID:24591508

Procalcitonin Testing to Guide Antibiotic Therapy in Acute Upper and Lower Respiratory Tract Infections.

PubMed

Schuetz, Philipp; Wirz, Yannick; Mueller, Beat

2018-03-06

Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with usual care? Among patients with varying types and severity of acute respiratory infection, using procalcitonin to guide decisions about antibiotics is associated with lower rates of antibiotic exposure, antibiotic-related adverse effects, and mortality.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.

PubMed

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.

The normalization heuristic: an untested hypothesis that may misguide medical decisions.

PubMed

Aberegg, Scott K; O'Brien, James M

2009-06-01

Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. One commonly utilized general clinical hypothesis is the assumption that normalizing abnormal laboratory values and physiological parameters will lead to improved patient outcomes. We refer to the general use of this clinical hypothesis to guide medical therapeutics as the "normalization heuristic". In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.

Development and Use of Engineering Standards for Computational Fluid Dynamics for Complex Aerospace Systems

NASA Technical Reports Server (NTRS)

Lee, Hyung B.; Ghia, Urmila; Bayyuk, Sami; Oberkampf, William L.; Roy, Christopher J.; Benek, John A.; Rumsey, Christopher L.; Powers, Joseph M.; Bush, Robert H.; Mani, Mortaza

2016-01-01

Computational fluid dynamics (CFD) and other advanced modeling and simulation (M&S) methods are increasingly relied on for predictive performance, reliability and safety of engineering systems. Analysts, designers, decision makers, and project managers, who must depend on simulation, need practical techniques and methods for assessing simulation credibility. The AIAA Guide for Verification and Validation of Computational Fluid Dynamics Simulations (AIAA G-077-1998 (2002)), originally published in 1998, was the first engineering standards document available to the engineering community for verification and validation (V&V) of simulations. Much progress has been made in these areas since 1998. The AIAA Committee on Standards for CFD is currently updating this Guide to incorporate in it the important developments that have taken place in V&V concepts, methods, and practices, particularly with regard to the broader context of predictive capability and uncertainty quantification (UQ) methods and approaches. This paper will provide an overview of the changes and extensions currently underway to update the AIAA Guide. Specifically, a framework for predictive capability will be described for incorporating a wide range of error and uncertainty sources identified during the modeling, verification, and validation processes, with the goal of estimating the total prediction uncertainty of the simulation. The Guide's goal is to provide a foundation for understanding and addressing major issues and concepts in predictive CFD. However, this Guide will not recommend specific approaches in these areas as the field is rapidly evolving. It is hoped that the guidelines provided in this paper, and explained in more detail in the Guide, will aid in the research, development, and use of CFD in engineering decision-making.

A conceptual framework for effectively anticipating water-quality changes resulting from changes in agricultural activities

USGS Publications Warehouse

Capel, Paul D.; Wolock, David M.; Coupe, Richard H.; Roth, Jason L.

2018-01-10

Agricultural activities can affect water quality and the health of aquatic ecosystems; many water-quality issues originate with the movement of water, agricultural chemicals, and eroded soil from agricultural areas to streams and groundwater. Most agricultural activities are designed to sustain or increase crop production, while some are designed to protect soil and water resources. Numerous soil- and water-protection practices are designed to reduce the volume and velocity of runoff and increase infiltration. This report presents a conceptual framework that combines generalized concepts on the movement of water, the environmental behavior of chemicals and eroded soil, and the designed functions of various agricultural activities, as they relate to hydrology, to create attainable expectations for the protection of—with the goal of improving—water quality through changes in an agricultural activity.The framework presented uses two types of decision trees to guide decision making toward attainable expectations regarding the effectiveness of changing agricultural activities to protect and improve water quality in streams. One decision tree organizes decision making by considering the hydrologic setting and chemical behaviors, largely at the field scale. This decision tree can help determine which agricultural activities could effectively protect and improve water quality in a stream from the movement of chemicals, or sediment, from a field. The second decision tree is a chemical fate accounting tree. This decision tree helps set attainable expectations for the permanent removal of sediment, elements, and organic chemicals—such as herbicides and insecticides—through trapping or conservation tillage practices. Collectively, this conceptual framework consolidates diverse hydrologic settings, chemicals, and agricultural activities into a single, broad context that can be used to set attainable expectations for agricultural activities. This framework also enables better decision making for future agricultural activities as a means to reduce current, and prevent new, water-quality issues.

Tools for Understanding Space Weather Impacts to Satellites

NASA Astrophysics Data System (ADS)

Green, J. C.; Shprits, Y.; Likar, J. J.; Kellerman, A. C.; Quinn, R. A.; Whelan, P.; Reker, N.; Huston, S. L.

2017-12-01

Space weather causes dramatic changes in the near-Earth radiation environment. Intense particle fluxes can damage electronic components on satellites, causing temporary malfunctions, degraded performance, or a complete system/mission loss. Understanding whether space weather is the cause of such problems expedites investigations and guides successful design improvements resulting in a more robust satellite architecture. Here we discuss our progress in developing tools for satellite designers, manufacturers, and decision makers - tools that summarize space weather impacts to specific satellite assets and enable confident identification of the cause and right solution.

Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic.

PubMed

DeJonckheere, Melissa; Robinson, Claire H; Evans, Lindsey; Lowery, Julie; Youles, Bradley; Tremblay, Adam; Kelley, Caitlin; Sussman, Jeremy B

2018-04-24

Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers. The objectives of this study were to identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on prescribing appropriate statins. We employed user-centered design principles to guide the development and testing of a multicomponent guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semistructured qualitative interviews with providers were conducted to (1) illuminate the knowledge, attitudes, and behaviors of providers and (2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana's Clinical Practice Guidelines Framework for Improvement and Nielsen's Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Semistructured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team professionals (13 physicians and 2 clinical pharmacists) at a single VA medical center. Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. By combining qualitative methods and user-centered design principles, we could inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts with an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions. ©Melissa DeJonckheere, Claire H Robinson, Lindsey Evans, Julie Lowery, Bradley Youles, Adam Tremblay, Caitlin Kelley, Jeremy B Sussman. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 24.04.2018.

Memory states influence value-based decisions.

PubMed

Duncan, Katherine D; Shohamy, Daphna

2016-11-01

Using memory to guide decisions allows past experience to improve future outcomes. However, the circumstances that modulate how and when memory influences decisions are not well understood. Here, we report that the use of memories to guide decisions depends on the context in which these decisions are made. We show that decisions made in the context of familiar images are more likely to be influenced by past events than are decisions made in the context of novel images (Experiment 1), that this bias persists even when a temporal gap is introduced between the image presentation and the decision (Experiment 2), and that contextual novelty facilitates value learning whereas familiarity facilitates the retrieval and use of previously learned values (Experiment 3). These effects are consistent with neurobiological and computational models of memory, which propose that familiar images evoke a lingering "retrieval state" that facilitates the recollection of other episodic memories. Together, these experiments highlight the importance of episodic memory for decision-making and provide an example of how computational and neurobiological theories can lead to new insights into how and when different types of memories guide our choices. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Integrating modeling, monitoring, and management to reduce critical uncertainties in water resource decision making.

PubMed

Peterson, James T; Freeman, Mary C

2016-12-01

Stream ecosystems provide multiple, valued services to society, including water supply, waste assimilation, recreation, and habitat for diverse and productive biological communities. Managers striving to sustain these services in the face of changing climate, land uses, and water demands need tools to assess the potential effectiveness of alternative management actions, and often, the resulting tradeoffs between competing objectives. Integrating predictive modeling with monitoring data in an adaptive management framework provides a process by which managers can reduce model uncertainties and thus improve the scientific bases for subsequent decisions. We demonstrate an integration of monitoring data with a dynamic, metapopulation model developed to assess effects of streamflow alteration on fish occupancy in a southeastern US stream system. Although not extensive (collected over three years at nine sites), the monitoring data allowed us to assess and update support for alternative population dynamic models using model probabilities and Bayes rule. We then use the updated model weights to estimate the effects of water withdrawal on stream fish communities and demonstrate how feedback in the form of monitoring data can be used to improve water resource decision making. We conclude that investment in more strategic monitoring, guided by a priori model predictions under alternative hypotheses and an adaptive sampling design, could substantially improve the information available to guide decision-making and management for ecosystem services from lotic systems. Published by Elsevier Ltd.

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

PubMed

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

2006-12-04

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

A practical guide to surveys and questionnaires.

PubMed

Slattery, Eric L; Voelker, Courtney C J; Nussenbaum, Brian; Rich, Jason T; Paniello, Randal C; Neely, J Gail

2011-06-01

Surveys with questionnaires play a vital role in decision and policy making in society. Within medicine, including otolaryngology, surveys with questionnaires may be the only method for gathering data on rare or unusual events. In addition, questionnaires can be developed and validated to be used as outcome measures in clinical trials and other clinical research architecture. Consequently, it is fundamentally important that such tools be properly developed and validated. Just asking questions that have not gone through rigorous design and development may be misleading and unfair at best; at worst, they can result in under- or overtreatment and unnecessary expense. Furthermore, it is important that consumers of the data produced by these instruments understand the principles of questionnaire design to interpret results in an optimal and meaningful way. This article presents a practical guide for understanding the methodologies of survey and questionnaire design, including the concepts of validity and reliability, how surveys are administered and implemented, and, finally, biases and pitfalls of surveys.

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

PubMed

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

2013-01-01

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

Linking data to decision-making: applying qualitative data analysis methods and software to identify mechanisms for using outcomes data.

PubMed

Patel, Vaishali N; Riley, Anne W

2007-10-01

A multiple case study was conducted to examine how staff in child out-of-home care programs used data from an Outcomes Management System (OMS) and other sources to inform decision-making. Data collection consisted of thirty-seven semi-structured interviews with clinicians, managers, and directors from two treatment foster care programs and two residential treatment centers, and individuals involved with developing the OMS; and observations of clinical and quality management meetings. Case study and grounded theory methodology guided analyses. The application of qualitative data analysis software is described. Results show that although staff rarely used data from the OMS, they did rely on other sources of systematically collected information to inform clinical, quality management, and program decisions. Analyses of how staff used these data suggest that improving the utility of OMS will involve encouraging staff to participate in data-based decision-making, and designing and implementing OMS in a manner that reflects how decision-making processes operate.

Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

PubMed Central

Whiting, Demian; Fielden, Hannah G.; Saini, Pooja; Beesley, Helen; Holcombe, Christopher; Holcombe, Susan; Greenhalgh, Lyn; Fairburn, Louise; Salmon, Peter

2017-01-01

Objective Contemporary approaches to medical decision-making advise that clinicians should respect patients’ decisions. However, patients’ decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients’ decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Methods Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Results Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do ‘all they could’ to prevent it. Most therefore perceived RRM to be the ‘obvious’ option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Conclusion Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients’ emotions. PMID:28552971

Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests.

PubMed

Brown, Stephen L; Whiting, Demian; Fielden, Hannah G; Saini, Pooja; Beesley, Helen; Holcombe, Christopher; Holcombe, Susan; Greenhalgh, Lyn; Fairburn, Louise; Salmon, Peter

2017-01-01

Contemporary approaches to medical decision-making advise that clinicians should respect patients' decisions. However, patients' decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients' decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do 'all they could' to prevent it. Most therefore perceived RRM to be the 'obvious' option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients' emotions.

Design of Protease Activated Optical Contrast Agents That Exploit a Latent Lysosomotropic Effect for Use in Fluorescence-Guided Surgery

PubMed Central

2015-01-01

There is a need for new molecular-guided contrast agents to enhance surgical procedures such as tumor resection that require a high degree of precision. Cysteine cathepsins are highly up-regulated in a wide variety of cancers, both in tumor cells and in the tumor-supporting cells of the surrounding stroma. Therefore, tools that can be used to dynamically monitor their activity in vivo could be used as imaging contrast agents for intraoperative fluorescence image guided surgery (FGS). Although multiple classes of cathepsin-targeted substrate probes have been reported, most suffer from overall fast clearance from sites of protease activation, leading to reduced signal intensity and duration in vivo. Here we describe the design and synthesis of a series of near-infrared fluorogenic probes that exploit a latent cationic lysosomotropic effect (LLE) to promote cellular retention upon protease activation. These probes show tumor-specific retention, fast activation kinetics, and rapid systemic distribution. We demonstrate that they are suitable for detection of diverse cancer types including breast, colon and lung tumors. Most importantly, the agents are compatible with the existing, FDA approved, da Vinci surgical system for fluorescence guided tumor resection. Therefore, our data suggest that the probes reported here can be used with existing clinical instrumentation to detect tumors and potentially other types of inflammatory lesions to guide surgical decision making in real time. PMID:26039341

Adaptive Mental Testing: The State of the Art

DTIC Science & Technology

1979-11-01

typically vary in their psychometric properties --particularly in their difficulty--the test designer must decide what configuration of these item...psychometric properties best suits the test’s purpose. There are two extreme ration- ales to guide that decision. One rationale is to choose items that are...development of item response theory (Rasch, 1960; Lord, 1952, 1970, 1974a; Birnbaum, 1968) that provided the needed invariance properties for item

The bottom line on wound care standardization.

PubMed

McNees, Patrick; Kueven, John A

2011-03-01

North Mississippi Medical Center learned four important lessons in its effort to standardize wound care products and processes of care: Designate clinical champions. Limit the number of vendors that provide products for a specialty. Reduce the number of similar-function wound care products that are available for use, with decisions guided by clinicians. Provide transparent information related to cost, the intentions of the initiative, usage patterns, and the criteria for evaluation.

Armed To Learn: Aiming At California K 12 School Gun Policy

DTIC Science & Technology

2016-03-01

involvement in, or presence of, any militia. In District of Columbia v. Heller in 2008, the Supreme Court changed the long-standing collective rights...research focused on decision-making processes that are based on risk management principles fostered by the Insurance Institute of America. Risk...Management, 3rd ed. (Malvern, PA: Insurance Institute of America, 2003), http://www.theinstitutes.org/guide/designations/associate-risk-management

A Designer’s Guide to Human Performance Modelling (La Modelisation des Performances Humaines: Manuel du Concepteur).

DTIC Science & Technology

1998-12-01

failure detection, monitoring, and decision making.) moderator function. Originally, the output from these One of the best known OCM implementations, the...imposed by the tasks themselves, the information and equipment provided, the task environment, operator skills and experience, operator strategies , the...problem-solving situation, including the toward failure.) knowledge necessary to generate the right problem- solving strategies , the attention that

Essential Steps for Web Surveys: A Guide to Designing, Administering and Utilizing Web Surveys for University Decision-Making. Professional File. Number 102, Winter 2006

ERIC Educational Resources Information Center

Cheskis-Gold, Rena; Loescher, Ruth; Shepard-Rabadam, Elizabeth; Carroll, Barbara

2006-01-01

During the past few years, several Harvard paper surveys were converted to Web surveys. These were high-profile surveys endorsed by the Provost and the Dean of the College, and covered major portions of the university population (all undergraduates, all graduate students, tenured and non-tenured faculty). When planning for these surveys started in…

Attention as foraging for information and value

PubMed Central

Manohar, Sanjay G.; Husain, Masud

2013-01-01

What is the purpose of attention? One avenue of research has led to the proposal that attention might be crucial for gathering information about the environment, while other lines of study have demonstrated how attention may play a role in guiding behavior to rewarded options. Many experiments that study attention require participants to make a decision based on information acquired discretely at one point in time. In real-world situations, however, we are usually not presented with information about which option to select in such a manner. Rather we must initially search for information, weighing up reward values of options before we commit to a decision. Here, we propose that attention plays a role in both foraging for information and foraging for value. When foraging for information, attention is guided toward the unknown. When foraging for reward, attention is guided toward high reward values, allowing decision-making to proceed by accept-or-reject decisions on the currently attended option. According to this account, attention can be regarded as a low-cost alternative to moving around and physically interacting with the environment—“teleforaging”—before a decision is made to interact physically with the world. To track the timecourse of attention, we asked participants to seek out and acquire information about two gambles by directing their gaze, before choosing one of them. Participants often made multiple refixations on items before making a decision. Their eye movements revealed that early in the trial, attention was guided toward information, i.e., toward locations that reduced uncertainty about value. In contrast, late in the trial, attention was guided by expected value of the options. At the end of the decision period, participants were generally attending to the item they eventually chose. We suggest that attentional foraging shifts from an uncertainty-driven to a reward-driven mode during the evolution of a decision, permitting decisions to be made by an engage-or-search strategy. PMID:24204335

The moving-ring field-reversed mirror prototype reactor

NASA Astrophysics Data System (ADS)

Smith, A. C., Jr.; Carlson, G. A.; Fleischmann, H. H.; Grossman, W., Jr.; Kammash, T.; Schultz, K. R.; Woodall, D. M.

1981-03-01

A prototype fusion reactor was designed based on magnetic field reversed plasma confinement. A set of physics, technology, and mechanical design criteria were developed in order to make this concept attractive. Six major criteria guide the commercial prototype design. The prototype must: (1) produce net electricity decisively P sub net 70% of P sub gross; (2) scale to an economical commercial plant and have small physical size; (3) have all features required of a correcial upgrade plant (H-3 breeding, etc.); (4) minimize exotic technology and maintenance complexity; (5) promise significantly lower safety hazards than fission plants (environmentally and socially acceptable); and (6) be modular in design to permit repetitive production of components.

Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis.

PubMed

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.

Design of an integrated team project as bachelor thesis in bioscience engineering

NASA Astrophysics Data System (ADS)

Peeters, Marie-Christine; Londers, Elsje; Van der Hoeven, Wouter

2014-11-01

Following the decision at the KU Leuven to implement the educational concept of guided independent learning and to encourage students to participate in scientific research, the Faculty of Bioscience Engineering decided to introduce a bachelor thesis. Competencies, such as communication, scientific research and teamwork, need to be present in the design of this thesis. Because of the high number of students and the multidisciplinary nature of the graduates, all research divisions of the faculty are asked to participate. The yearly surveys and hearings were used for further optimisation. The actual design of this bachelor thesis is presented and discussed in this paper.

AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline

PubMed Central

Kulikowski, Casimir A; Shortliffe, Edward H; Currie, Leanne M; Elkin, Peter L; Hunter, Lawrence E; Johnson, Todd R; Kalet, Ira J; Lenert, Leslie A; Musen, Mark A; Ozbolt, Judy G; Smith, Jack W; Tarczy-Hornoch, Peter Z

2012-01-01

The AMIA biomedical informatics (BMI) core competencies have been designed to support and guide graduate education in BMI, the core scientific discipline underlying the breadth of the field's research, practice, and education. The core definition of BMI adopted by AMIA specifies that BMI is ‘the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.’ Application areas range from bioinformatics to clinical and public health informatics and span the spectrum from the molecular to population levels of health and biomedicine. The shared core informatics competencies of BMI draw on the practical experience of many specific informatics sub-disciplines. The AMIA BMI analysis highlights the central shared set of competencies that should guide curriculum design and that graduate students should be expected to master. PMID:22683918

End-of-Life Decision Making in Palliative Care and Recommendations of the Council of Europe: Qualitative Secondary Analysis of Interviews and Observation Field Notes.

PubMed

Martins Pereira, Sandra; Fradique, Emília; Hernández-Marrero, Pablo

2018-05-01

End-of-life decisions (ELDs) are embedded in clinical, sociocultural, political, economic, and ethical concerns. In 2014, the Council of Europe (CoE) through its Committee on Bioethics launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations," aiming at improving decision-making processes and empowering professionals in making ELDs. To analyze if end-of-life decision making in palliative care (PC) is consistent with this Guide and to identify if disputed/controversial issues are part of current ELDs. Qualitative secondary analysis. Four qualitative datasets, including 44 interviews and 9 team observation field notes from previous studies with PC teams/professionals in Portugal. An analysis grid based on the abovementioned guide was created considering three dimensions: ethical and legal frameworks, decision-making process, and disputed/controversial issues. The majority of the professionals considered the ethical principle of autonomy paramount in end-of-life decision making. Justice and beneficence/nonmaleficence were also valued. Although not mentioned in the Guide, the professionals also considered other ethical principles when making ELDs, namely, responsibility, integrity, and dignity. Most of the interviewees and field notes referred to the collective interprofessional dimension of the decision-making process. Palliative sedation and the wish to hasten death were the most mentioned disputed/controversial issues. The nature, limitations, and benefits of qualitative secondary analysis are discussed. End-of-life decision-making processes made by Portuguese PC teams seem to be consistent with the guidelines of the CoE. Further research is needed about disputed/controversial issues and the actual use, effectiveness, and impact of ethical guidelines for end-of-life decision making on professionals' empowerment and for all parties involved.

Neural and neurochemical basis of reinforcement-guided decision making.

PubMed

Khani, Abbas; Rainer, Gregor

2016-08-01

Decision making is an adaptive behavior that takes into account several internal and external input variables and leads to the choice of a course of action over other available and often competing alternatives. While it has been studied in diverse fields ranging from mathematics, economics, ecology, and ethology to psychology and neuroscience, recent cross talk among perspectives from different fields has yielded novel descriptions of decision processes. Reinforcement-guided decision making models are based on economic and reinforcement learning theories, and their focus is on the maximization of acquired benefit over a defined period of time. Studies based on reinforcement-guided decision making have implicated a large network of neural circuits across the brain. This network includes a wide range of cortical (e.g., orbitofrontal cortex and anterior cingulate cortex) and subcortical (e.g., nucleus accumbens and subthalamic nucleus) brain areas and uses several neurotransmitter systems (e.g., dopaminergic and serotonergic systems) to communicate and process decision-related information. This review discusses distinct as well as overlapping contributions of these networks and neurotransmitter systems to the processing of decision making. We end the review by touching on neural circuitry and neuromodulatory regulation of exploratory decision making. Copyright © 2016 the American Physiological Society.

Restoration handbook for sagebrush steppe ecosystems with emphasis on greater sage-grouse habitat—Part 2. Landscape level restoration decisions

USGS Publications Warehouse

Pyke, David A.; Knick, Steven T.; Chambers, Jeanne C.; Pellant, Mike; Miller, Richard F.; Beck, Jeffrey L.; Doescher, Paul S.; Schupp, Eugene W.; Roundy, Bruce A.; Brunson, Mark; McIver, James D.

2015-12-07

Land managers do not have resources to restore all locations because of the extent of the restoration need and because some land uses are not likely to change, therefore, restoration decisions made at the landscape to regional scale may improve the effectiveness of restoration to achieve landscape and local restoration objectives. We present a landscape restoration decision tool intended to assist decision makers in determining landscape objectives, to identify and prioritize landscape areas where sites for priority restoration projects might be located, and to aid in ultimately selecting restoration sites guided by criteria used to define the landscape objectives. The landscape restoration decision tool is structured in five sections that should be addressed sequentially. Each section has a primary question or statement followed by related questions and statements to assist the user in addressing the primary question or statement. This handbook will guide decision makers through the important process steps of identifying appropriate questions, gathering appropriate data, developing landscape objectives, and prioritizing landscape patches where potential sites for restoration projects may be located. Once potential sites are selected, land managers can move to the site-specific decision tool to guide restoration decisions at the site level.

Knowledge Assisted Integrated Design of a Component and Its Manufacturing Process

NASA Astrophysics Data System (ADS)

Gautham, B. P.; Kulkarni, Nagesh; Khan, Danish; Zagade, Pramod; Reddy, Sreedhar; Uppaluri, Rohith

Integrated design of a product and its manufacturing processes would significantly reduce the total cost of the products as well as the cost of its development. However this would only be possible if we have a platform that allows us to link together simulations tools used for product design, performance evaluation and its manufacturing processes in a closed loop. In addition to that having a comprehensive knowledgebase that provides systematic knowledge guided assistance to product or process designers who may not possess in-depth design knowledge or in-depth knowledge of the simulation tools, would significantly speed up the end-to-end design process. In this paper, we propose a process and illustrate a case for achieving an integrated product and manufacturing process design assisted by knowledge support for the user to make decisions at various stages. We take transmission component design as an example. The example illustrates the design of a gear for its geometry, material selection and its manufacturing processes, particularly, carburizing-quenching and tempering, and feeding the material properties predicted during heat treatment into performance estimation in a closed loop. It also identifies and illustrates various decision stages in the integrated life cycle and discusses the use of knowledge engineering tools such as rule-based guidance, to assist the designer make informed decisions. Simulation tools developed on various commercial, open-source platforms as well as in-house tools along with knowledge engineering tools are linked to build a framework with appropriate navigation through user-friendly interfaces. This is illustrated through examples in this paper.

Student Analysis of Handout Development based on Guided Discovery Method in Process Evaluation and Learning Outcomes of Biology

NASA Astrophysics Data System (ADS)

Nerita, S.; Maizeli, A.; Afza, A.

2017-09-01

Process Evaluation and Learning Outcomes of Biology subjects discusses the evaluation process in learning and application of designed and processed learning outcomes. Some problems found during this subject was the student difficult to understand the subject and the subject unavailability of learning resources that can guide and make students independent study. So, it necessary to develop a learning resource that can make active students to think and to make decisions with the guidance of the lecturer. The purpose of this study is to produce handout based on guided discovery method that match the needs of students. The research was done by using 4-D models and limited to define phase that is student requirement analysis. Data obtained from the questionnaire and analyzed descriptively. The results showed that the average requirement of students was 91,43%. Can be concluded that students need a handout based on guided discovery method in the learning process.

Hospice decision making: diagnosis makes a difference.

PubMed

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

Designing Computerized Decision Support That Works for Clinicians and Families

PubMed Central

Fiks, Alexander G.

2011-01-01

Evidence-based decision-making is central to the practice of pediatrics. Clinical trials and other biomedical research provide a foundation for this process, and practice guidelines, drawing from their results, inform the optimal management of an increasing number of childhood health problems. However, many clinicians fail to adhere to guidelines. Clinical decision support delivered using health information technology, often in the form of electronic health records, provides a tool to deliver evidence-based information to the point of care and has the potential to overcome barriers to evidence-based practice. An increasing literature now informs how these systems should be designed and implemented to most effectively improve outcomes in pediatrics. Through the examples of computerized physician order entry, as well as the impact of alerts at the point of care on immunization rates, the delivery of evidence-based asthma care, and the follow-up of children with attention deficit hyperactivity disorder, the following review addresses strategies for success in using these tools. The following review argues that, as decision support evolves, the clinician should no longer be the sole target of information and alerts. Through the Internet and other technologies, families are increasingly seeking health information and gathering input to guide health decisions. By enlisting clinical decision support systems to deliver evidence-based information to both clinicians and families, help families express their preferences and goals, and connect families to the medical home, clinical decision support may ultimately be most effective in improving outcomes. PMID:21315295

Design Approaches to Support Preservice Teachers in Scientific Modeling

NASA Astrophysics Data System (ADS)

Kenyon, Lisa; Davis, Elizabeth A.; Hug, Barbara

2011-02-01

Engaging children in scientific practices is hard for beginning teachers. One such scientific practice with which beginning teachers may have limited experience is scientific modeling. We have iteratively designed preservice teacher learning experiences and materials intended to help teachers achieve learning goals associated with scientific modeling. Our work has taken place across multiple years at three university sites, with preservice teachers focused on early childhood, elementary, and middle school teaching. Based on results from our empirical studies supporting these design decisions, we discuss design features of our modeling instruction in each iteration. Our results suggest some successes in supporting preservice teachers in engaging students in modeling practice. We propose design principles that can guide science teacher educators in incorporating modeling in teacher education.

A description of nurses' decision-making in managing electrocardiographic monitor alarms.

PubMed

Gazarian, Priscilla K; Carrier, Natalie; Cohen, Rachel; Schram, Haley; Shiromani, Samara

2015-01-01

To describe the cues and factors that nurses use in their decision-making when responding to clinical alarms. Alarms are designed to be very sensitive, and as a result, they are not very specific. Lack of adherence to the practice standards for electrocardiographic monitoring in hospital settings has been observed, resulting in overuse of the electrocardiographic monitoring. Monitoring without consideration of clinical indicators uses scarce healthcare resources and may even produce untoward circumstances because of alarm fatigue. With so many false alarms, alarm fatigue represents a symptom of a larger problem. It cannot be fixed until all of the factors that contribute to its existence have been examined. This was a qualitative descriptive study. This study was conducted at an academic medical centre located in the Northeast United States. Eight participants were enrolled using purposive sampling. Nurses were observed for two three-hour periods. Following each observation, the nurse was interviewed using the critical decision method to describe the cognitive processes related to the alarm activities. Qualitative data from the conducted interviews were analysed via an a priori framework founded in the critical decision method. This study reveals information, experience, guidance and decision-making as the four prominent categories contributing to nurses' decision-making in relation to alarm management. Managing technology was a category not identified a priori that emerged in the data analysis. Nurses revealed a breadth of information needed to adequately identify and interpret monitor alarms, and how they used that information to put the alarms into the particular context of an individual patient's situations. Understanding the cues and factors nurses use when responding to cardiac alarms will guide the development of learning experiences and inform policies to guide practice. © 2014 John Wiley & Sons Ltd.

Midmarket Solar Policies in the United States: A Guide for Midsized Solar Customers

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

Tian, Tian; Liu, Chang; O'Shaughnessy, Eric

The midscale market for solar photovoltaics (PV) has not experienced the same high growth rate as residential- or utility-scale market segments in the past five years when solar PV deployment increased rapidly. Midscale solar can be defined as behind-the-meter solar PV between 50 kilowatts and 2 megawatts adopted by multi-housing residential, commercial, industrial, non-profit, and other entities. A number of challenges face the midscale segment, including difficulties in contracting, mismatch between tenant lease and PV financing terms, high transaction costs relative to project sizes, and inefficiencies in matching prospective projects with capital. The changing policy landscape across U.S. states providesmore » both opportunities and challenges to midmarket solar. Some states, such as California, are expanding system capacity limits for policies such as net metering, thus enabling a wider range of customers to benefit from excess generation. A number of states and utilities are making changes to rate design to introduce new or higher user fees for solar customers or reduced tariffs for net metering, which decrease the value of solar generation. An understanding of these policies relative to project feasibility and economics is important for prospective customers to make informed decisions to adopt solar PV. This guide complements existing solar policy resources to help potential customers navigate through the policy landscape in order to make informed decisions for their solar investment. The first part of this guide introduces the key solar policies necessary for policy-based decision-making, which involves using knowledge of a solar policy to improve project economics and efficiency. Policies that could result in policy-based decisions include interconnection standards, net metering, user fees, incentives, and third-party ownership policies. The goal of this section is to equip prospective customers and project developers with the tools necessary to understand and use solar policies in a dynamic policy environment. The second part of this guide provides a complete, state-by-state inventory of midmarket solar policies for potential customers and developers to use as reference when making policy-based decisions. Although solar policies are dynamic, the profiles provide a framework for assessing policies to build the parameters that could be used to determine feasibility and structure of a solar PV system for midmarket customers and developers.« less

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

PubMed

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

2008-11-01

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

Values and the Scientific Culture of Behavior Analysis

ERIC Educational Resources Information Center

Ruiz, Maria R.; Roche, Bryan

2007-01-01

As scientists and practitioners, behavior analysts must make frequent decisions that affect many lives. Scientific principles have been our guide as we work to promote effective action across a broad spectrum of cultural practices. Yet scientific principles alone may not be sufficient to guide our decision making in cases with potentially…

What criteria guide national entrepreneurs' policy decisions on user fee removal for maternal health care services? Use of a best-worst scaling choice experiment in West Africa.

PubMed

Torbica, Aleksandra; De Allegri, Manuela; Belemsaga, Danielle; Medina-Lara, Antonieta; Ridde, Valery

2014-10-01

Several countries in sub-Saharan Africa have implemented policies to remove or reduce user fees. Our aim was to identify criteria guiding such decisions among national policy entrepreneurs, those who link up problem definition, solution development and political processes. We administered a best-worst scaling (BWS) experiment to 89 policy entrepreneurs, asking them to identify the most and the least important criteria on a series of predefined sets. Sets were compiled using a Balance Incomplete Block Design which generated random combinations of all 11 criteria included in the experiment. In turn, those had emerged from a prior set of focus group discussions organized among policy entrepreneurs. Ordered logit models were used to investigate the value of single criteria as well as heterogeneity of preferences. Political commitment was identified as the most important criterion guiding policy decisions on user fee abolition or reduction to the overall sample, but particularly so for more experienced respondents aged over 50 years. International pressure and donor money were identified as least important while equity and institutional capacity were deemed of relatively little importance. Respondents more involved in advising on policy than on formulating policy rated economic issues such as financial sustainability and cost-effectiveness as less important. It is feasible to apply BWS experiments in low-income countries, although whether the technique can be adjusted to elicit preferences among non-literate respondents in these settings is unclear. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

PubMed Central

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

Constrained recycling: a framework to reduce landfilling in developing countries.

PubMed

Diaz, Ricardo; Otoma, Suehiro

2013-01-01

This article presents a model that integrates three branches of research: (i) economics of solid waste that assesses consumer's willingness to recycle and to pay for disposal; (ii) economics of solid waste that compares private and social costs of final disposal and recycling; and (iii) theories on personal attitudes and social influence. The model identifies two arenas where decisions are made: upstream arena, where residents are decision-makers, and downstream arena, where municipal authorities are decision-makers, and graphically proposes interactions between disposal and recycling, as well as the concept of 'constrained recycling' (an alternative to optimal recycling) to guide policy design. It finally concludes that formative instruments, such as environmental education and benchmarks, should be combined with economic instruments, such as subsidies, to move constraints on source separation and recycling in the context of developing countries.

A comprehensive guide to fuel management practices for dry mixed conifer forests in the northwestern United States: Monitoring

Treesearch

Theresa B. Jain; Mike A. Battaglia; Han-Sup Han; Russell T. Graham; Christopher R. Keyes; Jeremy S. Fried; Jonathan E. Sandquist

2014-01-01

Short- and medium-term evaluation of how fuel treatments are working is the only way to know if the hundreds of activities on the ground are adding up to the goals of more resilient landscapes and increased safety of people and property. Monitoring is a critical resource for decision makers who design fuels management programs, however it is an often neglected part of...

Schools for Strategy: Teaching Strategy for 21st Century Conflict

DTIC Science & Technology

2009-11-01

To illustrate, if for now your army cannot win decisive success by fighting (tactically), you are obliged to adopt a long-haul strategy guided by a...sense,” but also who could fight their commands successfully in battle through the competent exercise of real- and near-real- time leadership.27 In...should always be recognition that ultimately it must be a practical, not a scholarly, pursuit. Education in strategy for potentially designated

What can paper-based clinical information systems tell us about the design of computerized clinical information systems (CIS) in the ICU?

PubMed

Miller, A; Pilcher, D; Mercaldo, N; Leong, T; Scheinkestel, C; Schildcrout, J

2010-08-01

Screen designs in computerized clinical information systems (CIS) have been modeled on their paper predecessors. However, limited understanding about how paper forms support clinical work means that we risk repeating old mistakes and creating new opportunities for error and inefficiency as illustrated by problems associated with computerized provider order entry systems. This study was designed to elucidate principles underlying a successful ICU paper-based CIS. The research was guided by two exploratory hypotheses: (1) paper-based artefacts (charts, notes, equipment, order forms) are used differently by nurses, doctors and other healthcare professionals in different (formal and informal) conversation contexts and (2) different artefacts support different decision processes that are distributed across role-based conversations. All conversations undertaken at the bedsides of five patients were recorded with any supporting artefacts for five days per patient. Data was coded according to conversational role-holders, clinical decision process, conversational context and artefacts. 2133 data points were analyzed using Poisson logistic regression analyses. Results show significant interactions between artefacts used during different professional conversations in different contexts (chi(2)((df=16))=55.8, p<0.0001). The interaction between artefacts used during different professional conversations for different clinical decision processes was not statistically significant although all two-way interactions were statistically significant. Paper-based CIS have evolved to support complex interdisciplinary decision processes. The translation of two design principles - support interdisciplinary perspectives and integrate decision processes - from paper to computerized CIS may minimize the risks associated with computerization. 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Microsimulation Modeling for Health Decision Sciences Using R: A Tutorial.

PubMed

Krijkamp, Eline M; Alarid-Escudero, Fernando; Enns, Eva A; Jalal, Hawre J; Hunink, M G Myriam; Pechlivanoglou, Petros

2018-04-01

Microsimulation models are becoming increasingly common in the field of decision modeling for health. Because microsimulation models are computationally more demanding than traditional Markov cohort models, the use of computer programming languages in their development has become more common. R is a programming language that has gained recognition within the field of decision modeling. It has the capacity to perform microsimulation models more efficiently than software commonly used for decision modeling, incorporate statistical analyses within decision models, and produce more transparent models and reproducible results. However, no clear guidance for the implementation of microsimulation models in R exists. In this tutorial, we provide a step-by-step guide to build microsimulation models in R and illustrate the use of this guide on a simple, but transferable, hypothetical decision problem. We guide the reader through the necessary steps and provide generic R code that is flexible and can be adapted for other models. We also show how this code can be extended to address more complex model structures and provide an efficient microsimulation approach that relies on vectorization solutions.

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

PubMed

Diaby, Vakaramoko; Goeree, Ron

2014-02-01

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

Intertwining Risk Insights and Design Decisions

NASA Technical Reports Server (NTRS)

Cornford, Steven L.; Feather, Martin S.; Jenkins, J. Steven

2006-01-01

The state of systems engineering is such that a form of early and continued use of risk assessments is conducted (as evidenced by NASA's adoption and use of the 'Continuous Risk Management' paradigm developed by SEI). ... However, these practices fall short of theideal: (1) Integration between risk assessment techniques and other systems engineering tools is weak. (2) Risk assessment techniques and the insights they yield are only informally coupled to design decisions. (3) Individual riskassessment techniques lack the mix of breadth, fidelity and agility required to span the gamut of the design space. In this paper we present an approach that addresses these shortcomings. The hallmark of our approach is a simple representation comprising objectives (what the system is to do), risks (whose occurrence would detract from attainment of objectives) and activities (a.k.a. 'mitigations') that, if performed, will decrease those risks. These are linked to indicate by how much a risk would detract from attainment of an objective, and by how much an activity would reduce a risk. The simplicity of our representational framework gives it the breadth to encompass the gamut of the design space concerns, the agility to be utilized in even the earliest phases of designs, and the capability to connect to system engineering models and higher-fidelity risk tools. It is through this integration that we address the shortcomings listed above, and so achieve the intertwining between risk insights and design decisions needed to guide systems engineering towards superior final designs while avoiding costly rework to achieve them. The paper will use an example, constructed to be representative of space mission design, to illustrate our approach.

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

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1990-01-01

Ongoing research investigating perceptual and contextual influences on skilled human performance in dynamic decision making environments is discussed. The research is motivated by two general classes of findings in recent decision making research. First, many studies suggest that the concrete context in which a task is presented has strong influences on the psychological processes used to perform the task and on subsequent performance. Second, studies of skilled behavior in a wide variety of task environments typically implicate the perceptual system as an important contributor to decision-making performance, either in its role as a mediator between the current decision context and stored knowledge, or as a mechanism capable of directly initiating activity through the development of a 'trained eye.' Both contextual and perceptual influences place limits on the ability of traditional utility-theoretic accounts of decision-making to guide display design, as variance in behavior due to contextual factors or the development of a perceptual skill is left unexplained. The author outlines a framework in which to view questions of perceptual and contextual influences on behavior and describe an experimental task and analysis technique which will be used to diagnose the possible role of perception in skilled decision making performance.

Healthy School Meals...Healthy Kids! A Leadership Guide for School Decision-Makers.

ERIC Educational Resources Information Center

Food and Consumer Service (USDA), Washington, DC.

The School Meals Initiative for Healthy Children was launched in June 1994 to improve the health and education of children through better nutrition. This leadership guide provides information to school decision-makers on using materials and resources developed by the U.S. Department of Agriculture and describes Team Nutrition, an implementation…

Consumer Education: A Guide for Teachers of Home Economics.

ERIC Educational Resources Information Center

Gray, Ava A.; Whorley, Beulah

The guide offers suggested curriculum materials in consumer education for secondary schools or as background information for teaching adults. It focuses on an understanding of decision making, the economic system, and management. The units of instruction are based on 13 concepts: (1) the process of decision making in relation to consumer behavior;…

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

PubMed Central

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-01-01

Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. PMID:29179292

WE-EF-BRD-03: I Want It Now!: Advances in MRI Acquisition, Reconstruction and the Use of Priors to Enable Fast Anatomic and Physiologic Imaging to Inform Guidance and Adaptation Decisions

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

Hu, Y.

MRI-guided treatment is a growing area of medicine, particularly in radiotherapy and surgery. The exquisite soft tissue anatomic contrast offered by MRI, along with functional imaging, makes the use of MRI during therapeutic procedures very attractive. Challenging the utility of MRI in the therapy room are many issues including the physics of MRI and the impact on the environment and therapeutic instruments, the impact of the room and instruments on the MRI; safety, space, design and cost. In this session, the applications and challenges of MRI-guided treatment will be described. The session format is: Past, present and future: MRI-guided radiotherapymore » from 2005 to 2025: Jan Lagendijk Battling Maxwell’s equations: Physics challenges and solutions for hybrid MRI systems: Paul Keall I want it now!: Advances in MRI acquisition, reconstruction and the use of priors to enable fast anatomic and physiologic imaging to inform guidance and adaptation decisions: Yanle Hu MR in the OR: The growth and applications of MRI for interventional radiology and surgery: Rebecca Fahrig Learning Objectives: To understand the history and trajectory of MRI-guided radiotherapy To understand the challenges of integrating MR imaging systems with linear accelerators To understand the latest in fast MRI methods to enable the visualisation of anatomy and physiology on radiotherapy treatment timescales To understand the growing role and challenges of MRI for image-guided surgical procedures My disclosures are publicly available and updated at: http://sydney.edu.au/medicine/radiation-physics/about-us/disclosures.php.« less

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

PubMed Central

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

2006-01-01

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

When four principles are too many: bloodgate, integrity and an action-guiding model of ethical decision making in clinical practice.

PubMed

Muirhead, William

2012-04-01

Medical ethical analysis remains dominated by the principlist account first proposed by Beauchamp and Childress. This paper argues that the principlist model is unreflective of how ethical decisions are taken in clinical practice. Two kinds of medical ethical decisions are distinguished: biosocial ethics and clinical ethics. It is argued that principlism is an inappropriate model for clinical ethics as it is neither sufficiently action-guiding nor does it emphasise the professional integrity of the clinician. An alternative model is proposed for decision making in the realm of clinical ethics.

Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study.

PubMed

Barton, Jennifer L; Trupin, Laura; Schillinger, Dean; Evans-Young, Gina; Imboden, John; Montori, Victor M; Yelin, Edward

2016-07-01

Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence; however, few tools support SDM in RA. Our objective was to pilot a low-literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications. RA patients were consecutively enrolled into 1 of 3 arms: 1) control; patients received existing medication guide prior to clinic visit, 2) adapted guide prior to visit, and 3) adapted guide prior to plus decision aid during visit. Outcomes were collected immediately postvisit, at 1-week, and at 3- and 6-month interviews. Eligible adults had to have failed at least 1 disease-modifying antirheumatic drug and fulfill 1 of the following: age >65 years, immigrant, non-English speaker, less than high school education, limited health literacy, and racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions. The majority of 166 patients were immigrants (66%), non-English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge postvisit in arm 3 was higher (78%) than arm 1 (53%; adjusted odds ratio 2.7, 95% confidence interval 1.2, 6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (P = 0.03). There were no significant differences in acceptability. A low-literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with RA patients' values and preferences. © 2016, American College of Rheumatology.

Shared Decision-Making for Nursing Practice: An Integrative Review.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T

2018-01-01

Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

16 CFR 240.1 - Purpose of the Guides.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Guides is to provide assistance to businesses seeking to comply with sections 2 (d) and (e) of the... history, administrative and court decisions, and the purposes of the Act. Although the Guides are...

Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial.

PubMed

Sung, Vivian W; Borello-France, Diane; Dunivan, Gena; Gantz, Marie; Lukacz, Emily S; Moalli, Pamela; Newman, Diane K; Richter, Holly E; Ridgeway, Beri; Smith, Ariana L; Weidner, Alison C; Meikle, Susan

2016-10-01

Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

TIUPAM: A Framework for Trustworthiness-Centric Information Sharing

NASA Astrophysics Data System (ADS)

Xu, Shouhuai; Sandhu, Ravi; Bertino, Elisa

Information is essential to decision making. Nowadays, decision makers are often overwhelmed with large volumes of information, some of which may be inaccurate, incorrect, inappropriate, misleading, or maliciously introduced. With the advocated shift of information sharing paradigm from “need to know” to “need to share” this problem will be further compounded. This poses the challenge of achieving assured information sharing so that decision makers can always get and utilize the up-to-date information for making the right decisions, despite the existence of malicious attacks and without breaching privacy of honest participants. As a first step towards answering this challenge this paper proposes a systematic framework we call TIUPAM, which stands for “Trustworthiness-centric Identity, Usage, Provenance, and Attack Management.” The framework is centered at the need of trustworthiness and risk management for decision makers, and supported by four key components: identity management, usage management, provenance management and attack management. We explore the characterization of both the core functions and the supporting components in the TIUPAM framework, which may guide the design and realization of concrete schemes in the future.

New Solar PV Tool Accurately Calculates Degradation Rates, Saving Money and

Science.gov Websites

Guiding Business Decisions | News | NREL New Solar PV Tool Accurately Calculates Degradation Rates, Saving Money and Guiding Business Decisions News Release: New Solar PV Tool Accurately Calculates ; said Dirk Jordan, engineer and solar PV researcher at NREL. "We spent years building consensus in

Fire Effects Planning Framework: A user's guide

Treesearch

A. Black; T. Opperman

2005-01-01

Each decision to suppress fire reinforces a feedback cycle in which fuels continue to accumulate, risk escalates, and the tendency to suppress fires grows (Miller and others, 2003). Existing decision-support tools focus primarily on the negative consequences of fire. This guide outlines a framework managers can use to (1) identify key areas of fire risk and (2)...

An Educator's Guide to Questionnaire Development. REL 2016-108

ERIC Educational Resources Information Center

Harlacher, Jason

2016-01-01

Educators have many decisions to make and it's important that they have the right data to inform those decisions and access to questionnaires that can gather that data. This guide, developed by REL Central and based on work done through separate projects with the Wyoming Office of Public Instruction and the Nebraska Department of Education,…

Dorsal Striatal-Midbrain Connectivity in Humans Predicts How Reinforcements Are Used to Guide Decisions

ERIC Educational Resources Information Center

Kahnt, Thorsten; Park, Soyoung Q.; Cohen, Michael X.; Beck, Anne; Heinz, Andreas; Wrase, Jana

2009-01-01

It has been suggested that the target areas of dopaminergic midbrain neurons, the dorsal (DS) and ventral striatum (VS), are differently involved in reinforcement learning especially as actor and critic. Whereas the critic learns to predict rewards, the actor maintains action values to guide future decisions. The different midbrain connections to…

SBexpert users guide (version 1.0): a knowledge-based decision-support system for spruce beetle management.

Treesearch

Keith M. Reynolds; Edward H. Holsten; Richard A. Werner

1994-01-01

SBexpert version 1.0 is a knowledge-based decision-support system for spruce beetle (Dendroctonus rutipennis (Kby.)) management developed for use in Microsoft Windows with the KnowledgePro Windows development language. The SBexpert users guide provides detailed instructions on the use of all SBexpert features. SBexpert has four main topics (...

The dynamic interplay between perceived true self-knowledge and decision satisfaction.

PubMed

Schlegel, Rebecca J; Hicks, Joshua A; Davis, William E; Hirsch, Kelly A; Smith, Christina M

2013-03-01

The present research used multiple methods to examine the hypothesis that perceived true self-knowledge and decision satisfaction are inextricably linked together by a widely held "true-self-as-guide" lay theory of decision making. Consistent with this proposition, Study 1 found that participants rated using the true self as a guide as more important for achieving personal satisfaction than a variety of other potential decision-making strategies. After establishing the prevalence of this lay theory, the remaining studies then focused on examining the proposed consequent relationship between perceived true self-knowledge and decision satisfaction. Consistent with hypotheses, 2 cross-sectional correlational studies (Studies 2 and 3) found a positive relationship between perceived true self-knowledge and decision satisfaction for different types of major decisions. Study 4 used daily diary methods to demonstrate that fluctuations in perceived true self-knowledge reliably covary with fluctuations in decision satisfaction. Finally, 2 studies directly examined the causal direction of this relationship through experimental manipulation and revealed that the relationship is truly bidirectional. More specifically, Study 5 showed that manipulating perceived knowledge of the true self (but not other self-concepts) directly affects decision satisfaction. Study 6 showed that this effect also works in reverse by manipulating feelings of decision satisfaction, which directly affected perceived knowledge of the true self (but not other self-concepts). Taken together, these studies suggest that people believe the true self should be used as a guide when making major life decisions and that this belief has observable consequences for the self and decision making. PsycINFO Database Record (c) 2013 APA, all rights reserved

Values and the Scientific Culture of Behavior Analysis

PubMed Central

Ruiz, Maria R; Roche, Bryan

2007-01-01

As scientists and practitioners, behavior analysts must make frequent decisions that affect many lives. Scientific principles have been our guide as we work to promote effective action across a broad spectrum of cultural practices. Yet scientific principles alone may not be sufficient to guide our decision making in cases with potentially conflicting outcomes. In such cases, values function as guides to work through ethical conflicts. We will examine two ethical systems, radical behaviorism and functional contextualism, from which to consider the role of values in behavior analysis, and discuss potential concerns. Finally, we propose philosophical pragmatism, focusing on John Dewey's notions of community and dialogue, as a tradition that can help behavior analysts to integrate talk about values and scientific practices in ethical decision making. PMID:22478484

Decision Support System For Management Of Low-Level Radioactive Waste Disposal At The Nevada Test Site

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

Shott, G.; Yucel, V.; Desotell, L.

2006-07-01

The long-term safety of U.S. Department of Energy (DOE) low-level radioactive disposal facilities is assessed by conducting a performance assessment -- a systematic analysis that compares estimated risks to the public and the environment with performance objectives contained in DOE Manual 435.1-1, Radioactive Waste Management Manual. Before site operations, facilities design features such as final inventory, waste form characteristics, and closure cover design may be uncertain. Site operators need a modeling tool that can be used throughout the operational life of the disposal site to guide decisions regarding the acceptance of problematic waste streams, new disposal cell design, environmental monitoringmore » program design, and final site closure. In response to these needs the National Nuclear Security Administration Nevada Site Office (NNSA/NSO) has developed a decision support system for the Area 5 Radioactive Waste Management Site in Frenchman Flat on the Nevada Test Site. The core of the system is a probabilistic inventory and performance assessment model implemented in the GoldSim{sup R} simulation platform. The modeling platform supports multiple graphic capabilities that allow clear documentation of the model data sources, conceptual model, mathematical implementation, and results. The combined models have the capability to estimate disposal site inventory, contaminant concentrations in environmental media, and radiological doses to members of the public engaged in various activities at multiple locations. The model allows rapid assessment and documentation of the consequences of waste management decisions using the most current site characterization information, radionuclide inventory, and conceptual model. The model is routinely used to provide annual updates of site performance, evaluate the consequences of disposal of new waste streams, develop waste concentration limits, optimize the design of new disposal cells, and assess the adequacy of environmental monitoring programs. (authors)« less

A framework for guiding sustainability assessment and on-farm strategic decision making

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

Coteur, Ine, E-mail: ine.coteur@ilvo.vlaanderen.be; Marchand, Fleur; University of Antwerp, Ecosystem Management Research Group and IMDO, Universiteitsplein 1, 2610 Wilrijk

Responding to future challenges and societal needs, various actions are taken in agriculture to evolve towards more sustainable farming practices. These actions imply strategic choices and suppose adequate sustainability assessments to identify, measure, evaluate and communicate sustainable development. However, literature is scarce on the link between strategic decision making and sustainability assessment. As questions emerge on how, what and when to measure, the objective of this paper is to construct a framework for guiding sustainability assessment and on-farm strategic decision making. Qualitative research on own experiences from the past and a recent project revealed four categories of actual needs farmers,more » advisors and experts have regarding sustainability assessment: context, flexibility, focus on farm and farmer and communication. These stakeholders' needs are then incorporated into a two-dimensional framework that marries the intrinsic complexity of sustainability assessment tools and the time frame of strategic decision making. The framework allows a farm-specific and flexible approach leading to harmonized actions towards sustainable farming. As this framework is mainly a procedural instrument to guide the use of sustainability assessment tools within strategic decision making, it fits to incorporate, even guide, future research on sustainability assessment tools themselves and on their adoption on farms. - Highlights: • How to link sustainability assessment and on-farm strategic decision making is unclear. • Two-dimensional framework incorporating stakeholders' needs regarding sustainability assessment • Linking complexity of sustainability assessment tools and the time frame of strategic decision making • Farm-specific and flexible approach to harmonize action towards sustainable farming.« less

Feasibility and Design Options for a Potential Entity to Research the Comparative Effectiveness of Medical Treatments.

PubMed

Hussey, Peter S; Gillen, Emily M; McGlynn, Elizabeth A

2011-01-01

In 2008, the Massachusetts state legislature mandated an examination of the feasibility of the state's participation in establishing a comparative effectiveness center (CEC) and requested recommendations for the entity's design. "Comparative effectiveness" research involves the direct comparative assessment of the efficacy and cost-effectiveness of health care interventions and strategies. The center's findings would guide purchasing and payment decisions related to medical procedures, devices, drugs, and biologics by public- and private-sector organizations. The state has several options in terms of its approach to comparative effectiveness research. It could establish an interstate CEC that synthesizes existing findings for regional decisionmakers, it could establish an interstate CEC that supports new research, it could join an existing CEC, it could join the Drug Effectiveness Review Project and the Medicare Evidence-Based Decisions Project and also establish a regional center, or it could elect not to establish a CEC at all. An exploration of the options and the types of research that could be sponsored reveals that all of the options are potentially feasible, but the legislature's decision with regard to design must consider the level of prioritization of comparative effectiveness research relative to other approaches to improving health care quality and reducing spending growth.

A Communications Guide for Sustainable Development: How Interested Parties Become Partners, 2nd Edition

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

Fowler, Kimberly M.; Hund, Gretchen; Engel-Cox, Jill A.

2016-03-06

The 2nd edition is an updated version plus an e-book. This book was developed to assist organizations in designing and managing their communication and stakeholder involvement programs. The guidebook describes a step-by-step approach, provides case studies, and presents tools to consider. The book uses a scenario approach to outline changes an organization may confront, and provides a menu of communication and engagement activities that support organizational decision making.

School Property: The Legality of Its Use and Disposition. ERIC/CEM State-of-the-Knowledge Series, Number 26. NOLPE Second Monograph Series on Legal Aspects of School Administration, Number 5.

ERIC Educational Resources Information Center

Piele, Philip K.; Forsberg, James R.

Designed to be a general outline and guide for school administrators and board members, this monograph provides a broad overview of State statutes and State and Federal court decisions that affect the use and disposition of school property. The first part of the paper presents typical statutes granting to or withholding from school boards…

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

PubMed

Doran, Diane M; Sidani, Souraya

2007-01-01

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

From Learning to Decision-Making: A Cross-Sectional Survey of a Clinical Pharmacist-Steered Journal Club

PubMed Central

Ismail, Sherine; Al Khansa, Sara; Aseeri, Mohammed; Alhamdan, Hani; Quadri, K. H. Mujtaba

2017-01-01

Journal clubs have been traditionally incorporated into academic training programs to enhance competency in the interpretation of literature. We designed a structured journal club (JC) to improve skills in the interpretation of literature; however, we were not aware of how learners (interns, residents, clinical pharmacists, etc.) would perceive it. We aimed to assess the perception of learners at different levels of pharmacy training. A cross-sectional design was used. A self-administered online survey was emailed to JC attendees from 2010–2014 at King Abdulaziz Medical City, Jeddah, Saudi Arabia. The survey questions included: introduction sessions, topic selection, JC layout, interaction with the moderator, and decision-making skills by clinical pharmacists. The response rate was 58/89 (65%); 52/54 (96%) respondents believed that JC adds to their knowledge in interpreting literature. Topic selection met the core curriculum requirements for credentials exams for 16/36 (44.4%), while 16/22 (73%) presenters had good to excellent interaction with the moderator. JC facilitated decision-making for 10/12 (83%) of clinical pharmacists. The results suggest that clinical pharmacist-steered JC may serve as an effective tool to empower learners at different levels of pharmacy practice, with evidence-based principles for interpretation of literature and guide informed decision-making. PMID:28970415

Decision-support models for empiric antibiotic selection in Gram-negative bloodstream infections.

PubMed

MacFadden, D R; Coburn, B; Shah, N; Robicsek, A; Savage, R; Elligsen, M; Daneman, N

2018-04-25

Early empiric antibiotic therapy in patients can improve clinical outcomes in Gram-negative bacteraemia. However, the widespread prevalence of antibiotic-resistant pathogens compromises our ability to provide adequate therapy while minimizing use of broad antibiotics. We sought to determine whether readily available electronic medical record data could be used to develop predictive models for decision support in Gram-negative bacteraemia. We performed a multi-centre cohort study, in Canada and the USA, of hospitalized patients with Gram-negative bloodstream infection from April 2010 to March 2015. We analysed multivariable models for prediction of antibiotic susceptibility at two empiric windows: Gram-stain-guided and pathogen-guided treatment. Decision-support models for empiric antibiotic selection were developed based on three clinical decision thresholds of acceptable adequate coverage (80%, 90% and 95%). A total of 1832 patients with Gram-negative bacteraemia were evaluated. Multivariable models showed good discrimination across countries and at both Gram-stain-guided (12 models, areas under the curve (AUCs) 0.68-0.89, optimism-corrected AUCs 0.63-0.85) and pathogen-guided (12 models, AUCs 0.75-0.98, optimism-corrected AUCs 0.64-0.95) windows. Compared to antibiogram-guided therapy, decision-support models of antibiotic selection incorporating individual patient characteristics and prior culture results have the potential to increase use of narrower-spectrum antibiotics (in up to 78% of patients) while reducing inadequate therapy. Multivariable models using readily available epidemiologic factors can be used to predict antimicrobial susceptibility in infecting pathogens with reasonable discriminatory ability. Implementation of sequential predictive models for real-time individualized empiric antibiotic decision-making has the potential to both optimize adequate coverage for patients while minimizing overuse of broad-spectrum antibiotics, and therefore requires further prospective evaluation. Readily available epidemiologic risk factors can be used to predict susceptibility of Gram-negative organisms among patients with bacteraemia, using automated decision-making models. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2013-01-01

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

The impact of simulation sequencing on perceived clinical decision making.

PubMed

Woda, Aimee; Hansen, Jamie; Paquette, Mary; Topp, Robert

2017-09-01

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students' perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources. Copyright © 2017. Published by Elsevier Ltd.

Dose Transition Pathways: The Missing Link Between Complex Dose-Finding Designs and Simple Decision-Making.

PubMed

Yap, Christina; Billingham, Lucinda J; Cheung, Ying Kuen; Craddock, Charlie; O'Quigley, John

2017-12-15

The ever-increasing pace of development of novel therapies mandates efficient methodologies for assessment of their tolerability and activity. Evidence increasingly support the merits of model-based dose-finding designs in identifying the recommended phase II dose compared with conventional rule-based designs such as the 3 + 3 but despite this, their use remains limited. Here, we propose a useful tool, dose transition pathways (DTP), which helps overcome several commonly faced practical and methodologic challenges in the implementation of model-based designs. DTP projects in advance the doses recommended by a model-based design for subsequent patients (stay, escalate, de-escalate, or stop early), using all the accumulated information. After specifying a model with favorable statistical properties, we utilize the DTP to fine-tune the model to tailor it to the trial's specific requirements that reflect important clinical judgments. In particular, it can help to determine how stringent the stopping rules should be if the investigated therapy is too toxic. Its use to design and implement a modified continual reassessment method is illustrated in an acute myeloid leukemia trial. DTP removes the fears of model-based designs as unknown, complex systems and can serve as a handbook, guiding decision-making for each dose update. In the illustrated trial, the seamless, clear transition for each dose recommendation aided the investigators' understanding of the design and facilitated decision-making to enable finer calibration of a tailored model. We advocate the use of the DTP as an integral procedure in the co-development and successful implementation of practical model-based designs by statisticians and investigators. Clin Cancer Res; 23(24); 7440-7. ©2017 AACR . ©2017 American Association for Cancer Research.

Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment.

PubMed

Liu, Shan; Brandeau, Margaret L; Goldhaber-Fiebert, Jeremy D

2017-03-01

How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient's quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3-4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment-despite expectations for future treatment improvement-for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population.

Optimizing Patient Treatment Decisions in an Era of Rapid Technological Advances: The Case of Hepatitis C Treatment

PubMed Central

Liu, Shan; Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

2015-01-01

How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient’s quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3–4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment—despite expectations for future treatment improvement—for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population. PMID:26188961

Implementation of inpatient models of pharmacogenetics programs

PubMed Central

Cavallari, Larisa H.; Lee, Craig R.; Duarte, Julio D.; Nutescu, Edith A.; Weitzel, Kristin W.; Stouffer, George A.; Johnson, Julie A.

2017-01-01

Purpose The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. Summary Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results. Conclusion With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care. PMID:27864202

Implementation of inpatient models of pharmacogenetics programs.

PubMed

Cavallari, Larisa H; Lee, Craig R; Duarte, Julio D; Nutescu, Edith A; Weitzel, Kristin W; Stouffer, George A; Johnson, Julie A

2016-12-01

The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results. With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Evaluation of occupational health interventions using a randomized controlled trial: challenges and alternative research designs.

PubMed

Schelvis, Roosmarijn M C; Oude Hengel, Karen M; Burdorf, Alex; Blatter, Birgitte M; Strijk, Jorien E; van der Beek, Allard J

2015-09-01

Occupational health researchers regularly conduct evaluative intervention research for which a randomized controlled trial (RCT) may not be the most appropriate design (eg, effects of policy measures, organizational interventions on work schedules). This article demonstrates the appropriateness of alternative designs for the evaluation of occupational health interventions, which permit causal inferences, formulated along two study design approaches: experimental (stepped-wedge) and observational (propensity scores, instrumental variables, multiple baseline design, interrupted time series, difference-in-difference, and regression discontinuity). For each design, the unique characteristics are presented including the advantages and disadvantages compared to the RCT, illustrated by empirical examples in occupational health. This overview shows that several appropriate alternatives for the RCT design are feasible and available, which may provide sufficiently strong evidence to guide decisions on implementation of interventions in workplaces. Researchers are encouraged to continue exploring these designs and thus contribute to evidence-based occupational health.

Schools and Data: The Educator's Guide for Using Data To Improve Decision Making.

ERIC Educational Resources Information Center

Creighton, Theodore B.

This book focuses on the relevance of statistics in the day-to-day lives of principals and teachers. The step-by-step guide to using existing school data can help school leaders make more appropriate and effective decisions. The information is presented with easy-to-follow instructions, illustrations, and pertinent examples. The chapters are: (1)…

SBexpert users guide (version 2.0): a knowledge-based decision-support system for spruce beetle management.

Treesearch

Keith M. Reynolds; Edward H. Holsten

1997-01-01

SBexpert version 2.0 is a knowledge-based decision-support system for spruce beetle (Dendroctonus rufipennis (Kby.)) management developed for use in Microsoft (MS) Windows with the KnowledgePro Windows development language. Version 2.0 is a significant enhancement of version 1.0. The SBexpert users guide provides detailed instructions on the use of...

Ethical conflicts in caring for patients with cochlear implants.

PubMed

McCormick, Thomas R

2010-10-01

Although the use of cochlear implants as a treatment designed to help deaf individuals hear has a relatively brief history, the use of this therapy has given rise to a number of ethical conflicts. This article identifies ethical conflicts in cochlear implantation therapy and shows how ethical principles that are commonly accepted in health care ethics may guide decision making in resolving these issues. Furthermore, clinicians are often confronted with particular cases in which ethical conflicts arise. A useful paradigm for the clinical context, the 4-box method, is offered as a means of organizing the facts of a "case" so that the important facts are considered, and a principled approach to decision making can be used in working toward a resolution.

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

Thumann, A.

This book presents the detailed guidance on how to effectively purchase deregulated energy, based on first-hand reports from many of the nation`s most knowledgeable experts. It is designed to provide the kind of practical advice needed by professionals who are responsible for making energy purchasing decisions. The book gives a ten-step program to guide building owners in purchasing decision making, a state-by-state retail competition update, and guidelines for buying electricity and natural gas over the worldwide web. Other topics include contract renegotiation strategies, an assessment of power pools, the role of aggregators in the energy market, real time pricing issues,more » where cogeneration fits within today`s marketplace, and lessons learned from deregulation experiences in Scandinavia and England.« less

Effects of Newly Designed Hospital Buildings on Staff Perceptions: A Pre-Post Study to Validate Design Decisions.

PubMed

Schreuder, Eliane; van Heel, Liesbeth; Goedhart, Rien; Dusseldorp, Elise; Schraagen, Jan Maarten; Burdorf, Alex

2015-01-01

This study investigates effects of the newly built nonpatient-related buildings of a large university medical center on staff perceptions and whether the design objectives were achieved. The medical center is gradually renewing its hospital building area of 200,000 m.(2) This redevelopment is carefully planned and because lessons learned can guide design decisions of the next phase, the medical center is keen to evaluate the performance of the new buildings. A pre- and post-study with a control group was conducted. Prior to the move to the new buildings an occupancy evaluation was carried out in the old setting (n = 729) (pre-study). Post occupation of the new buildings another occupancy evaluation (post-study) was carried out in the new setting (intervention group) and again in some old settings (control group) (n = 664). The occupancy evaluation consisted of an online survey that measured the perceived performance of different aspects of the building. Longitudinal multilevel analysis was used to compare the performance of the old buildings with the new buildings. Significant improvements were found in indoor climate, perceived safety, working environment, well-being, facilities, sustainability, and overall satisfaction. Commitment to the employer, working atmosphere, orientation, work performance, and knowledge sharing did not improve. The results were interpreted by relating them to specific design choices. We showed that it is possible to measure the performance improvements of a complex intervention being a new building design and validate design decisions. A focused design process aiming for a safe, pleasant and sustainable building resulted in actual improvements in some of the related performance measures. © The Author(s) 2015.

Vision Guided Intelligent Robot Design And Experiments

NASA Astrophysics Data System (ADS)

Slutzky, G. D.; Hall, E. L.

1988-02-01

The concept of an intelligent robot is an important topic combining sensors, manipulators, and artificial intelligence to design a useful machine. Vision systems, tactile sensors, proximity switches and other sensors provide the elements necessary for simple game playing as well as industrial applications. These sensors permit adaption to a changing environment. The AI techniques permit advanced forms of decision making, adaptive responses, and learning while the manipulator provides the ability to perform various tasks. Computer languages such as LISP and OPS5, have been utilized to achieve expert systems approaches in solving real world problems. The purpose of this paper is to describe several examples of visually guided intelligent robots including both stationary and mobile robots. Demonstrations will be presented of a system for constructing and solving a popular peg game, a robot lawn mower, and a box stacking robot. The experience gained from these and other systems provide insight into what may be realistically expected from the next generation of intelligent machines.

Random vibration (stress screening) of printed wiring assemblies

NASA Technical Reports Server (NTRS)

Bastien, Gilbert J.

1988-01-01

The results of a random vibration test screening (RVSS) study of the determination of the upper and lower vibration limits on printed wiring assemblies (PWA) are summarized. The study results are intended to serve as a guide for engineers and designers who make decisions on PWA features that need to withstand the stresses of dynamic testing and screening. The maximum allowable PWA deflection, G levels, and PSD levels are compared to the expected or actual levels to determine if deleterious effects will occur.

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

PubMed

Nilsson, Tomas; Lindström, Veronica

2016-07-01

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

BAM! Guide to Getting Along

MedlinePlus

... Vegetables Desserts Dining Decisions Mobile App – Dining Decisions Game Online Game – Dining Decisions Questions Answered Under the Microscope Xpert ... Test Your Smarts Feeling Frazzled…? Feeling Stressed Out? Game Grind Your Mind Game Kabam! Comic Creator Best ...

Shared Decision-Making for Nursing Practice: An Integrative Review

PubMed Central

Truglio-Londrigan, Marie; Slyer, Jason T.

2018-01-01

Background: Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. Objective: To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. Methods: An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Results: Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. Conclusion: A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions. PMID:29456779

Renewable Energy Data, Analysis, and Decisions: A Guide for Practitioners

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

Cox, Sarah L; Lopez, Anthony J; Watson, Andrea C

High-quality renewable energy resource data and other geographic information system (GIS) data are essential for the transition to a clean energy economy that prioritizes local resources, improves resiliency, creates jobs, and promotes energy independence. This guide is intended to support policymakers and planners, as well as technical experts, consultants, and academics in incorporating improved data and analysis into renewable energy decision-making.

Assessor Decision Making While Marking a Note-Taking Listening Test: The Case of the OET

ERIC Educational Resources Information Center

Harding, Luke; Pill, John; Ryan, Kerry

2011-01-01

This article investigates assessor decision making when using and applying a marking guide for a note-taking task in a specific purpose English language listening test. In contexts where note-taking items are used, a marking guide is intended to stipulate what kind of response should be accepted as evidence of the ability under test. However,…

Architects' perspectives on construction waste reduction by design

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

Osmani, M.; Glass, J.; Price, A.D.F.

2008-07-01

The construction, demolition and excavation waste arising in England was estimated at 91 million tonnes in 2003. The current thinking on construction waste minimisation is heavily focussed on several issues relating to physical construction waste and recycling guides. Indeed, much had been published on ways to improve on-site waste management and recycling activities but very few attempts made to address the effect of design practices on waste generation. However, there is a consensus in the literature that the architect has a decisive role to play in helping to reduce waste by focussing on designing out waste. This paper examines previousmore » studies on architects' approach towards construction waste minimisation; and by means of a postal questionnaire, investigates: the origins of waste; waste minimisation design practices in the UK; and responsibilities and barriers within the UK architectural profession. The findings reveal that waste management is not a priority in the design process. Additionally, the architects seemed to take the view that waste is mainly produced during site operations and rarely generated during the design stages; however, about one-third of construction waste could essentially arise from design decisions. Results also indicate that a number of constraints, namely: lack of interest from clients; attitudes towards waste minimisation; and training all act as disincentives to a proactive and sustainable implementation of waste reduction strategies during the design process.« less

Architects' perspectives on construction waste reduction by design.

PubMed

Osmani, M; Glass, J; Price, A D F

2008-01-01

The construction, demolition and excavation waste arising in England was estimated at 91 million tonnes in 2003. The current thinking on construction waste minimisation is heavily focussed on several issues relating to physical construction waste and recycling guides. Indeed, much had been published on ways to improve on-site waste management and recycling activities but very few attempts made to address the effect of design practices on waste generation. However, there is a consensus in the literature that the architect has a decisive role to play in helping to reduce waste by focussing on designing out waste. This paper examines previous studies on architects' approach towards construction waste minimisation; and by means of a postal questionnaire, investigates: the origins of waste; waste minimisation design practices in the UK; and responsibilities and barriers within the UK architectural profession. The findings reveal that waste management is not a priority in the design process. Additionally, the architects seemed to take the view that waste is mainly produced during site operations and rarely generated during the design stages; however, about one-third of construction waste could essentially arise from design decisions. Results also indicate that a number of constraints, namely: lack of interest from clients; attitudes towards waste minimisation; and training all act as disincentives to a proactive and sustainable implementation of waste reduction strategies during the design process.

Partially dissociable roles of OFC and ACC in stimulus-guided and action-guided decision making.

PubMed

Khani, Abbas

2014-05-01

Recently, the functional specialization of prefrontal areas of the brain, and, specifically, the functional dissociation of the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC), during decision making have become a particular focus of research. A number of neuropsychological and lesion studies have shown that the OFC and ACC have dissociable functions in various dimensions of decision making, which are supported by their different anatomical connections. A recent single-neuron study, however, described a more complex picture of the functional dissociation between these two frontal regions during decision making. Here, I discuss the results of that study and consider alternative interpretations in connection with other findings.

Apparel. Vocational Home Economics Education.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This curriculum guide for apparel is one of a number of guides developed for use in vocational home economics education in Texas. Introductory materials address use of the guide and list the essential elements upon which the content is based. The guide is divided into six units: individual and family apparel decisions, apparel management,…

76 FR 46321 - Record of Decision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... involvement in the decision-making process. The approved General Management Plan will guide long-term... management plan for the park; it is intended to be a useful, long-term decision- making tool, providing a... DEPARTMENT OF THE INTERIOR National Park Service [4240-CEBE-409] Record of Decision AGENCY...

Discrete Choice Experiments: A Guide to Model Specification, Estimation and Software.

PubMed

Lancsar, Emily; Fiebig, Denzil G; Hole, Arne Risa

2017-07-01

We provide a user guide on the analysis of data (including best-worst and best-best data) generated from discrete-choice experiments (DCEs), comprising a theoretical review of the main choice models followed by practical advice on estimation and post-estimation. We also provide a review of standard software. In providing this guide, we endeavour to not only provide guidance on choice modelling but to do so in a way that provides a 'way in' for researchers to the practicalities of data analysis. We argue that choice of modelling approach depends on the research questions, study design and constraints in terms of quality/quantity of data and that decisions made in relation to analysis of choice data are often interdependent rather than sequential. Given the core theory and estimation of choice models is common across settings, we expect the theoretical and practical content of this paper to be useful to researchers not only within but also beyond health economics.

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

PubMed

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

2018-01-01

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

Objective evaluation of situation awareness for dynamic decision makers in teleoperations

NASA Technical Reports Server (NTRS)

Endsley, Mica R.

1991-01-01

Situation awareness, a current mental mode of the environment, is critical to the ability of operators to perform complex and dynamic tasks. This should be particularly true for teleoperators, who are separated from the situation they need to be aware of. The design of the man-machine interface must be guided by the goal of maintaining and enhancing situation awareness. The objective of this work has been to build a foundation upon which research in the area can proceed. A model of dynamic human decision making which is inclusive of situation awareness will be presented, along with a definition of situation awareness. A method for measuring situation awareness will also be presented as a tool for evaluating design concepts. The Situation Awareness Global Assessment Technique (SAGAT) is an objective measure of situation awareness originally developed for the fighter cockpit environment. The results of SAGAT validation efforts will be presented. Implications of this research for teleoperators and other operators of dynamic systems will be discussed.

A guide to understanding the variation in premiums in rural health insurance marketplaces.

PubMed

Barker, Abigail R; McBride, Timothy D; Kemper, Leah M; Mueller, Keith

2014-05-01

Key Findings. (1) State-level decisions in implementing the Patient Protection and Affordable Care Act of 2010 (ACA) have led to significant state variation in the design of Health Insurance Marketplace (HIM) rating areas. In some designs, rural counties are grouped together, while in others, rural and urban counties have been deliberately mixed. (2) Urban counties have, on average, approximately one more firm participating in the marketplaces, representing about 11 more plan offerings, than rural counties have. (3) The highest-valued "platinum" plan types are less likely to be available in rural areas. Thus, the overall mix of plan types should be factored into the reporting of average premiums. (4) Levels of competition are likely to have a greater impact on the decisions of firms considering whether to operate in higher-cost areas or not, as those firms must determine how they can pass such costs on to consumers, conditional on the market share they are likely to control.

Advanced medical imaging protocol workflow-a flexible electronic solution to optimize process efficiency, care quality and patient safety in the National VA Enterprise.

PubMed

Medverd, Jonathan R; Cross, Nathan M; Font, Frank; Casertano, Andrew

2013-08-01

Radiologists routinely make decisions with only limited information when assigning protocol instructions for the performance of advanced medical imaging examinations. Opportunity exists to simultaneously improve the safety, quality and efficiency of this workflow through the application of an electronic solution leveraging health system resources to provide concise, tailored information and decision support in real-time. Such a system has been developed using an open source, open standards design for use within the Veterans Health Administration. The Radiology Protocol Tool Recorder (RAPTOR) project identified key process attributes as well as inherent weaknesses of paper processes and electronic emulators of paper processes to guide the development of its optimized electronic solution. The design provides a kernel that can be expanded to create an integrated radiology environment. RAPTOR has implications relevant to the greater health care community, and serves as a case model for modernization of legacy government health information systems.

Measuring the impact of an API-first mentality with ScienceBase after 4.5 years

NASA Astrophysics Data System (ADS)

Bristol, S.; Tekell, S.

2016-12-01

ScienceBase is a research infrastructure developed and operated by the U.S. Geological Survey with users and uses across a number of other agency and organization partners. Over four years ago, we released an Application Programming Interface (API) as the foundation of the system and took on the mindset that our progress would be measured by the uptake of the API by others beyond ourselves in developing interesting applications. We now measure success more by someone finding ScienceBase, organizing their data and information, developing an innovative API-driven application and then serendipitous discovery through a science meeting. Because of the way we built the RESTful API, we can characterize what parts of the system are employed. Analysis of usage data helps us take the supposition out of what works and guides design and funding decisions. This analytics-based process facilitates regular adjustments to our thinking and allows us to test design decisions as hypotheses rather than untestable aspirations.

Electrical Grounding Architecture for Unmanned Spacecraft

NASA Technical Reports Server (NTRS)

1998-01-01

This handbook is approved for use by NASA Headquarters and all NASA Centers and is intended to provide a common framework for consistent practices across NASA programs. This handbook was developed to describe electrical grounding design architecture options for unmanned spacecraft. This handbook is written for spacecraft system engineers, power engineers, and electromagnetic compatibility (EMC) engineers. Spacecraft grounding architecture is a system-level decision which must be established at the earliest point in spacecraft design. All other grounding design must be coordinated with and be consistent with the system-level architecture. This handbook assumes that there is no one single 'correct' design for spacecraft grounding architecture. There have been many successful satellite and spacecraft programs from NASA, using a variety of grounding architectures with different levels of complexity. However, some design principles learned over the years apply to all types of spacecraft development. This handbook summarizes those principles to help guide spacecraft grounding architecture design for NASA and others.

[The social representation guiding parental decisions to face drug consumption of their teenage children].

PubMed

Nuño-Gutiérrez, Bertha Lidia; González-Forteza, Catalina

2004-01-01

To identify the social representation guiding decisions of parents of teenage drug users to face consumption of their children. A qualitative study using free lists, characterization questionnaires, and in-depth interviews was performed among 60 systematically selected parents of young drug users who were receiving treatment in Centros de Integración Juvenil. Data analysis included correlations and interpretive analysis. Three stages were identified: 1) discovery of the addiction, characterized by parental disappointment; 2) permanence: The highest in duration, resource investment, and losses; and 3) withdrawal: Featured by seeking health services. The representation that guided parental decisions was "the offer of a better world", which stemmed from the social, cultural, and family context that revolves around consumption and that was sustained by two beliefs: "Learning from mistakes" and "where there is a will there is a way".

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design.

PubMed

Zeeman, Heidi; Kendall, Elizabeth; Whitty, Jennifer A; Wright, Courtney J; Townsend, Clare; Smith, Dianne; Lakhani, Ali; Kennerley, Samantha

2016-03-15

Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met. This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested. It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline.

PubMed

Harris, Lyndsay N; Ismaila, Nofisat; McShane, Lisa M; Andre, Fabrice; Collyar, Deborah E; Gonzalez-Angulo, Ana M; Hammond, Elizabeth H; Kuderer, Nicole M; Liu, Minetta C; Mennel, Robert G; Van Poznak, Catherine; Bast, Robert C; Hayes, Daniel F

2016-04-01

To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences. © 2016 by American Society of Clinical Oncology.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

PubMed Central

Harris, Lyndsay N.; McShane, Lisa M.; Andre, Fabrice; Collyar, Deborah E.; Gonzalez-Angulo, Ana M.; Hammond, Elizabeth H.; Kuderer, Nicole M.; Liu, Minetta C.; Mennel, Robert G.; Van Poznak, Catherine; Bast, Robert C.; Hayes, Daniel F.

2016-01-01

Purpose To provide recommendations on appropriate use of breast tumor biomarker assay results to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer. Methods A literature search and prospectively defined study selection sought systematic reviews, meta-analyses, randomized controlled trials, prospective-retrospective studies, and prospective comparative observational studies published from 2006 through 2014. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert panel members used informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 50 relevant studies. One randomized clinical trial and 18 prospective-retrospective studies were found to have evaluated the clinical utility, as defined by the guideline, of specific biomarkers for guiding decisions on the need for adjuvant systemic therapy. No studies that met guideline criteria for clinical utility were found to guide choice of specific treatments or regimens. Recommendations In addition to estrogen and progesterone receptors and human epidermal growth factor receptor 2, the panel found sufficient evidence of clinical utility for the biomarker assays Oncotype DX, EndoPredict, PAM50, Breast Cancer Index, and urokinase plasminogen activator and plasminogen activator inhibitor type 1 in specific subgroups of breast cancer. No biomarker except for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to guide choices of specific treatment regimens. Treatment decisions should also consider disease stage, comorbidities, and patient preferences. PMID:26858339

Do Algorithms Homogenize Students' Achievements in Secondary School Better than Teachers' Tracking Decisions?

ERIC Educational Resources Information Center

Klapproth, Florian

2015-01-01

Two objectives guided this research. First, this study examined how well teachers' tracking decisions contribute to the homogenization of their students' achievements. Second, the study explored whether teachers' tracking decisions would be outperformed in homogenizing the students' achievements by statistical models of tracking decisions. These…

Developing and Teaching Ethical Decision Making Skills.

ERIC Educational Resources Information Center

Robinson, John

1991-01-01

Student leaders and campus activities professionals can use a variety of techniques to help college students develop skill in ethical decision making, including teaching about the decision-making process, guiding students through decisions with a series of questions, playing ethics games, exploring assumptions, and best of all, role modeling. (MSE)

Simultaneous sequential monitoring of efficacy and safety led to masking of effects.

PubMed

van Eekelen, Rik; de Hoop, Esther; van der Tweel, Ingeborg

2016-08-01

Usually, sequential designs for clinical trials are applied on the primary (=efficacy) outcome. In practice, other outcomes (e.g., safety) will also be monitored and influence the decision whether to stop a trial early. Implications of simultaneous monitoring on trial decision making are yet unclear. This study examines what happens to the type I error, power, and required sample sizes when one efficacy outcome and one correlated safety outcome are monitored simultaneously using sequential designs. We conducted a simulation study in the framework of a two-arm parallel clinical trial. Interim analyses on two outcomes were performed independently and simultaneously on the same data sets using four sequential monitoring designs, including O'Brien-Fleming and Triangular Test boundaries. Simulations differed in values for correlations and true effect sizes. When an effect was present in both outcomes, competition was introduced, which decreased power (e.g., from 80% to 60%). Futility boundaries for the efficacy outcome reduced overall type I errors as well as power for the safety outcome. Monitoring two correlated outcomes, given that both are essential for early trial termination, leads to masking of true effects. Careful consideration of scenarios must be taken into account when designing sequential trials. Simulation results can help guide trial design. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation and purchase of an analytical flow cytometer: some of the numerous factors to consider.

PubMed

Zucker, Robert M; Fisher, Nancy C

2013-01-01

When purchasing a flow cytometer, the decision of which brand, model, specifications, and accessories may be challenging. The decisions should initially be guided by the specific applications intended for the instrument. However, many other factors need to be considered, which include hardware, software, quality assurance, support, service, and price and recommendations from colleagues. These issues are discussed to help guide the purchasing process.

Guiding the process of health technology disinvestment.

PubMed

Ibargoyen-Roteta, Nora; Gutiérrez-Ibarluzea, Iñaki; Asua, José

2010-12-01

To develop a guideline for health technology disinvestment. The Nominal Group Technique was used to determine relevant aspects of disinvestment decision-making. Ideas reaching consensus and previous Spanish guidelines on the acquisition of new health technologies (GANT) and new genetic tests (GEN) structures were used to develop the domains and contents of GuNFT (Guideline for Not Funding Health Technologies). The draft was peer reviewed by local and international experts and their suggestions were incorporated to the first GuNFT version. Thirty-five ideas reached consensus. The most relevant ones referred to the reasons for disinvesting in a technology and the key aspects that would facilitate disinvestment acceptance. Considering both consensus ideas and GANT and GEN guidelines, the first GuNFT draft was elaborated. After the review process, section numbers and contents were changed. The resulting GuNFT guideline was finally divided into six domains related to: (1) general preliminary recommendations, (2) completing the application form, (3) checking and prioritising applications, (4) assessment, (5) final decision and (6) action plan design. A software was also developed to facilitate GuNFT implementation. Disinvestment should be a guided process. Accordingly, we present the first guideline for that purpose. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Accuracy of intuition in clinical decision-making among novice clinicians.

PubMed

Price, Amanda; Zulkosky, Kristen; White, Krista; Pretz, Jean

2017-05-01

To assess the reliance on intuitive and analytical approaches during clinical decision-making among novice clinicians and whether that reliance is associated with accurate decision-making. Nurse educators and managers tend to emphasize analysis over intuition during clinical decision-making though nurses typically report some reliance on intuition in their practice. We hypothesized that under certain conditions, reliance on intuition would support accurate decision-making, even among novices. This study utilized an experimental design with clinical complication (familiar vs. novel) and decision phase (cue acquisition, diagnosis and action) as within-subjects' factors, and simulation role (observer, family, auxiliary nurse and primary nurse) as between-subjects' factor. We examined clinical decision-making accuracy among final semester pre-licensure nursing students in a simulation experience. Students recorded their reasoning about emerging clinical complications with their patient during two distinct points in the simulation; one point involved a familiar complication and the other a relatively novel complication. All data were collected during Spring 2015. Although most participants relied more heavily on analysis than on intuition, use of intuition during the familiar complication was associated with more accurate decision-making, particularly in guiding attention to relevant cues. With the novel complication, use of intuition appeared to hamper decision-making, particularly for those in an observer role. Novice clinicians should be supported by educators and nurse managers to note when their intuitions are likely to be valid. Our findings emphasize the integrated nature of intuition and analysis in clinical decision-making. © 2016 John Wiley & Sons Ltd.

End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

PubMed

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

Managing Home and Work Responsibilities. Secondary Learning Guide 9. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on managing home and work responsibilities is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve…

Strengthening Parenting Skills: Teenagers. Secondary Learning Guide 3. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on strengthening parenting skills is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems;…

Making Consumer Choices. Secondary Learning Guide 6. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on making consumer choices is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems; establish…

Strengthening Parenting Skills: School Age. Secondary Learning Guide 2. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on strengthening parenting skills is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems;…

Five Steps for Structuring Data-Informed Conversations and Action in Education. REL 2013-001

ERIC Educational Resources Information Center

Kekahio, Wendy; Baker, Myriam

2013-01-01

Using data strategically to guide decisions and actions can have a positive effect on education practices and processes. This facilitation guide shows education data teams how to move beyond simply reporting data to applying data to direct strategic action. Using guiding questions, suggested activities, and activity forms, this guide provides…

Conserving Limited Resources. Secondary Learning Guide 14. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on conserving limited resources is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems; establish…

Preventing Teen Pregnancy. Secondary Learning Guide 4. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on preventing teen pregnancy is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems; establish…

Balancing Work and Family. Secondary Learning Guide 5. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on balancing work and family is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems; establish…

Assisting At-Risk Populations. Secondary Learning Guide 11. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on assisting at-risk populations (dropouts and homeless people) is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative…

Using the IRPA Guiding Principles on Stakeholder Engagement: putting theory into practice.

PubMed

Jones, C Rick

2011-11-01

The International Radiation Protection Association (IRPA) published their Guiding Principles for Radiation Protection Professionals on Stakeholder Engagement in February 2009. The publication of this document is the culmination of four years of work by the Spanish Society for Radiological Protection, the French Society of Radioprotection, the United Kingdom Society of Radiological Protection, and the IRPA organization, with full participation by the Italian Associate Society and the Nuclear Energy Agency's Committee on Radiation Protection and Public Health. The Guiding Principles provide field-tested and sound counsel to the radiation protection profession to aid it in successfully engaging with stakeholders in decision-making processes that result in mutually agreeable and sustainable decisions. Stakeholders in the radiation protection decision making process are now being recognized as a spectrum of individuals and organizations specific to the situation. It is also important to note that stakeholder engagement is not needed or advised in all decision making situations, although it has been shown to be a tool of first choice in dealing with such topics as intervention and chronic exposure situations, as well as situations that have reached an impasse using traditional approaches to decision-making. To enhance the contribution of the radiation protection profession, it is important for radiation protection professionals and their national professional societies to embrace and implement the IRPA Guiding Principles in a sustainable way by making them a cornerstone of their operations and an integral part of day-to-day activities.

Adaptive harvest management of North American waterfowl populations - recent successes and future prospects

USGS Publications Warehouse

Nichols, J.D.; Runge, M.C.; Johnson, F.A.; Williams, B.K.; Schodde, Richard; Hannon, Susan; Scheiffarth, Gregor; Bairlein, Franz

2006-01-01

The history of North American waterfowl harvest management has been characterized by attempts to use population monitoring data to make informed harvest management decisions. Early attempts can be characterized as intuitive decision processes, and later efforts were guided increasingly by population models and associated predictions. In 1995, a formal adaptive management process was implemented, and annual decisions about duck harvest regulations in the United States are still based on this process. This formal decision process is designed to deal appropriately with the various forms of uncertainty that characterize management decisions, environmental uncertainty, structural uncertainty, partial controllability and partial observability. The key components of the process are (1) objectives, (2) potential management actions, (3) model(s) of population response to management actions, (4) credibility measures for these models, and (5) a monitoring program. The operation of this iterative process is described, and a brief history of a decade of its use is presented. Future challenges range from social and political issues such as appropriate objectives and management actions, to technical issues such as multispecies management, geographic allocation of harvest, and incorporation of actions that include habitat acquisition and management.

Single dose testosterone administration modulates emotional reactivity and counterfactual choice in healthy males.

PubMed

Wu, Yin; Clark, Luke; Zilioli, Samuele; Eisenegger, Christoph; Gillan, Claire M; Deng, Huihua; Li, Hong

2018-04-01

Testosterone has been implicated in the regulation of emotional responses and risky decision-making. However, the causal effect of testosterone upon emotional decision-making, especially in non-social settings, is still unclear. The present study investigated the role of testosterone in counterfactual thinking: regret is an intense negative emotion that arises from comparison of an obtained outcome from a decision against a better, non-obtained (i.e. counterfactual) alternative. Healthy male participants (n = 64) received a single-dose of 150 mg testosterone Androgel in a double-blind, placebo-controlled, between-participants design. At 180 min post-administration, participants performed the counterfactual thinking task. We applied a computational model derived from behavioral economic principles to uncover latent decision-making mechanisms that may be invisible in simple choice analyses. Our data showed that testosterone increased the ability to use anticipated regret to guide choice behavior, while reducing choice based on expected value. On affective ratings, testosterone increased sensitivity to both obtained and counterfactual outcomes. These findings provide evidence that testosterone causally modulates emotional decision-making, and highlight the role of testosterone in affective sensitivity. Copyright © 2018 Elsevier Ltd. All rights reserved.

CONCEPTUAL AND METHODOLOGICAL ISSUES IN DESIGNING A RANDOMIZED CONTROLLED TREATMENT TRIAL FOR GERIATRIC BIPOLAR DISORDER: GERI-BD

PubMed Central

Young, Robert C.; Schulberg, Herbert C.; Gildengers, Ariel G.; Sajatovic, Martha; Mulsant, Benoit H.; Gyulai, Laszlo; Beyer, John; Marangell, Lauren; Kunik, Mark; Have, Thomas Ten; Bruce, Martha L.; Gur, Ruben; Marino, Patricia; Evans, Jovier D.; Reynolds, Charles F.; Alexopoulos, George S.

2010-01-01

Aim This report considers the conceptual and methodological concerns confronting clinical investigators seeking to generate knowledge regarding the tolerability and benefits of pharmacotherapy in geriatric bipolar (BP) patients. Method There is continuing need for evidence-based guidelines derived from randomized controlled trials that will enhance drug treatment of geriatric BP patients. We, therefore, present the complex conceptual and methodological choices encountered in designing a multi-site clinical trial and the decisions reached by the investigators with the intention that study findings are pertinent to, and can facilitate, routine treatment decisions. Results Guided by a literature review and input from peers, the tolerability and anti-manic effect of lithium and valproate were judged to be the key mood stabilizers to investigate with regard to treating BP I manic, mixed and hypomanic states. The patient selection criteria are intended to generate a sample that experiences common treatment needs but which also represents the variety of older patients seen in university-based clinical settings. The clinical protocol guides titratation of lithium and valproate to target serum concentrations, with lower levels allowed when necessitated by limited tolerability. The protocol emphasizes initial monotherapy. However, augmentation with risperidone is permitted after three weeks when indicated by operational criteria. Conclusions A randomized controlled trial that both investigates commonly prescribed mood stabilizers and maximizes patient participation can meaningfully address high priority clinical concerns directly relevant to the routine pharmacologic treatment of geriatric BP patients. PMID:20148867

Choosing phenomenology as a guiding philosophy for nursing research.

PubMed

Matua, Gerald Amandu

2015-03-01

To provide an overview of important methodological considerations that nurse researchers need to adhere to when choosing phenomenology as a guiding philosophy and research method. Phenomenology is a major philosophy and research method in the humanities, human sciences and arts disciplines with a central goal of describing people's experiences. However, many nurse researchers continue to grapple with methodological issues related to their choice of phenomenological method. The author conducted online and manual searches of relevant research books and electronic databases. Using an integrative method, peer-reviewed research and discussion papers published between January 1990 and December 2011 and listed in the CINAHL, Science Direct, PubMed and Google Scholar databases were reviewed. In addition, textbooks that addressed research methodologies such as phenomenology were used. Although phenomenology is widely used today to broaden understanding of human phenomena relevant to nursing practice, nurse researchers often fail to adhere to acceptable scientific and phenomenological standards. Cognisant of these challenges, researchers are expected to indicate in their work the focus of their investigations, designs, and approaches to collecting and analysing data. They are also expected to present their findings in an evocative and expressive manner. Choosing phenomenology requires researchers to understand it as a philosophy, including basic assumptions and tenets of phenomenology as a research method. This awareness enables researchers, especially novices, to make important methodological decisions, particularly those necessary to indicate the study's scientific rigour and phenomenological validity. This paper adds to the discussion of phenomenology as a guiding philosophy for nursing research. It aims to guide new researchers on important methodological decisions they need to make to safeguard their study's scientific rigour and phenomenological validity.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

PubMed

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-03-06

Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. © 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.

V-TECS Guide for Bookkeeping/Accounting/Payroll Clerk.

ERIC Educational Resources Information Center

Gregory, Margaret R.; Benson, Robert T.

This guide, an extension of the Vocational-Technical Education Consortium of States (V-TECS) catalog, includes such considerations as background information, decision-making skills, attitudes, and learning methods surrounding the occupations of bookkeeper/accountant/payroll clerk. The guide provides job-relevant task, performance objectives,…

Consent to treatment by minors attending accident and emergency departments: guidelines.

PubMed Central

Williams, L; Harris, A; Thompson, M; Brayshaw, A

1997-01-01

The absolute right to refuse medical treatment, even if the reasons are irrational, is confined to competent adults. Children under 16 years can give legal consent to treatment in the absence of consent from those with parental responsibility. Children under 18 years do not, however, have an absolute right to consent, or refuse to consent, to treatment. The views of children assume increasing importance with age and maturity. Accident and emergency medical and nursing staff may face difficult decisions when children, or those with parental responsibility, refuse to consent to medical treatment. This paper presents guidelines designed to guide the decision making process in immediately or potentially life threatening conditions and in non-life-threatening conditions. Images Figure 1 Figure 2 p289-a PMID:9315927

Using a Discrete Choice Conjoint Experiment to Engage Stakeholders in the Design of an Outpatient Children's Health Center.

PubMed

Cunningham, Charles E; Niccols, Alison; Rimas, Heather; Robicheau, Randi; Anderson, Colleen; DeVries, Bart

2017-10-01

To engage users in the design of a regional child and youth health center. The perspective of users should be an integral component of a patient-centered, evidence-based approach to the design of health facilities. We conducted a discrete choice conjoint experiment (DCE), a method from marketing research and health economics, as a component of a strategy to engage users in the preconstruction planning process. A sample of 467 participants (290 staff and 177 clients or community stakeholders) completed the DCE. Latent class analysis identified three segments with different design preferences. A group we termed an enhanced design (57%) segment preferred a fully featured facility with personal contacts at the start of visits (in-person check-in, personal waiting room notification, volunteer-assisted wayfinding, and visible security), a family resource center with a health librarian, and an outdoor playground equipped with covered heated pathways. The self-guided design segment (11%), in contrast, preferred a design allowing a more independent use of the facility (e.g., self-check-in at computer kiosks, color-coded wayfinding, and a self-guided family resource center). Designs affording privacy and personal contact with staff were important to the private design segment (32%). The theme and decor of the building was less important than interactive features and personal contacts. A DCE allowed us to engage users in the planning process by estimating the value of individual design elements, identifying segments with differing views, informing decisions regarding design trade-offs, and simulating user response to design options.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

PubMed

Armstrong, Rebecca; Waters, Elizabeth; Moore, Laurence; Dobbins, Maureen; Pettman, Tahna; Burns, Cate; Swinburn, Boyd; Anderson, Laurie; Petticrew, Mark

2014-12-14

The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions. The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making. This study makes an important contribution to understanding how evidence is used within the public health LG context. ACTRN12609000953235.

Resource allocation on the frontlines of public health preparedness and response: report of a summit on legal and ethical issues.

PubMed

Barnett, Daniel J; Taylor, Holly A; Hodge, James G; Links, Jonathan M

2009-01-01

In the face of all-hazards preparedness challenges, local and state health department personnel have to date lacked a discrete set of legally and ethically informed public health principles to guide the distribution of scarce resources in crisis settings. To help address this gap, we convened a Summit of academic and practice experts to develop a set of principles for legally and ethically sound public health resource triage decision-making in emergencies. The invitation-only Summit, held in Washington, D.C., on June 29, 2006, assembled 20 experts from a combination of academic institutions and nonacademic leadership, policy, and practice settings. The Summit featured a tabletop exercise designed to highlight resource scarcity challenges in a public health infectious disease emergency. This exercise served as a springboard for Summit participants' subsequent identification of 10 public health emergency resource allocation principles through an iterative process. The final product of the Summit was a set of 10 principles to guide allocation decisions involving scarce resources in public health emergencies. The principles are grouped into three categories: obligations to community; balancing personal autonomy and community well-being/benefit; and good preparedness practice. The 10 Summit-derived principles represent an attempt to link law, ethics, and real-world public health emergency resource allocation practices, and can serve as a useful starting framework to guide further systematic approaches and future research on addressing public health resource scarcity in an all-hazards context.

Developing and pilot testing a shared decision-making intervention for dialysis choice.

PubMed

Finderup, Jeanette; Jensen, Jens K D; Lomborg, Kirsten

2018-04-17

Evidence is inconclusive on how best to guide the patient in decision-making around haemodialysis and peritoneal dialysis choice. International guidelines recommend involvement of the patient in the decision to choose the dialysis modality most suitable for the individual patient. Nevertheless, studies have shown lack of involvement of the patient in decision-making. To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. This study reflects the first two phases of a complex intervention design: phase 1, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9) and the Decision Quality Measure (DQM) applied to evaluate the intervention. A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority of the patients experienced this intervention as shared decision-making. An intervention based on shared decision-making supported by decision aids seemed to increase the number of patients choosing home dialysis. The SDM Q9 and DQM were feasible evaluation tools. Further research is needed to gain insight into the patients' experiences of involvement and the implications for their choice of dialysis modality. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

PubMed

Molina-Mula, Jesús; Gallo-Estrada, Julia; Perelló-Campaner, Catalina

2017-12-29

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Pruning a decision tree for selecting computer-related assistive devices for people with disabilities.

PubMed

Chi, Chia-Fen; Tseng, Li-Kai; Jang, Yuh

2012-07-01

Many disabled individuals lack extensive knowledge about assistive technology, which could help them use computers. In 1997, Denis Anson developed a decision tree of 49 evaluative questions designed to evaluate the functional capabilities of the disabled user and choose an appropriate combination of assistive devices, from a selection of 26, that enable the individual to use a computer. In general, occupational therapists guide the disabled users through this process. They often have to go over repetitive questions in order to find an appropriate device. A disabled user may require an alphanumeric entry device, a pointing device, an output device, a performance enhancement device, or some combination of these. Therefore, the current research eliminates redundant questions and divides Anson's decision tree into multiple independent subtrees to meet the actual demand of computer users with disabilities. The modified decision tree was tested by six disabled users to prove it can determine a complete set of assistive devices with a smaller number of evaluative questions. The means to insert new categories of computer-related assistive devices was included to ensure the decision tree can be expanded and updated. The current decision tree can help the disabled users and assistive technology practitioners to find appropriate computer-related assistive devices that meet with clients' individual needs in an efficient manner.

Impact of Interprofessional Relationships from Nurses’ Perspective on the Decision-Making Capacity of Patients in a Clinical Setting

PubMed Central

Gallo-Estrada, Julia; Perelló-Campaner, Catalina

2017-01-01

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses’ perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care. PMID:29286342

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

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

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

A Resource Guide Identifying Technology Tools for Schools. Appendix

ERIC Educational Resources Information Center

Fox, Christine; Jones, Rachel

2009-01-01

SETDA and NASTID's "Technology Tools for Schools Resource Guide" provides definitions of key technology components and relevant examples, where appropriate as a glossary for educators. The guide also presents essential implementation and infrastructure considerations that decision makers should think about when implementing technology in schools.…

Effects of risk attitudes on extended attack fire management decisionmaking

Treesearch

Donald G. MacGregor; Armando González-Cabán

2009-01-01

Fire management inherently involves the assessment and management of risk, and decision making under uncertainty. Although organizational standards and guides are an important determinant of how decision problems are structured and framed, decision makers may view risk-based decisions from a perspective that is unique to their background and experience. Previous...

Family health care decision making and self-efficacy with patients with ALS at the end of life

PubMed Central

NOLAN, MARIE T.; KUB, JOAN; HUGHES, MARK T.; TERRY, PETER B.; ASTROW, ALAN B.; CARBO, CYNTHIA A.; THOMPSON, RICHARD E.; CLAWSON, LORA; TEXEIRA, KENNETH; SULMASY, DANIEL P.

2008-01-01

Objective: Persons with ALS differ from those with other terminal illnesses in that they commonly retain capacity for decision making close to death. The role patients would opt to have their families play in decision making at the end of life may therefore be unique. This study compared the preferences of patients with ALS for involving family in health care decisions at the end of life with the actual involvement reported by the family after death. Methods: A descriptive correlational design with 16 patient–family member dyads was used. Quantitative findings were enriched with in-depth interviews of a subset of five family members following the patient's death. Results: Eighty-seven percent of patients had issued an advance directive. Patients who would opt to make health care decisions independently (i.e., according to the patient's preferences alone) were most likely to have their families report that decisions were made in the style that the patient preferred. Those who preferred shared decision making with family or decision making that relied upon the family were more likely to have their families report that decisions were made in a style that was more independent than preferred. When interviewed in depth, some family members described shared decision making although they had reported on the survey that the patient made independent decisions. Significance of results: The structure of advance directives may suggest to families that independent decision making is the ideal, causing them to avoid or underreport shared decision making. Fear of family recriminations may also cause family members to avoid or underreport shared decision making. Findings from this study might be used to guide clinicians in their discussions of treatments and health care decision making with persons with ALS and their families. PMID:18662421

Exploration of peptides that fit into the thermally vibrating active site of cathepsin K protease by alternating artificial intelligence and molecular simulation

NASA Astrophysics Data System (ADS)

Nishiyama, Katsuhiko

2017-08-01

Eighteen tripeptides that fit into the thermally vibrating active site of cathepsin K were discovered by alternating artificial intelligence and molecular simulation. The 18 tripeptides fit the active site better than the cysteine protease inhibitor E64, and a better inhibitor of cathepsin K could be designed considering these tripeptides. Among the 18 tripeptides, Phe-Arg-Asp and Tyr-Arg-Asp fit the active site the best and their structural similarity should be considered in the design process. Interesting factors emerged from the structure of the decision tree, and its structural information will guide exploration of potential inhibitor molecules for proteases.

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

2017-01-01

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Opportunities and pitfalls in clinical proof-of-concept: principles and examples.

PubMed

Chen, Chao

2018-04-01

Clinical proof-of-concept trials crucially inform major resource deployment decisions. This paper discusses several mechanisms for enhancing their rigour and efficiency. The importance of careful consideration when using a surrogate endpoint is illustrated; situational effectiveness of run-in patient enrichment is explored; a versatile tool is introduced to ensure a strong pharmacological underpinning; the benefits of dose-titration are revealed by simulation; and the importance of adequately scheduled observations is shown. The general process of model-based trial design and analysis is described and several examples demonstrate the value in historical data, simulation-guided design, model-based analysis and trial adaptation informed by interim analysis. Copyright © 2018 Elsevier Ltd. All rights reserved.

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence.

PubMed

Siebert, Uwe; Rochau, Ursula; Claxton, Karl

2013-01-01

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions. Copyright © 2013. Published by Elsevier GmbH.

Sea-level rise modeling handbook: Resource guide for coastal land managers, engineers, and scientists

USGS Publications Warehouse

Doyle, Thomas W.; Chivoiu, Bogdan; Enwright, Nicholas M.

2015-08-24

Global sea level is rising and may accelerate with continued fossil fuel consumption from industrial and population growth. In 2012, the U.S. Geological Survey conducted more than 30 training and feedback sessions with Federal, State, and nongovernmental organization (NGO) coastal managers and planners across the northern Gulf of Mexico coast to evaluate user needs, potential benefits, current scientific understanding, and utilization of resource aids and modeling tools focused on sea-level rise. In response to the findings from the sessions, this sea-level rise modeling handbook has been designed as a guide to the science and simulation models for understanding the dynamics and impacts of sea-level rise on coastal ecosystems. The review herein of decision-support tools and predictive models was compiled from the training sessions, from online research, and from publications. The purpose of this guide is to describe and categorize the suite of data, methods, and models and their design, structure, and application for hindcasting and forecasting the potential impacts of sea-level rise in coastal ecosystems. The data and models cover a broad spectrum of disciplines involving different designs and scales of spatial and temporal complexity for predicting environmental change and ecosystem response. These data and models have not heretofore been synthesized, nor have appraisals been made of their utility or limitations. Some models are demonstration tools for non-experts, whereas others require more expert capacity to apply for any given park, refuge, or regional application. A simplified tabular context has been developed to list and contrast a host of decision-support tools and models from the ecological, geological, and hydrological perspectives. Criteria were established to distinguish the source, scale, and quality of information input and geographic datasets; physical and biological constraints and relations; datum characteristics of water and land components; utility options for setting sea-level rise and climate change scenarios; and ease or difficulty of storing, displaying, or interpreting model output. Coastal land managers, engineers, and scientists can benefit from this synthesis of tools and models that have been developed for projecting causes and consequences of sea-level change on the landscape and seascape.

Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy.

PubMed

Li, Chi-Kong; Tong, Brian C Y; You, Joyce H S

2016-02-01

Clinical findings suggest that the use of rectal culture-guided antibiotic prophylaxis reduces the infection rate following transrectal ultrasound-guided prostate biopsy (TRUSBx). A decision-analytic model was designed to compare the outcomes of TRUSBx performed with (rectal culture-guided group) and without (standard ciprofloxacin prophylaxis) rectal swab culture-guided antimicrobial prophylaxis in Hong Kong. The post-biopsy infection rate, infection-related costs, quality-adjusted life years (QALYs) lost for infection, and incremental cost per QALY saved (ICER) were assessed. Model inputs were retrieved from local epidemiology data and the medical literature. A sensitivity analysis was performed to test the robustness of the model results. Base-case analysis showed that the infection rate in the culture-guided group was reduced from 2.42% to 0.23% and saved 0.0002 QALYs, with a lower cost (USD 31.4 versus USD 55.6) (USD 1=HKD 7.8). The number needed to screen to prevent an infection episode was 45.7. The hospital days avoided per 100 patients using culture-guided prophylaxis was 7.08 days. The relative effectiveness of culture-guided antimicrobial prophylaxis versus standard prophylaxis in carriers and non-carriers of FQ-resistant rectal flora were identified as potential influencing factors. In 10000 Monte Carlo simulations, ICERs of the culture-guided group were below the willingness-to-pay threshold 99.12% of the time. Using rectal culture-guided antimicrobial prophylaxis for men undergoing TRUSBx appears to be a cost-saving strategy to avert post-biopsy infection and QALY loss in Hong Kong. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Improving Responses to Individual and Family Crises. Secondary Learning Guide 10. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on improving responses to crises is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve problems;…

Improving Individual, Child, and Family Nutrition, Health and Wellness. Secondary Learning Guide 8. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on improving individual, child, and family nutrition is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to…

Applying Consumer and Homemaking Skills to Jobs and Careers. Secondary Learning Guide 13. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on applying consumer and homemaking skills to jobs and careers is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative…

Washington State Traffic Safety Education Curriculum Guide. A Master Guide for Implementing a Performance-Based Curriculum.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia. Div. of Vocational-Technical and Adult Education Services.

This guide for implementing performance-based curriculum is intended to teach students decision-making driving. Heavy emphasis is put on the tasks and concepts involving traffic flow tasks (interacting with other highway users) and the functions and factors that affect that interaction. It is a "90-hour" guide, that is, the average student needs…

Fidelity to a behavioral intervention to improve goals of care decisions for nursing home residents with advanced dementia.

PubMed

Hanson, Laura C; Song, Mi-Kyung; Zimmerman, Sheryl; Gilliam, Robin; Rosemond, Cherie; Chisholm, Latarsha; Lin, Feng-Chang

2016-12-01

Ensuring fidelity to a behavioral intervention implemented in nursing homes requires awareness of the unique considerations of this setting for research. The purpose of this article is to describe the goals of care cluster-randomized trial and the methods used to monitor and promote fidelity to a goals of care decision aid intervention delivered in nursing homes. The cluster randomized trial tested whether a decision aid for goals of care in advanced dementia could improve (1) the quality of communication and decision-making, (2) the quality of palliative care, and (3) the quality of dying for nursing home residents with advanced dementia. In 11 intervention nursing homes, family decision-makers for residents with advanced dementia received a two-component intervention: viewing a video decision aid about goals of care choices and then participating in a structured decision-making discussion with the nursing home care plan team, ideally within 3 months after the decision aid was viewed. Following guidelines from the National Institutes of Health Behavior Change Consortium, fidelity was assessed in study design, in nursing home staff training for intervention implementation, and in monitoring and receipt of the intervention. We also monitored the content and timing of goals of care discussions. Investigators enrolled 151 family decision-maker/resident dyads in intervention sites; of those, 136 (90%) received both components of the intervention, and 92%-99% of discussions addressed each of four recommended content areas-health status, goals of care, choice of a goal, and treatment planning. A total of 94 (69%) of the discussions between family decision-makers and the nursing home care team were completed within 3 months. The methods we used for intervention fidelity allowed nursing home staff to implement a goals of care decision aid intervention for advanced dementia. Key supports for implementation included design features that aligned with nursing home practice, efficient staff training, and a structured guide for goals of care discussions between family decision-makers and staff. These approaches may be used to promote fidelity to behavioral interventions in future clinical trials. © The Author(s) 2016.

Conditional Use of Social and Private Information Guides House-Hunting Ants

PubMed Central

Cronin, Adam L.

2013-01-01

Social animals can use both social and private information to guide decision making. While social information can be relatively economical to acquire, it can lead to maladaptive information cascades if attention to environmental cues is supplanted by unconditional copying. Ants frequently employ pheromone trails, a form of social information, to guide collective processes, and this can include consensus decisions made when choosing a place to live. In this study, I examine how house-hunting ants balance social and private information when these information sources conflict to different degrees. Social information, in the form of pre-established pheromone trails, strongly influenced the decision process in choices between equivalent nests, and lead to a reduced relocation time. When trails lead to non-preferred types of nest, however, social information had less influence when this preference was weak and no influence when the preference was strong. These results suggest that social information is vetted against private information during the house-hunting process in this species. Private information is favoured in cases of conflict and this may help insure colonies against costly wrong decisions. PMID:23741364

Conditional use of social and private information guides house-hunting ants.

PubMed

Cronin, Adam L

2013-01-01

Social animals can use both social and private information to guide decision making. While social information can be relatively economical to acquire, it can lead to maladaptive information cascades if attention to environmental cues is supplanted by unconditional copying. Ants frequently employ pheromone trails, a form of social information, to guide collective processes, and this can include consensus decisions made when choosing a place to live. In this study, I examine how house-hunting ants balance social and private information when these information sources conflict to different degrees. Social information, in the form of pre-established pheromone trails, strongly influenced the decision process in choices between equivalent nests, and lead to a reduced relocation time. When trails lead to non-preferred types of nest, however, social information had less influence when this preference was weak and no influence when the preference was strong. These results suggest that social information is vetted against private information during the house-hunting process in this species. Private information is favoured in cases of conflict and this may help insure colonies against costly wrong decisions.

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

NASA Astrophysics Data System (ADS)

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

2014-03-01

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

THE CLEAN ENERGY-ENVIRONMENT GUIDE TO ACTION ...

EPA Pesticide Factsheets

The Guide to Action identifies and describes sixteen clean energy policies and strategies that are delivering economic and environmental results for states. For each policy, the Guide describes: Objectives and benefits of the policy; Examples of states that have implemented the policy; Responsibilities of key players at the state level, including typical roles of the main stakeholders; Opportunities to coordinate implementation with other federal and state policies, partnerships and technical assistance resources; Best practices for policy design, implementation, and evaluation, including state examples; Action steps for states to take when adopting or modifying their clean energy policies, based on existing state experiences; Resources for additional information on individual state policies, legislative and regulatory language, and analytical tools and methods. States participating in the Clean Energy-Environment State Partnership Program will use the Guide to Action to: Develop their own Clean Energy-Environment Action Plan that is appropriate to their state; Identify the roles and responsibilities of key decision-makers, such as environmental regulators, state legislatures, public utility commissioners, and state energy offices; Access and apply technical assistance resources, models, and tools available for state-specific analyses and program implementation; and Learn from each other as they develop their own clean energy programs and policies.

Decision-making tool for applying adaptive traffic control systems : final report.

DOT National Transportation Integrated Search

2016-03-01

Adaptive traffic signal control technologies have been increasingly deployed in real world situations. The objective of this project was to develop a decision-making tool to guide traffic engineers and decision-makers who must decide whether or not a...

Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

PubMed

Mao, Feng; Dong, Yi; Ji, Zhengbiao; Cao, Jiaying; Wang, Wen-Ping

2017-01-01

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group ( n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

Basolateral Amygdala to Orbitofrontal Cortex Projections Enable Cue-Triggered Reward Expectations.

PubMed

Lichtenberg, Nina T; Pennington, Zachary T; Holley, Sandra M; Greenfield, Venuz Y; Cepeda, Carlos; Levine, Michael S; Wassum, Kate M

2017-08-30

To make an appropriate decision, one must anticipate potential future rewarding events, even when they are not readily observable. These expectations are generated by using observable information (e.g., stimuli or available actions) to retrieve often quite detailed memories of available rewards. The basolateral amygdala (BLA) and orbitofrontal cortex (OFC) are two reciprocally connected key nodes in the circuitry supporting such outcome-guided behaviors. But there is much unknown about the contribution of this circuit to decision making, and almost nothing known about the whether any contribution is via direct, monosynaptic projections, or the direction of information transfer. Therefore, here we used designer receptor-mediated inactivation of OFC→BLA or BLA→OFC projections to evaluate their respective contributions to outcome-guided behaviors in rats. Inactivation of BLA terminals in the OFC, but not OFC terminals in the BLA, disrupted the selective motivating influence of cue-triggered reward representations over reward-seeking decisions as assayed by Pavlovian-to-instrumental transfer. BLA→OFC projections were also required when a cued reward representation was used to modify Pavlovian conditional goal-approach responses according to the reward's current value. These projections were not necessary when actions were guided by reward expectations generated based on learned action-reward contingencies, or when rewards themselves, rather than stored memories, directed action. These data demonstrate that BLA→OFC projections enable the cue-triggered reward expectations that can motivate the execution of specific action plans and allow adaptive conditional responding. SIGNIFICANCE STATEMENT Deficits anticipating potential future rewarding events are associated with many psychiatric diseases. Presently, we know little about the neural circuits supporting such reward expectation. Here we show that basolateral amygdala to orbitofrontal cortex projections are required for expectations of specific available rewards to influence reward seeking and decision making. The necessity of these projections was limited to situations in which expectations were elicited by reward-predictive cues. These projections therefore facilitate adaptive behavior by enabling the orbitofrontal cortex to use environmental stimuli to generate expectations of potential future rewarding events. Copyright © 2017 the authors 0270-6474/17/378374-11$15.00/0.

Basolateral Amygdala to Orbitofrontal Cortex Projections Enable Cue-Triggered Reward Expectations

PubMed Central

Lichtenberg, Nina T.; Pennington, Zachary T.; Holley, Sandra M.; Greenfield, Venuz Y.; Levine, Michael S.

2017-01-01

To make an appropriate decision, one must anticipate potential future rewarding events, even when they are not readily observable. These expectations are generated by using observable information (e.g., stimuli or available actions) to retrieve often quite detailed memories of available rewards. The basolateral amygdala (BLA) and orbitofrontal cortex (OFC) are two reciprocally connected key nodes in the circuitry supporting such outcome-guided behaviors. But there is much unknown about the contribution of this circuit to decision making, and almost nothing known about the whether any contribution is via direct, monosynaptic projections, or the direction of information transfer. Therefore, here we used designer receptor-mediated inactivation of OFC→BLA or BLA→OFC projections to evaluate their respective contributions to outcome-guided behaviors in rats. Inactivation of BLA terminals in the OFC, but not OFC terminals in the BLA, disrupted the selective motivating influence of cue-triggered reward representations over reward-seeking decisions as assayed by Pavlovian-to-instrumental transfer. BLA→OFC projections were also required when a cued reward representation was used to modify Pavlovian conditional goal-approach responses according to the reward's current value. These projections were not necessary when actions were guided by reward expectations generated based on learned action-reward contingencies, or when rewards themselves, rather than stored memories, directed action. These data demonstrate that BLA→OFC projections enable the cue-triggered reward expectations that can motivate the execution of specific action plans and allow adaptive conditional responding. SIGNIFICANCE STATEMENT Deficits anticipating potential future rewarding events are associated with many psychiatric diseases. Presently, we know little about the neural circuits supporting such reward expectation. Here we show that basolateral amygdala to orbitofrontal cortex projections are required for expectations of specific available rewards to influence reward seeking and decision making. The necessity of these projections was limited to situations in which expectations were elicited by reward-predictive cues. These projections therefore facilitate adaptive behavior by enabling the orbitofrontal cortex to use environmental stimuli to generate expectations of potential future rewarding events. PMID:28743727

Health care consumer reports: an evaluation of consumer perspectives.

PubMed

Longo, Daniel R; Everet, Kevin D

2003-01-01

There has been a proliferation of health care consumer reports, also known as "consumer guides," "report cards," and "performance reports," which are designed to assist consumers in making more informed health care decisions. While there is evidence that providers use such reports to identify and make changes in practice, thus improving the quality of care, there is little empirical evidence on how consumer guides/report cards are used by consumers. This study fills that gap by surveying 925 patients as they wait for ambulatory care in several clinics in a midwestern city. Findings indicate that consumers are selective in their use of these reports and quickly identify those sections of the report of most interest to them. Report developers should take precautions to ensure such reports are viewed as credible sources of health care information.

An ecological basis for ecosystem management

Treesearch

M. R. Kaufmann; R. T. Graham; D. A. Boyce; W. H. Moir; L. Perry; R. T. Reynolds; R. L. Bassett; P. Mehlhop; C. B. Edminster; W. M. Block; P. S. Corn

1994-01-01

Guiding principles based on conservation biology are applied in assessing ecosystem needs. Ecosystem, economic, and social needs are integrated in a decision model in which the guiding principles are used as a primary filter for evaluating proposed actions. Management practices consistent with the guiding principles are likely to lead to ecological, economic, and...

Economic Literacy: An Instructional Guide for Vocational Education.

ERIC Educational Resources Information Center

Blackman, Linda L.; And Others

This instructor's guide consists of materials for use in helping vocational education students acquire basic economic literacy. Addressed in the individual units of the guide are the following topics: worker productivity, the free enterprise system, components of the economy, the consumer as a decision maker, small business functions, economic…

The influence of the design matrix on treatment effect estimates in the quantitative analyses of single-subject experimental design research.

PubMed

Moeyaert, Mariola; Ugille, Maaike; Ferron, John M; Beretvas, S Natasha; Van den Noortgate, Wim

2014-09-01

The quantitative methods for analyzing single-subject experimental data have expanded during the last decade, including the use of regression models to statistically analyze the data, but still a lot of questions remain. One question is how to specify predictors in a regression model to account for the specifics of the design and estimate the effect size of interest. These quantitative effect sizes are used in retrospective analyses and allow synthesis of single-subject experimental study results which is informative for evidence-based decision making, research and theory building, and policy discussions. We discuss different design matrices that can be used for the most common single-subject experimental designs (SSEDs), namely, the multiple-baseline designs, reversal designs, and alternating treatment designs, and provide empirical illustrations. The purpose of this article is to guide single-subject experimental data analysts interested in analyzing and meta-analyzing SSED data. © The Author(s) 2014.

Surveillance theory applied to virus detection: a case for targeted discovery

USGS Publications Warehouse

Bogich, Tiffany L.; Anthony, Simon J.; Nichols, James D.

2013-01-01

Virus detection and mathematical modeling have gone through rapid developments in the past decade. Both offer new insights into the epidemiology of infectious disease and characterization of future risk; however, modeling has not yet been applied to designing the best surveillance strategies for viral and pathogen discovery. We review recent developments and propose methods to integrate viral and pathogen discovery and mathematical modeling through optimal surveillance theory, arguing for a more targeted approach to novel virus detection guided by the principles of adaptive management and structured decision-making.

Decision making from economic and signal detection perspectives: development of an integrated framework

PubMed Central

Lynn, Spencer K.; Wormwood, Jolie B.; Barrett, Lisa F.; Quigley, Karen S.

2015-01-01

Behavior is comprised of decisions made from moment to moment (i.e., to respond one way or another). Often, the decision maker cannot be certain of the value to be accrued from the decision (i.e., the outcome value). Decisions made under outcome value uncertainty form the basis of the economic framework of decision making. Behavior is also based on perception—perception of the external physical world and of the internal bodily milieu, which both provide cues that guide decision making. These perceptual signals are also often uncertain: another person's scowling facial expression may indicate threat or intense concentration, alternatives that require different responses from the perceiver. Decisions made under perceptual uncertainty form the basis of the signals framework of decision making. Traditional behavioral economic approaches to decision making focus on the uncertainty that comes from variability in possible outcome values, and typically ignore the influence of perceptual uncertainty. Conversely, traditional signal detection approaches to decision making focus on the uncertainty that arises from variability in perceptual signals and typically ignore the influence of outcome value uncertainty. Here, we compare and contrast the economic and signals frameworks that guide research in decision making, with the aim of promoting their integration. We show that an integrated framework can expand our ability to understand a wider variety of decision-making behaviors, in particular the complexly determined real-world decisions we all make every day. PMID:26217275

Vocational Decision-Making Interview. Administration Manual.

ERIC Educational Resources Information Center

Czerlinsky, Thomas; McCray, Paul M.

This guide is intended to assist rehabilitation counselors, school guidance personnel, and others involved in administering and interpreting the results of the Vocational Decision-Making Interview (VDMI). (The VDMI is a structured interview instrument that was developed to facilitate the assessment of an individual's vocational decision-making…

14 CFR § 1216.302 - Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... responsible for overseeing and guiding NASA's integration of NEPA into the Agency's planning and decision... NEPA analysis into Agency planning and decision-making processes. The SEO shall monitor this process to... Agency's planning and decision making for all NASA activities. The HQ/EMD provides advice and...

Competence, practical rationality and what a patient values.

PubMed

Craigie, Jillian

2011-07-01

According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions. In this paper I examine this claim in light of theories of practical rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case. © 2009 Blackwell Publishing Ltd.

Distinct effects of prefrontal and parietal cortex inactivations on an accumulation of evidence task in the rat

PubMed Central

Erlich, Jeffrey C; Brunton, Bingni W; Duan, Chunyu A; Hanks, Timothy D; Brody, Carlos D

2015-01-01

Numerous brain regions have been shown to have neural correlates of gradually accumulating evidence for decision-making, but the causal roles of these regions in decisions driven by accumulation of evidence have yet to be determined. Here, in rats performing an auditory evidence accumulation task, we inactivated the frontal orienting fields (FOF) and posterior parietal cortex (PPC), two rat cortical regions that have neural correlates of accumulating evidence and that have been proposed as central to decision-making. We used a detailed model of the decision process to analyze the effect of inactivations. Inactivation of the FOF induced substantial performance impairments that were quantitatively best described as an impairment in the output pathway of an evidence accumulator with a long integration time constant (>240 ms). In contrast, we found a minimal role for PPC in decisions guided by accumulating auditory evidence, even while finding a strong role for PPC in internally-guided decisions. DOI: http://dx.doi.org/10.7554/eLife.05457.001 PMID:25869470

A Qualitative Study of Decision Making by First Time Parents for Their Child's Prekindergarten Year Programming

ERIC Educational Resources Information Center

Cronin, Timothy David

2013-01-01

This study sought to gain a better understanding of how participants made decisions regarding placement for their first-born children for the prekindergarten year. The purpose of this research, to explore participants' decision-making process, was guided by the following research question: "How do parents make decisions to select placements…

A strategic value management approach for energy and maintenance management in a building

NASA Astrophysics Data System (ADS)

Nawi, Mohd Nasrun Mohd; Dahlan, Nofri Yenita; Nadarajan, Santhirasegaran

2015-05-01

Fragmentation process is always been highlighted by the stakeholders in the construction industry as one of the `critical' issue that diminishing the opportunity for stakeholders that involved during the operation and maintenance stage to influence design decisions. Failure of design professionals to consider how a maintenance contractor or facility manager will construct the design thus results in higher operating cost, wastage, defects during the maintenance and operation process. Moving towards team integration is considered a significant strategy for overcoming the issue. Value Management is a style of management dedicated to guiding people and promoting innovation with the aim to improve overall building performance through structured, team-oriented exercises which make explicit, and appraise subsequent decisions, by reference to the value requirements of the clients. Accordingly, this paper discusses the fragmentation issue in more detail including the definition, causes and effects to the maintenance and operation of building and at the same time will highlighted the potential of VM integrated team approach as a strategic management approach for overcoming that issue. It also explores that the team integration strategy alleviates scheduling problems, delays and disputes during the construction process, and, hence, prevent harming the overall building performance.

Understanding the Impact of New Technology on Life and Work. Secondary Learning Guide 12. Project Connect. Linking Self-Family-Work.

ERIC Educational Resources Information Center

Emily Hall Tremaine Foundation, Inc., Hartford, CT.

This competency-based secondary learning guide on understanding the impact of new technology is part of a series that are adaptations of guides developed for adult consumer and homemaking education programs. The guides provide students with experiences that help them learn to do the following: make decisions; use creative approaches to solve…

Family involvement in medical decision-making: Perceptions of nursing and psychology students.

PubMed

Itzhaki, Michal; Hildesheimer, Galya; Barnoy, Sivia; Katz, Michael

2016-05-01

Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. A descriptive cross-sectional design was used. First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.

PubMed

Veinot, Tiffany C; Campbell, Terrance R; Kruger, Daniel J; Grodzinski, Alison

2013-01-01

We investigated the user requirements of African-American youth (aged 14-24 years) to inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections (STI). We conducted 10 focus groups with 75 African-American youth from a city with high HIV/STI prevalence. Data analyses involved coding using qualitative content analysis procedures and memo writing. Unexpectedly, the majority of participants' design recommendations concerned trust. Youth expressed distrust towards people and groups, which was amplified within the context of information technology-mediated interactions about HIV/STI. Participants expressed distrust in the reliability of condoms and the accuracy of HIV tests. They questioned the benevolence of many institutions, and some rejected authoritative HIV/STI information. Therefore, reputational information, including rumor, influenced HIV/STI-related decision making. Participants' design requirements also focused on trust-related concerns. Accordingly, we developed a novel trust-centered design framework to guide intervention design. Current approaches to online trust for health informatics do not consider group-level trusting patterns. Yet, trust was the central intervention-relevant issue among African-American youth, suggesting an important focus for culturally informed design. Our design framework incorporates: intervention objectives (eg, network embeddedness, participation); functional specifications (eg, decision support, collective action, credible question and answer services); and interaction design (eg, member control, offline network linkages, optional anonymity). Trust is a critical focus for HIV/STI informatics interventions for young African Americans. Our design framework offers practical, culturally relevant, and systematic guidance to designers to reach this underserved group better.

Developing an electronic health record (EHR) for methadone treatment recording and decision support

PubMed Central

2011-01-01

Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. PMID:21284849

Observational Research Opportunities and Limitations

PubMed Central

Boyko, Edward J.

2013-01-01

Medical research continues to progress in its ability to identify treatments and characteristics associated with benefits and adverse outcomes. The principle engine for the evaluation of treatment efficacy is the randomized controlled trial (RCT). Due to the cost and other considerations, RCTs cannot address all clinically important decisions. Observational research often is used to address issues not addressed or not addressable by RCTs. This article provides an overview of the benefits and limitations of observational research to serve as a guide to the interpretation of this category of research designs in diabetes investigations. The potential for bias is higher in observational research but there are design and analysis features that can address these concerns although not completely eliminate them. Pharmacoepidemiologic research may provide important information regarding relative safety and effectiveness of diabetes pharmaceuticals. Such research must effectively address the important issue of confounding by indication in order to produce clinically meaningful results. Other methods such as instrumental variable analysis are being employed to enable stronger causal inference but these methods also require fulfillment of several key assumptions that may or may not be realistic. Nearly all clinical decisions involve probabilistic reasoning and confronting uncertainly, so a realistic goal for observational research may not be the high standard set by RCTs but instead the level of certainty needed to influence a diagnostic or treatment decision. PMID:24055326

Observational research--opportunities and limitations.

PubMed

Boyko, Edward J

2013-01-01

Medical research continues to progress in its ability to identify treatments and characteristics associated with benefits and adverse outcomes. The principal engine for the evaluation of treatment efficacy is the randomized controlled trial (RCT). Due to the cost and other considerations, RCTs cannot address all clinically important decisions. Observational research often is used to address issues not addressed or not addressable by RCTs. This article provides an overview of the benefits and limitations of observational research to serve as a guide to the interpretation of this category of research designs in diabetes investigations. The potential for bias is higher in observational research but there are design and analysis features that can address these concerns although not completely eliminate them. Pharmacoepidemiologic research may provide important information regarding relative safety and effectiveness of diabetes pharmaceuticals. Such research must effectively address the important issue of confounding by indication in order to produce clinically meaningful results. Other methods such as instrumental variable analysis are being employed to enable stronger causal inference but these methods also require fulfillment of several key assumptions that may or may not be realistic. Nearly all clinical decisions involve probabilistic reasoning and confronting uncertainly, so a realistic goal for observational research may not be the high standard set by RCTs but instead the level of certainty needed to influence a diagnostic or treatment decision. © 2013.

Which species? A decision-support tool to guide plant selection in stormwater biofilters

NASA Astrophysics Data System (ADS)

Payne, Emily G. I.; Pham, Tracey; Deletic, Ana; Hatt, Belinda E.; Cook, Perran L. M.; Fletcher, Tim D.

2018-03-01

Plant species are diverse in form, function and environmental response. This provides enormous potential for designing nature-based stormwater treatment technologies, such as biofiltration systems. However, species can vary dramatically in their pollutant-removal performance, particularly for nitrogen removal. Currently, there is a lack of information on how to efficiently select from the vast palette of species. This study aimed to identify plant traits beneficial to performance and create a decision-support tool to screen species for further testing. A laboratory experiment using 220 biofilter columns paired plant morphological characteristics with nitrogen removal and water loss for 20 Australian native species and two lawn grasses. Testing was undertaken during wet and dry conditions, for two biofilter designs (saturated zone and free-draining). An extensive root system and high total biomass were critical to the effective removal of total nitrogen (TN) and nitrate (NO3-), driven by high nitrogen assimilation. The same characteristics were key to performance under dry conditions, and were associated with high water use for Australian native plants; linking assimilation and transpiration. The decision-support tool uses these scientific relationships and readily-available information to identify the morphology, natural distribution and stress tolerances likely to be good predictors of plant nitrogen and water uptake.

Two-stage seasonal streamflow forecasts to guide water resources decisions and water rights allocation

NASA Astrophysics Data System (ADS)

Block, P. J.; Gonzalez, E.; Bonnafous, L.

2011-12-01

Decision-making in water resources is inherently uncertain producing copious risks, ranging from operational (present) to planning (season-ahead) to design/adaptation (decadal) time-scales. These risks include human activity and climate variability/change. As the risks in designing and operating water systems and allocating available supplies vary systematically in time, prospects for predicting and managing such risks become increasingly attractive. Considerable effort has been undertaken to improve seasonal forecast skill and advocate for integration to reduce risk, however only minimal adoption is evident. Impediments are well defined, yet tailoring forecast products and allowing for flexible adoption assist in overcoming some obstacles. The semi-arid Elqui River basin in Chile is contending with increasing levels of water stress and demand coupled with insufficient investment in infrastructure, taxing its ability to meet agriculture, hydropower, and environmental requirements. The basin is fed from a retreating glacier, with allocation principles founded on a system of water rights and markets. A two-stage seasonal streamflow forecast at leads of one and two seasons prescribes the probability of reductions in the value of each water right, allowing water managers to inform their constituents in advance. A tool linking the streamflow forecast to a simple reservoir decision model also allows water managers to select a level of confidence in the forecast information.

Behavioral modeling of human choices reveals dissociable effects of physical effort and temporal delay on reward devaluation.

PubMed

Klein-Flügge, Miriam C; Kennerley, Steven W; Saraiva, Ana C; Penny, Will D; Bestmann, Sven

2015-03-01

There has been considerable interest from the fields of biology, economics, psychology, and ecology about how decision costs decrease the value of rewarding outcomes. For example, formal descriptions of how reward value changes with increasing temporal delays allow for quantifying individual decision preferences, as in animal species populating different habitats, or normal and clinical human populations. Strikingly, it remains largely unclear how humans evaluate rewards when these are tied to energetic costs, despite the surge of interest in the neural basis of effort-guided decision-making and the prevalence of disorders showing a diminished willingness to exert effort (e.g., depression). One common assumption is that effort discounts reward in a similar way to delay. Here we challenge this assumption by formally comparing competing hypotheses about effort and delay discounting. We used a design specifically optimized to compare discounting behavior for both effort and delay over a wide range of decision costs (Experiment 1). We then additionally characterized the profile of effort discounting free of model assumptions (Experiment 2). Contrary to previous reports, in both experiments effort costs devalued reward in a manner opposite to delay, with small devaluations for lower efforts, and progressively larger devaluations for higher effort-levels (concave shape). Bayesian model comparison confirmed that delay-choices were best predicted by a hyperbolic model, with the largest reward devaluations occurring at shorter delays. In contrast, an altogether different relationship was observed for effort-choices, which were best described by a model of inverse sigmoidal shape that is initially concave. Our results provide a novel characterization of human effort discounting behavior and its first dissociation from delay discounting. This enables accurate modelling of cost-benefit decisions, a prerequisite for the investigation of the neural underpinnings of effort-guided choice and for understanding the deficits in clinical disorders characterized by behavioral inactivity.

Behavioral Modeling of Human Choices Reveals Dissociable Effects of Physical Effort and Temporal Delay on Reward Devaluation

PubMed Central

Klein-Flügge, Miriam C.; Kennerley, Steven W.; Saraiva, Ana C.; Penny, Will D.; Bestmann, Sven

2015-01-01

There has been considerable interest from the fields of biology, economics, psychology, and ecology about how decision costs decrease the value of rewarding outcomes. For example, formal descriptions of how reward value changes with increasing temporal delays allow for quantifying individual decision preferences, as in animal species populating different habitats, or normal and clinical human populations. Strikingly, it remains largely unclear how humans evaluate rewards when these are tied to energetic costs, despite the surge of interest in the neural basis of effort-guided decision-making and the prevalence of disorders showing a diminished willingness to exert effort (e.g., depression). One common assumption is that effort discounts reward in a similar way to delay. Here we challenge this assumption by formally comparing competing hypotheses about effort and delay discounting. We used a design specifically optimized to compare discounting behavior for both effort and delay over a wide range of decision costs (Experiment 1). We then additionally characterized the profile of effort discounting free of model assumptions (Experiment 2). Contrary to previous reports, in both experiments effort costs devalued reward in a manner opposite to delay, with small devaluations for lower efforts, and progressively larger devaluations for higher effort-levels (concave shape). Bayesian model comparison confirmed that delay-choices were best predicted by a hyperbolic model, with the largest reward devaluations occurring at shorter delays. In contrast, an altogether different relationship was observed for effort-choices, which were best described by a model of inverse sigmoidal shape that is initially concave. Our results provide a novel characterization of human effort discounting behavior and its first dissociation from delay discounting. This enables accurate modelling of cost-benefit decisions, a prerequisite for the investigation of the neural underpinnings of effort-guided choice and for understanding the deficits in clinical disorders characterized by behavioral inactivity. PMID:25816114

A Social Science Guide for Communication on Climate Change

NASA Astrophysics Data System (ADS)

St John, C.; Marx, S.; Markowitz, E.

2014-12-01

Researchers from the Center for Research on Environmental Decisions (CRED) published "The Psychology of Climate Change Communication: A Guide for Scientists, Journalists, Educators, Political Aides, and the Interested Public" in 2009. This landmark guide provided climate change communicators a synthesis of the social science research that was pertinent to understanding how people think about climate change and how the practice could be improved. In the fall of 2014 this guide will be rereleased, with a new title, and in a partnership between CRED and ecoAmerica. The updated guide addresses how and why Americans respond in certain ways to climate change and explains how communicators can apply best practices to their own work. The guide, which includes research from a range of social science fields including psychology, anthropology, communications, and behavioral economics, is designed to be useful for experienced and novice communicators alike. Included in the guide are strategies to boost engagement, common mistakes to avoid, and best practices that organizations around the world have used to meaningfully engage individuals and groups on climate change. The proposed presentation will provide an overview of the main findings and tips from the 2014 climate change communication guide. It will provide a deeper look at a few of the key points that are crucial for increasing audience engagement with climate change including understanding how identity shapes climate change, how to lead with solutions, and how to bring the impacts of climate change close to home. It will highlight tips for motivating positive behavior change that will lead people down the path toward solutions. Finally, it will address the benefits and challenges associated with producing a communication guide and insight into synthesizing social science research findings into a usable format for a variety of audiences.

Real-time dynamic modelling for the design of a cluster-randomized phase 3 Ebola vaccine trial in Sierra Leone.

PubMed

Camacho, A; Eggo, R M; Goeyvaerts, N; Vandebosch, A; Mogg, R; Funk, S; Kucharski, A J; Watson, C H; Vangeneugden, T; Edmunds, W J

2017-01-23

Declining incidence and spatial heterogeneity complicated the design of phase 3 Ebola vaccine trials during the tail of the 2013-16 Ebola virus disease (EVD) epidemic in West Africa. Mathematical models can provide forecasts of expected incidence through time and can account for both vaccine efficacy in participants and effectiveness in populations. Determining expected disease incidence was critical to calculating power and determining trial sample size. In real-time, we fitted, forecasted, and simulated a proposed phase 3 cluster-randomized vaccine trial for a prime-boost EVD vaccine in three candidate regions in Sierra Leone. The aim was to forecast trial feasibility in these areas through time and guide study design planning. EVD incidence was highly variable during the epidemic, especially in the declining phase. Delays in trial start date were expected to greatly reduce the ability to discern an effect, particularly as a trial with an effective vaccine would cause the epidemic to go extinct more quickly in the vaccine arm. Real-time updates of the model allowed decision-makers to determine how trial feasibility changed with time. This analysis was useful for vaccine trial planning because we simulated effectiveness as well as efficacy, which is possible with a dynamic transmission model. It contributed to decisions on choice of trial location and feasibility of the trial. Transmission models should be utilised as early as possible in the design process to provide mechanistic estimates of expected incidence, with which decisions about sample size, location, timing, and feasibility can be determined. Copyright © 2016. Published by Elsevier Ltd.

Success matters: Recasting the relationship among geophysical, biological, and behavioral scientists to support decision making on major environmental challenges

NASA Astrophysics Data System (ADS)

Knopman, Debra S.

2006-03-01

Coping with global change, providing clean water for growing populations, and disposing of nuclear waste are some of the most difficult public policy challenges of our time. Unknowns in the physical sciences are one source of the difficulty. Real difficulties in meeting these challenges also arise in the behavioral sciences. A potentially rich vein of transdisciplinary research is to integrate the psychology of decision making, known as "judgment and decision making," or JDM, with the development of technical information and decision support tools for complex, long-term environmental problems. Practitioners of JDM conduct research on how individuals and groups respond to uncertainty and ambiguity, hedge against risks, anchor decisions to the status quo, compare relative risks and rewards of alternative strategies, and cope with other classes of decisions. Practitioners use a variety of stimuli, chance devices, hypothetical and real choices involving small stakes, scenarios, and questionnaires to measure (directly and indirectly) preferences under varying conditions. These kinds of experiments can help guide choices about the level of complexity required for different types of decision-making processes, the value of new data collection efforts, and the ways in which uncertainty in model outcomes can be cast to minimize decision-making paralysis. They can also provide a scientific basis for interacting with decision makers throughout the model development process, designing better ways of eliciting and combining opinions and of communicating information relevant to public policy issues with the goal of improving the value of the scientific contribution to the social decision.

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

PubMed

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

2015-01-01

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

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions

PubMed Central

Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-01-01

Abstract Background: Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps. Aim: We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. Design: A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital. Setting/Participants: Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study. Results: Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes. Conclusions: The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians. PMID:26418215

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

PubMed Central

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

2016-01-01

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

Observational Study Designs for Comparative Effectiveness Research: An Alternative Approach to Close Evidence Gaps in Head-and-Neck Cancer

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

Goulart, Bernardo H.L., E-mail: bhg@uw.edu; University of Washington, Seattle, Washington; Ramsey, Scott D.

Comparative effectiveness research (CER) has emerged as an approach to improve quality of care and patient outcomes while reducing healthcare costs by providing evidence to guide healthcare decisions. Randomized controlled trials (RCTs) have represented the ideal study design to support treatment decisions in head-and-neck (H and N) cancers. In RCTs, formal chance (randomization) determines treatment allocation, which prevents selection bias from distorting the measure of treatment effects. Despite this advantage, only a minority of patients qualify for inclusion in H and N RCTs, which limits the validity of their results to the broader H and N cancer patient population seenmore » in clinical practice. Randomized controlled trials often do not address other knowledge gaps in the management of H and N cancer, including treatment comparisons for rare types of H and N cancers, monitoring of rare or late toxicity events (eg, osteoradionecrosis), or in some instances an RCT is simply not feasible. Observational studies, or studies in which treatment allocation occurs independently of investigators' choice or randomization, may address several of these gaps in knowledge, thereby complementing the role of RCTs. This critical review discusses how observational CER studies complement RCTs in generating the evidence to inform healthcare decisions and improve the quality of care and outcomes of H and N cancer patients. Review topics include a balanced discussion about the strengths and limitations of both RCT and observational CER study designs; a brief description of design and analytic techniques to handle selection bias in observational studies; examples of observational studies that inform current clinical practices and management of H and N cancers; and suggestions for relevant CER questions that could be addressed by an observational study design.« less

Observational study designs for comparative effectiveness research: an alternative approach to close evidence gaps in head-and-neck cancer.

PubMed

Goulart, Bernardo H L; Ramsey, Scott D; Parvathaneni, Upendra

2014-01-01

Comparative effectiveness research (CER) has emerged as an approach to improve quality of care and patient outcomes while reducing healthcare costs by providing evidence to guide healthcare decisions. Randomized controlled trials (RCTs) have represented the ideal study design to support treatment decisions in head-and-neck (H&N) cancers. In RCTs, formal chance (randomization) determines treatment allocation, which prevents selection bias from distorting the measure of treatment effects. Despite this advantage, only a minority of patients qualify for inclusion in H&N RCTs, which limits the validity of their results to the broader H&N cancer patient population seen in clinical practice. Randomized controlled trials often do not address other knowledge gaps in the management of H&N cancer, including treatment comparisons for rare types of H&N cancers, monitoring of rare or late toxicity events (eg, osteoradionecrosis), or in some instances an RCT is simply not feasible. Observational studies, or studies in which treatment allocation occurs independently of investigators' choice or randomization, may address several of these gaps in knowledge, thereby complementing the role of RCTs. This critical review discusses how observational CER studies complement RCTs in generating the evidence to inform healthcare decisions and improve the quality of care and outcomes of H&N cancer patients. Review topics include a balanced discussion about the strengths and limitations of both RCT and observational CER study designs; a brief description of design and analytic techniques to handle selection bias in observational studies; examples of observational studies that inform current clinical practices and management of H&N cancers; and suggestions for relevant CER questions that could be addressed by an observational study design. Copyright © 2014 Elsevier Inc. All rights reserved.

Contract Management or Self-Operation: A Decision-Making Guide for Higher Education.

ERIC Educational Resources Information Center

Goldstein, Philip J.; And Others

This guide offers an objective framework for deciding whether self-operation or contract management (also known as privatization or "outsourcing") will best serve the goals and objectives of an individual institution of higher education. The guide is organized into four chapters. Chapter 1 briefly outlines the evolution of contract…

Consumer Education: Ecological Resource Management. Home & Family Life Curriculum Guide: H.E. Bulletin No. 43.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia.

The future ability of secondary students to interact in a progressively technologically-oriented society is the purpose of this curriculum guide on consumer education. The guide teaches consumer decision-making, resource management, and advocacy/action. The introduction discusses the future of society and technology. Each of three sections…

From Evidence Based Medicine to Medicine Based Evidence.

PubMed

Horwitz, Ralph I; Hayes-Conroy, Allison; Caricchio, Roberto; Singer, Burton H

2017-11-01

Evidence based medicine, using randomized controlled trials and meta-analyses as the major tools and sources of evidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guide to decision-making about a patient at hand. However, these tools do not answer the clinician's question: "Will a given therapeutic regimen help my patient at a given point in her/his clinical course?" We introduce fine-grained profiling of the patient at hand, accompanied by comparative evidence of responses from approximate matches to this patient on whom a contemplated treatment has/has not been administered. This represents medicine based evidence that is tuned to decision-making for the particular patient. Copyright © 2017 Elsevier Inc. All rights reserved.

Country planning for health interventions under development: lessons from the malaria vaccine decision-making framework and implications for other new interventions

PubMed Central

Brooks, Alan; Ba-Nguz, Antoinette

2012-01-01

Traditionally it has taken years or decades for new public health interventions targeting diseases found in developing countries to be accessible to those most in need. One reason for the delay has been insufficient anticipation of the eventual processes and evidence required for decision making by countries. This paper describes research into the anticipated processes and data needed to inform decision making on malaria vaccines, the most advanced of which is still in phase 3 trials. From 2006 to 2008, a series of country consultations in Africa led to the development of a guide to assist countries in preparing their malaria vaccine decision-making frameworks. The guide builds upon the World Health Organization’s Vaccine Introduction Guidelines. It identifies the processes and data for decisions, when they would be needed relative to the development timelines of the intervention, and where they will come from. Policy development will be supported by data (e.g. malaria disease burden; roles of other malaria interventions; malaria vaccine impact; economic and financial issues; malaria vaccine efficacy, quality and safety) as will implementation decisions (e.g. programmatic issues and socio-cultural environment). This generic guide can now be applied to any future malaria vaccine. The paper discusses the opportunities and challenges to early planning for country decision-making—from the potential for timely, evidence-informed decisions to the risks of over-promising around an intervention still under development. Careful and well-structured planning by countries is an important way to ensure that new interventions do not remain unused for years or decades after they become available. PMID:22513733

RE-Powering’s Electronic Decision Tree

EPA Pesticide Factsheets

Developed by US EPA's RE-Powering America's Land Initiative, the RE-Powering Decision Trees tool guides interested parties through a process to screen sites for their suitability for solar photovoltaics or wind installations

Post-fall decision tree development and implementation.

PubMed

Gordon, Bonita M; Wnek, Theresa Frissora; Glorius, Nancy; Hasdorff, Carmen; Shiverski, Joyce; Ginn, Janet

2010-01-01

Care and evaluation after a patient's fall require a number of steps to ensure that appropriate care is given and injury is minimized. Astute and appropriate assessment skills with strategic interventions and communication can minimize the harm from a fall. Post-Fall Decision Guidelines were developed to guide care and treatment and to identify potential complications after a patient has fallen. This systematic approach mobilizes the steps of communication, using the Situation-Background-Assessment-Recommendation (SBAR) format, and guides assessment interventions.

Counterfactual Processing of Economic Action-Outcome Alternatives in Obsessive-Compulsive Disorder: Further Evidence of Impaired Goal-Directed Behavior

PubMed Central

Gillan, Claire M.; Morein-Zamir, Sharon; Kaser, Muzaffer; Fineberg, Naomi A.; Sule, Akeem; Sahakian, Barbara J.; Cardinal, Rudolf N.; Robbins, Trevor W.

2014-01-01

Background Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. Methods We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. Results The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Conclusions Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD. PMID:23452663

34 CFR 602.14 - Purpose and organization.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) At least one member of the agency's decision-making body is a representative of the public, and at... and implemented guide lines for each member of the decision-making body to avoid conflicts of interest... this section, the term separate and independent means that— (1) The members of the agency's decision...

Bayesian Decision Theory Guiding Educational Decision-Making: Theories, Models and Application

ERIC Educational Resources Information Center

Pan, Yilin

2016-01-01

Given the importance of education and the growing public demand for improving education quality under tight budget constraints, there has been an emerging movement to call for research-informed decisions in educational resource allocation. Despite the abundance of rigorous studies on the effectiveness, cost, and implementation of educational…

Promoting Metacognitive Decision-Making in Teacher Education

ERIC Educational Resources Information Center

Griffith, Robin; Bauml, Michelle; Quebec-Fuentes, Sarah

2016-01-01

Effective teachers are characterized by their abilities to make thoughtful, deliberate, and informed adaptations while teaching (Hoffman & Pearson, 2000). These in-the-moment teaching decisions are guided by a complex web of teacher knowledge. Raising teachers' awareness of the decisions they make on a moment-by-moment basis may aid in…

Evaluating patient-reported outcome measurement comparability between paper and alternate versions, using the lung function questionnaire as an example.

PubMed

Dalal, Anand A; Nelson, Lauren; Gilligan, Theresa; McLeod, Lori; Lewis, Sandy; DeMuro-Mercon, Carla

2011-01-01

The goal of this study was to provide recommended steps to assess measurement comparability using a crossover study design and to demonstrate these steps using a short patient-reported outcome (PRO) instrument as an example. The example PRO instrument was administered via paper, Web, interactive voice response system, and interview; a randomized crossover design was used to gather data across the multiple administration types. Participants completed the PRO instrument, demographic and health questions, and a short preference questionnaire. Evaluation included comparisons of the item-level responses and agreement, comparison of mean scale scores, score classifications, and questions designed to collect usability and administration preference. Here the authors provide a four-step evaluation guide to evaluate measurement comparability and illustrate these steps using a case-finding tool. In the example, item-level kappa statistics between the paper and the alternate versions ranged from good to excellent, intraclass correlation coefficient for mean scores were above 0.70, and the rate of disagreement ranged from 2% to 14%. In addition, although participants had an administration preference, they reported few difficulties with the versions they were assigned. The steps described in this article provide a guide for evaluating whether to combine scores across administration versions to simplify analyses and interpretation under a crossover design. The guide recommends the investigation of item-level responses, summary scores, and participant usability/preference when comparing versions, with each step providing unique information to support comprehensive evaluation and informed decisions regarding whether to combine data. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

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

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

1995-03-01

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

Clinician Use of a Palmtop Drug Reference Guide

PubMed Central

Rothschild, Jeffrey M.; Lee, Thomas H.; Bae, Taran; Bates, David W.

2002-01-01

Objective: Problems involving drug knowledge are one of the most common causes of serious medication errors. Although the information that clinicians need is often available somewhere, retrieving it expeditiously has been problematic. At the same time, clinicians are faced with an ever-expanding pharmacology knowledge base. Recently, point-of-care technology has become more widely available and more practical with the advent of handheld, or palmtop, computing. Therefore, the authors evaluated the clinical contribution of a drug database developed for the handheld computer. ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California) is a comprehensive drug information guide that is downloadable free from the Internet and designed for the Palm OS platform align="right". Design: A seven-day online survey of 3,000 randomly selected ePocrates Rx users was conducted during March 2000. Measurements: User technology experience, product evaluation and usage patterns, and the effects of the drug reference database on information-seeking behavior, practice efficiency, decision making, and patient care. Results: The survey response rate was 32 percent (n=946). Physicians reported that ePocrates Rx saves time during information retrieval, is easily incorporated into their usual workflow, and improves drug-related decision making. They also felt that it reduced the rate of preventable adverse drug events. Conclusions: Self-reported perceptions by responding clinicians endorse improved access to drug information and improved practice efficiency associated with the use of handheld devices. The clinical and practical value of using these devices in clinical settings will clearly grow further as wireless communication becomes more ubiquitous and as more applications become available. PMID:11971883

A practical guide to assessing clinical decision-making skills using the key features approach.

PubMed

Farmer, Elizabeth A; Page, Gordon

2005-12-01

This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or 'key features' in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats. The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking. The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided.

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

Clayton, Daniel James; Lipinski, Ronald J.; Bechtel, Ryan D.

As compact and light weight power sources with reliable, long lives, Radioisotope Power Systems (RPSs) have made space missions to explore the solar system possible. Due to the hazardous material that can be released during a launch accident, the potential health risk of an accident must be quantified, so that appropriate launch approval decisions can be made. One part of the risk estimation involves modeling the response of the RPS to potential accident environments. Due to the complexity of modeling the full RPS response deterministically on dynamic variables, the evaluation is performed in a stochastic manner with a Monte Carlomore » simulation. The potential consequences can be determined by modeling the transport of the hazardous material in the environment and in human biological pathways. The consequence analysis results are summed and weighted by appropriate likelihood values to give a collection of probabilistic results for the estimation of the potential health risk. This information is used to guide RPS designs, spacecraft designs, mission architecture, or launch procedures to potentially reduce the risk, as well as to inform decision makers of the potential health risks resulting from the use of RPSs for space missions.« less

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation.

PubMed

Jiang, Yun; Sereika, Susan M; DeVito Dabbs, Annette; Handler, Steven M; Schlenk, Elizabeth A

2016-10-01

Lung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH(®), a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators. To examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation. A cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support. Of the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n=23) were less likely to follow technology decision support than the high (odds ratio [OR]=0.11, p=0.02) and low (OR=0.04, p=0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR=0.01, p=0.01) or who had longer hospital stays (OR=0.94, p=0.004). A significant interaction was found between gender and past technology experience (OR=0.21, p=0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women. The majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A reexamination of the evidence for the somatic marker hypothesis: what participants really know in the Iowa gambling task.

PubMed

Maia, Tiago V; McClelland, James L

2004-11-09

Bechara, Damasio, and coworkers [Bechara, A., Damasio, H., Tranel, D. & Damasio, A. R. (1997) Science 275, 1293-1295] have reported that normal participants decide advantageously before knowing the advantageous strategy in a simple card game designed to mimic real-life decision-making. Bechara et al. have used this result to support their view that nonconscious somatic markers can guide advantageous behavior. By using more sensitive methods, we show that participants have much more knowledge about the game than previously thought. In fact, participants report knowledge of the advantageous strategy more reliably than they behave advantageously. Furthermore, when they behave advantageously, their verbal reports nearly always reveal evidence of quantitative knowledge about the outcomes of the decks that would be sufficient to guide such advantageous behavior. In addition, there is evidence that participants also have access to more qualitative reportable knowledge. These results are compatible with the view that, in this task, both overt behavior and verbal reports reflect sampling from consciously accessible knowledge; there is no need to appeal to nonconscious somatic markers. We also discuss the findings of other studies that similarly suggest alternative interpretations of other evidence previously used to support a role for somatic markers in decision-making.

Development of a patient decision aid for prevention of myocardial infarction in type 2 diabetes - rationale, design and pilot testing.

PubMed

Lenz, Matthias; Kasper, Jürgen; Mühlhauser, Ingrid

2009-10-19

Development and testing of a decision aid about prevention of myocardial infarction for persons with type 2 diabetes. Development and testing were guided by the UK Medical Research Council's guidance for the development and evaluation of complex interventions. This comprised a systematic literature review, a focus group of 9 potential providers, modelling a prototype, interviews to qualitatively explore understanding and additional information needs, and revision of the decision aid. The decision aid includes evidence-based information, a tool for individual risk-assessment, worksheets, and an action plan. Five diabetes educators and 15 patients underwent two 60-minutes face-to-face interviews, firstly browsing the decision aid for the first time and then after using it. Both groups differed in their ratings. Overall, the decision aid was rated to present essential information in a complex but understandable and unbiased manner. Difficulties involved understanding of terminology and risk interpretation. "Social status as a risk factor" was the most challenged content by educators but considered as highly important by patients. The risk assessment tool was used inadequately. 5 patients allocated themselves into false risk categories. After revision of the tool, all 12 patients who were recruited for reassessment used the tool correctly. The decision aid was evaluated with diabetes educators and patients. Qualitative data analysis revealed aspects for revision. The decision aid is planned to be part of a shared decision making programme, comprising a strategy for patient counselling and educational modules addressed to providers. Quantitative evaluation is required to assess its effectiveness.

Implementation of a Medication Reconciliation Assistive Technology: A Qualitative Analysis

PubMed Central

Wright, Theodore B.; Adams, Kathleen; Church, Victoria L.; Ferraro, Mimi; Ragland, Scott; Sayers, Anthony; Tallett, Stephanie; Lovejoy, Travis; Ash, Joan; Holahan, Patricia J.; Lesselroth, Blake J.

2017-01-01

Objective: To aid the implementation of a medication reconciliation process within a hybrid primary-specialty care setting by using qualitative techniques to describe the climate of implementation and provide guidance for future projects. Methods: Guided by McMullen et al’s Rapid Assessment Process1, we performed semi-structured interviews prior to and iteratively throughout the implementation. Interviews were coded and analyzed using grounded theory2 and cross-examined for validity. Results: We identified five barriers and five facilitators that impacted the implementation. Facilitators identified were process alignment with user values, and motivation and clinical champions fostered by the implementation team rather than the administration. Barriers included a perceived limited capacity for change, diverging priorities, and inconsistencies in process standards and role definitions. Discussion: A more complete, qualitative understanding of existing barriers and facilitators helps to guide critical decisions on the design and implementation of a successful medication reconciliation process. PMID:29854251

Offshore Wind Guidance Document: Oceanography and Sediment Stability (Version 1) Development of a Conceptual Site Model.

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

Roberts, Jesse D.; Jason Magalen; Craig Jones

This guidance document provide s the reader with an overview of the key environmental considerations for a typical offshore wind coastal location and the tools to help guide the reader through a thoro ugh planning process. It will enable readers to identify the key coastal processes relevant to their offshore wind site and perform pertinent analysis to guide siting and layout design, with the goal of minimizing costs associated with planning, permitting , and long - ter m maintenance. The document highlight s site characterization and assessment techniques for evaluating spatial patterns of sediment dynamics in the vicinity of amore » wind farm under typical, extreme, and storm conditions. Finally, the document des cribe s the assimilation of all of this information into the conceptual site model (CSM) to aid the decision - making processes.« less

Clustered lot quality assurance sampling: a tool to monitor immunization coverage rapidly during a national yellow fever and polio vaccination campaign in Cameroon, May 2009.

PubMed

Pezzoli, L; Tchio, R; Dzossa, A D; Ndjomo, S; Takeu, A; Anya, B; Ticha, J; Ronveaux, O; Lewis, R F

2012-01-01

We used the clustered lot quality assurance sampling (clustered-LQAS) technique to identify districts with low immunization coverage and guide mop-up actions during the last 4 days of a combined oral polio vaccine (OPV) and yellow fever (YF) vaccination campaign conducted in Cameroon in May 2009. We monitored 17 pre-selected districts at risk for low coverage. We designed LQAS plans to reject districts with YF vaccination coverage <90% and with OPV coverage <95%. In each lot the sample size was 50 (five clusters of 10) with decision values of 3 for assessing OPV and 7 for YF coverage. We 'rejected' 10 districts for low YF coverage and 14 for low OPV coverage. Hence we recommended a 2-day extension of the campaign. Clustered-LQAS proved to be useful in guiding the campaign vaccination strategy before the completion of the operations.

The Role of Nurses in E-Health: The MobiGuide Project Experience.

PubMed

Parimbelli, Enea; Sacchi, Lucia; Budasu, Roxana; Napolitano, Carlo; Peleg, Mor; Quaglini, Silvana

2016-01-01

Leveraging the experience of the European project MobiGuide, this paper elaborates on the nurses' role in developing, delivering and evaluating e-health based services. We focus on the home monitoring of atrial fibrillation. Patients enrolled in our study are provided with a smartphone and an ECG sensor, and receive recommendations, reminders and alerts concerning medications and measurements that they should perform through a mobile decision support system that is constantly updated by a backend system. Patients' data are sent to health care personnel that may visualize them, and act accordingly. Nurses play a central role in such setting. After being involved in the design of the caregiver interface, they are responsible for the patients' enrollment phase (which includes patients' training), for the daily checking of incoming data, for the triage of patients' complaints, and for the final phase of the study where patients are interviewed about their experience with the system.

Energy and Man's Environment Activity Guide: An Interdisciplinary Teacher's Guide to Energy and Environmental Activities, Section Three - Conversion of Energy.

ERIC Educational Resources Information Center

Jones, John, Ed.

This publication presents the activities pertaining to the third goal of this activity guide series. The activities in this publication focus on understanding conservation processes, efficiencies, socioeconomic costs, and personal decision-making. These materials are appropriate for middle school and junior high school students. These activities,…

K-12 Energy Education Program: A Conceptual Guide To K-12 Energy Education in Wisconsin.

ERIC Educational Resources Information Center

Wisconsin Univ., Stevens Point. Energy Center of Wisconsin.

In addition to presenting concepts that can help students understand and make decisions about energy issues, this guide provides guidance for teachers to incorporate energy education into their curricula. The guide is divided into two major sections: (1) the Energy Education Conceptual Framework and (2) the Suggested Scope and Sequence. The…

Involvement of the Rat Anterior Cingulate Cortex in Control of Instrumental Responses Guided by Reward Expectancy

ERIC Educational Resources Information Center

Schweimer, Judith; Hauber, Wolfgang

2005-01-01

The anterior cingulate cortex (ACC) plays a critical role in stimulus-reinforcement learning and reward-guided selection of actions. Here we conducted a series of experiments to further elucidate the role of the ACC in instrumental behavior involving effort-based decision-making and instrumental learning guided by reward-predictive stimuli. In…

A Citizen's Guide to U.S. Foreign Policy: Election '88. Nonpartisan Briefs on 18 Key Issues.

ERIC Educational Resources Information Center

Hoepli, Nancy, Ed.; And Others

In order to make informed voting decisions citizens need background information on complex foreign policy issues facing the United States. This guide presents current issues and provides information to help citizens cast a thoughtful vote. The guide is divided into six main headings: Leadership; Security; Economic and Social Issues; Critical…

Guiding Students to Develop an Understanding of Scientific Inquiry: A Science Skills Approach to Instruction and Assessment

ERIC Educational Resources Information Center

Stone, Elisa M.

2014-01-01

New approaches for teaching and assessing scientific inquiry and practices are essential for guiding students to make the informed decisions required of an increasingly complex and global society. The Science Skills approach described here guides students to develop an understanding of the experimental skills required to perform a scientific…

Making the Most of Opportunities to Learn What Works: A School District's Guide. REL 2014-048

ERIC Educational Resources Information Center

Akers, Lauren; Resch, Alexandra; Berk, Jillian

2014-01-01

This guide for district and school leaders shows how to recognize opportunities to embed randomized controlled trials (RCTs) into planned policies or programs. Opportunistic RCTs can generate strong evidence for informing education decisions--with minimal added cost and disruption. The guide also outlines the key steps to conduct RCTs and responds…

Kentucky Consumer & Homemaking Education. Management-Consumer Education. Curriculum Guide, Comprehensive Courses.

ERIC Educational Resources Information Center

Waldrop, Suzanne H.

Intended for use by teachers on the junior high and high school levels, this curriculum guide, which is one in a series of guides for consumer and homemaking education in Kentucky, outlines three courses in the area of management-consumer education. The junior high unit acquaints the student with the concepts of decision making and assessing…

Contract Administration: Understanding Limitations on Management Rights. A Presenter's Guide. Research Based Training for School Administrators.

ERIC Educational Resources Information Center

Oregon Univ., Eugene. Center for Educational Policy and Management.

This workshop presenter's guide is intended for use by administrators in training one another in the Project Leadership program developed by the Association of California School Administrators (ACSA). The purpose of this particular guide is to train administrators to interpret common contract provisions that affect management's decision-making…

The Mortgage Money Guide. Creative Financing for Home Buyers. Updated Edition.

ERIC Educational Resources Information Center

Federal Trade Commission, Washington, DC.

This guide to creative home financing outlines basic concepts needed in shopping for a home loan. Many plans are described so that buyers can make their own decisions. The guide contains three sections: (1) getting started--highlighting the essentials; (2) defining terms; and (3) payment tables. The first section summarizes 15 financing plans in a…

Deciding How To Decide: Decision Making in Schools. A Presenter's Guide. Research Based Training for School Administrators. Revised.

ERIC Educational Resources Information Center

Oregon Univ., Eugene. Center for Educational Policy and Management.

This workshop presenter's guide is intended for use by administrators in training one another in the Project Leadership program developed by the Association of California School Administrators (ACSA). The purposes of the guide are: to provide administrators with a framework for deciding when others (particularly subordinates) should participate in…

Building Blocks: A Legislator's Guide to Child Care Policy.

ERIC Educational Resources Information Center

Culkin, Mary L.; Groginsky, Scott; Christian, Steve

The care and education of the youngest children in the United States has become a critical public policy issue affecting millions of families. This guide closely examines the issues and tradeoffs in key child care policy decisions that face state legislators. The guide provides a discussion of state efforts to build supply, improve quality, and…

Methods of Product Evaluation. Guide Number 10. Evaluation Guides Series.

ERIC Educational Resources Information Center

St. John, Mark

In this guide the logic of product evaluation is described in a framework that is meant to be general and adaptable to all kinds of evaluations. Evaluators should consider using the logic and methods of product evaluation when (1) the purpose of the evaluation is to aid evaluators in making a decision about purchases; (2) a comprehensive…

Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran.

PubMed

Azmal, Mohammad; Sari, Ali Akbari; Foroushani, Abbas Rahimi; Ahmadi, Batoul

2016-06-01

Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and legitimate the representative of people they served for. This model can provide a practical guide for managers and policy makers to involve people in making the decisions that influence their lives.

Designing nanomaterials to maximize performance and minimize undesirable implications guided by the Principles of Green Chemistry.

PubMed

Gilbertson, Leanne M; Zimmerman, Julie B; Plata, Desiree L; Hutchison, James E; Anastas, Paul T

2015-08-21

The Twelve Principles of Green Chemistry were first published in 1998 and provide a framework that has been adopted not only by chemists, but also by design practitioners and decision-makers (e.g., materials scientists and regulators). The development of the Principles was initially motivated by the need to address decades of unintended environmental pollution and human health impacts from the production and use of hazardous chemicals. Yet, for over a decade now, the Principles have been applied to the synthesis and production of engineered nanomaterials (ENMs) and the products they enable. While the combined efforts of the global scientific community have led to promising advances in the field of nanotechnology, there remain significant research gaps and the opportunity to leverage the potential global economic, societal and environmental benefits of ENMs safely and sustainably. As such, this tutorial review benchmarks the successes to date and identifies critical research gaps to be considered as future opportunities for the community to address. A sustainable material design framework is proposed that emphasizes the importance of establishing structure-property-function (SPF) and structure-property-hazard (SPH) relationships to guide the rational design of ENMs. The goal is to achieve or exceed the functional performance of current materials and the technologies they enable, while minimizing inherent hazard to avoid risk to human health and the environment at all stages of the life cycle.

Solar and Wind Site Screening Decision Trees

EPA Pesticide Factsheets

EPA and NREL created a decision tree to guide state and local governments and other stakeholders through a process for screening sites for their suitability for future redevelopment with solar photovoltaic (PV) energy and wind energy.

The pursuit of Leadership in Energy and Environmental Design (LEED) certification for campus housing at public universities

NASA Astrophysics Data System (ADS)

Konvalinka, April Hicks

This dissertation identifies the reasons why institutions of higher education pursue Leadership in Energy and Environmental Design (LEED) certification for new construction of campus housing. The research was guided by three questions: 1. Why did the institution choose to pursue LEED certification for campus housing? 2. What considerations should be made in the design, development, and planning process of a LEED residence hall? 3. What significant impact has the LEED residence hall made on campus? The outcomes of this study will provide insight to university and housing administrators who are considering pursuit of LEED certification for new residence hall development. The primary sources of data are chief housing officers or their designees at public four-year colleges and universities with new campus housing awarded LEED certification. Qualitative research techniques were used to conduct interviews by LEED certification level: Platinum, Silver, Gold, and Certified. Data collection ended when data saturation of each question in each certification level was achieved. This dissertation offers reasons why universities pursue LEED certification: state requirement, institutional commitment, institutional standard, environmental stewardship, departmental decision, and student interest. Additionally, considerations and lessons learned from the pursuit of LEED certification have been identified and can serve as a guide to housing administrators who aim to achieve any LEED level certification.

Trial-Type Dependent Frames of Reference for Value Comparison

PubMed Central

Hunt, Laurence T.; Woolrich, Mark W.; Rushworth, Matthew F. S.; Behrens, Timothy E. J.

2013-01-01

A central question in cognitive neuroscience regards the means by which options are compared and decisions are resolved during value-guided choice. It is clear that several component processes are needed; these include identifying options, a value-based comparison, and implementation of actions to execute the decision. What is less clear is the temporal precedence and functional organisation of these component processes in the brain. Competing models of decision making have proposed that value comparison may occur in the space of alternative actions, or in the space of abstract goods. We hypothesized that the signals observed might in fact depend upon the framing of the decision. We recorded magnetoencephalographic data from humans performing value-guided choices in which two closely related trial types were interleaved. In the first trial type, each option was revealed separately, potentially causing subjects to estimate each action's value as it was revealed and perform comparison in action-space. In the second trial type, both options were presented simultaneously, potentially leading to comparison in abstract goods-space prior to commitment to a specific action. Distinct activity patterns (in distinct brain regions) on the two trial types demonstrated that the observed frame of reference used for decision making indeed differed, despite the information presented being formally identical, between the two trial types. This provides a potential reconciliation of conflicting accounts of value-guided choice. PMID:24068906

Vocational Choice: A Decision Making Perspective

ERIC Educational Resources Information Center

Sauermann, Henry

2005-01-01

We propose a model of vocational choice that can be used for analyzing and guiding the decision processes underlying career and job choices. Our model is based on research in behavioral decision making (BDM), in particular the choice goals framework developed by Bettman, Luce, and Payne (1998). The basic model involves two major processes. First,…

A Web-Based Tool to Support Data-Based Early Intervention Decision Making

ERIC Educational Resources Information Center

Buzhardt, Jay; Greenwood, Charles; Walker, Dale; Carta, Judith; Terry, Barbara; Garrett, Matthew

2010-01-01

Progress monitoring and data-based intervention decision making have become key components of providing evidence-based early childhood special education services. Unfortunately, there is a lack of tools to support early childhood service providers' decision-making efforts. The authors describe a Web-based system that guides service providers…

Clinical Decision Making of Rural Novice Nurses

ERIC Educational Resources Information Center

Seright, Teresa J.

2010-01-01

The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

Guiding Adolescents toward Responsible Sexual Decisions.

ERIC Educational Resources Information Center

Juhasz, Anne McCreary

Many teenagers will be pressured by either external or internal forces to become involved in sexual experiences. Assuming that adolescents will be faced with the question of whether or not to have intercourse, that this will be an individual decision involving internal control, and that each individual will have to make that decision, it becomes…

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

Treesearch

Keith M. Reynolds

1999-01-01

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